Apomorphine / Sildenafil / Tadalafil / Vardenafil Troches
Quad-mix troche combining three PDE5 inhibitors with apomorphine dopamine agonist for maximum potency and comprehensive mechanism.
Troche
from $79/mo
Injected at the base of the penis · As needed, 10–15 min before
Sexual healthErectile dysfunctionInjection
Bi-Mix Injection
Papaverine and phentolamine without alprostadil, for men who get an ache from PGE1. Injected into the side of the penis before sex.
- No alprostadil, so less injection ache
- Starts in 5 to 15 minutes
- Titrated by your physician
- Monthly$219/mo
- Every 3 months$572 billed up front$191/mo
- Every 6 monthsBest value$1,025 billed up front$171/mo
- Free, discreet shipping
- Licensed U.S. pharmacy
- Board-certified physicians
Disclaimer: Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Products are compounded by a licensed pharmacy. The FDA has not reviewed or approved compounded products for any use for safety, efficacy, or quality. Compounded medications are not FDA-approved brand-name products.
- How
- Injected at the base of the penis
- How often
- As needed, 10–15 min before
- Each shipment
- 1 vial
- Strength
- 1 mg / 30 mg/mL
What is Bi-Mix?
(bi-mix)
Two vasodilators that relax the erectile tissue directly. Leaving out alprostadil avoids the burning ache some men feel with Tri-Mix.
What's in it
- PhentolamineWidens blood vessels
- PapaverineRelaxes smooth muscle
2
active ingredients, no PGE1
Papaverine carries a slightly higher risk of priapism and scarring; dose is titrated carefully.
Is it right for you?
Who it's for
Men for whom ED pills did not work and who get pain from alprostadil.
What sets it apart
Two medicines and no alprostadil, the ingredient that causes the ache with Tri-Mix.
Worth knowing before you start
An erection lasting more than four hours is an emergency. Know where your nearest ER is before the first dose.
Results when pills are not enough
Fast response
an erection in 5 to 15 minutes
Reliable
works in most men who did not respond to pills
Titrated to you
dose adjusted in small steps
Safety plan
a written priapism rescue plan from day one
How injection therapy works
Day 1
A physician reviews your history, why oral medicines did not work, and bleeding and blood disorders. You get training on technique and a written priapism plan.
1First dose
Start at a low dose. Inject into the side of the shaft, avoiding the top (vessels) and bottom (urethra); press for 5 minutes.
2Weeks 1-4
The dose is raised in small steps until the erection is firm and lasts under an hour. Alternate sides each time.
3Month 1
Check-in: dose, technique, any bruising, pain or nodules.
4Beyond
Regular reviews to watch for scarring and adjust the dose.
5
Individual results vary. Benefits reflect what Zepym Health members commonly report to their physician at check-ins; they are not the results of a clinical trial.
How you use it
This is the starting dose the pharmacy prints on the label. Your physician sets yours and adjusts it with you.
- How
- Injected at the base of the penis
- Dose
- 20 units (0.2 mL)
- How often
- As needed, 10–15 min before
- Each shipment
- 1 vial
- Pharmacy label
- Inject 20 units (0.2 mL) intracavernosally 10 to 15 minutes before sexual activity as needed, no more than once in 24 hours and no more than 3 times per week. Discard any remaining medication.
The science of intracavernosal therapy
Papaverine and phentolamine combinations have been used for decades with good response rates.
Scarring risk is linked to papaverine; alternate sides and report any lumps.
Learn moreImportant safety information and common side effects
Intracavernosal injections are highly effective but need training. The main risk is priapism: an erection lasting more than 4 hours is an emergency that can permanently damage the penis. If an erection lasts 2 hours, use your rescue plan (phenylephrine as directed, cold pack, climbing stairs); if it lasts 4 hours, go to the emergency room. Other risks are bruising, pain (more with alprostadil/PGE1), and scarring (fibrosis) with repeated use at the same spot. Do not use with sickle cell disease, multiple myeloma, leukemia, a penile implant, or on blood thinners without your physician's approval. Never use more than once in 24 hours or more than 3 times a week.
Every plan includes
- Personalized, physician-guided plan
- Monthly, 3-month and 6-month plans
- Dispensed by a US-licensed compounding pharmacy
- Unlimited protocol adjustments and messaging
- Ongoing support and check-ins
- Pause or cancel anytime
- Reviewed by our in-house physicians
How it works
1.Connect with a physician
Answer a few questions online and a US-licensed physician reviews your health, history and goals to make sure treatment is right for you. 100% online. No in-person visit required.
2.Get your discreet shipment
If approved, your treatment is compounded by a US-licensed, LegitScript-certified pharmacy, inspected for quality, and shipped discreetly to your door.
3.Receive continuous support
Start with one goal, then keep building over time. Unlimited physician messaging, easy refills and dose adjustments, all from the Zepym Health app.
Bi-Mix educational content reviewed by our physician
Scott Nass, MDDoctor of Medicine, board-certified in Family Medicine
Charles R. Drew University and David Geffen School of Medicine at UCLA. Family Medicine residency at Ventura County Medical Center.
Frequently asked questions
How do I use Bi-Mix Injection?
Injected at the base of the penis, as needed, 10–15 min before. The starting prescription is 20 units (0.2 mL) each time. Your physician sets your own dose and it is printed on your label.
What exactly is in it?
Phentolamine, Papaverine.
How much arrives in each shipment?
1 vial at the starting strength, shipped to your door from a licensed US pharmacy.
Bi-Mix or Tri-Mix?
Tri-Mix is usually stronger; Bi-Mix is chosen when alprostadil causes pain.
Does the injection hurt?
The needle is the same tiny insulin needle used for diabetes; most men feel a brief pinch. Alprostadil (PGE1) can cause an ache afterwards, which is why Bi-Mix exists.
How fast does it work?
Usually within 5 to 15 minutes, and it does not require arousal to start, although arousal helps.
What do I do if the erection will not go down?
At 2 hours, follow your rescue plan. At 4 hours, go to the emergency room without waiting.
Can I use it with pills?
Only if your physician says so. Combining with PDE5 inhibitors raises the risk of priapism.
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The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Individual results vary.
Sources
- 1
Intracavernosal injection therapy for erectile dysfunction: efficacy and safety of papaverine, phentolamine and prostaglandin E1 combinations.
PubMed - 2
AUA/SMSNA guideline on the diagnosis and management of priapism.
J Urol, 2022
Bi-Mix Injectionfrom $171/mo