Quad 2 Mix Injection

(PAP / PHE / ALP / ATR) (Ship Cold)

Available Dosage Strengths

9 mg / 1 mg / 10 mcg / 0.1 mg/mL

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Product Overview

Description

Quad 1-4 PAP/PHE/ALP/ATR Injection Description^1-7

Quad 1-4 is a compounded formulation composed of three vasoactive agents:

Papaverine (a nonselective phosphodiesterase inhibitor)
Phentolamine (a nonselective alpha-adrenergic antagonist)
Alprostadil (prostaglandin E1 analog)
Atropine (muscarinic acetylcholine receptor antagonist)

Administered via intracavernosal injection, this combination acts synergistically and may relax corpus cavernosum smooth muscle, enhance arterial inflow, and inhibit venous outflow, which may lead to penile erection.

Mechanism of Action

Mechanism of Action^1-7

Papaverine inhibits phosphodiesterase enzymes, leading to increased intracellular cAMP and cGMP, which promotes smooth muscle relaxation.
Phentolamine blocks alpha-1 and alpha-2 adrenergic receptors, reducing sympathetic-mediated vasoconstriction.
Alprostadil binds to prostaglandin E receptors, activating adenylate cyclase, increasing cAMP, and promoting vasodilation and smooth muscle relaxation in penile tissue.
Atropine competitively blocks acetylcholine receptors leading to smooth muscle relaxation, promoting increased blood flow

These mechanisms collectively facilitate increased blood flow into the corpora cavernosa and reduced venous outflow.

Adverse Reactions

Common Adverse Effects^1-7

Penile pain
Injection site hematoma, bruising, or fibrosis
Local erythema or swelling
Dizziness
Penile plaques or curvature with long-term use
Prolonged erection (erection >4 hours) or priapism

Contraindications & Precautions

Contraindications / Precautions^1-7

Contraindications:

Anatomical penile deformities (e.g., Peyronie’s disease)
Conditions predisposing to priapism (e.g., sickle cell anemia, multiple myeloma, leukemia)
Hypersensitivity to any component of Quad 1-4
Concurrent use with PDE5 inhibitors (sildenafil, tadalafil, vardenafil etc..) unless clinically directed by your prescriber.

Precautions:

Educate patients on correct administration technique to reduce trauma and fibrosis
Limit use to no more than 3 times per week, with at least 24 hours between doses
Monitor for development of fibrosis or priapism with regular follow-up
Use with caution in patients on anticoagulants or with underlying cardiovascular disease

Storage

Storage and Stability⁸

Store Frozen at 0°F or lower
Once thawed, may re-freeze or refrigerate for up to 28 days after 1st use.

References

Clinical Pharmacology. Elsevier. Papaverine Monograph. Accessed June 10, 2025; https://www.clinicalkey.com/pharmacology/monograph/1495
Clinical Pharmacology. Elsevier. Phentolamine Monograph. Accessed June 10, 2025; https://www.clinicalkey.com/pharmacology/monograph/481
Clinical Pharmacology. Elsevier. Alprostadil Monograph. Accessed June 10, 2025; https://www.clinicalkey.com/pharmacology/monograph/1184
Clinical Pharmacology. Elsevier. Atropine Monograph. Accessed June 10, 2025; https://www.clinicalkey.com/pharmacology/monograph/49
Montague DK, et al. “Guidelines for the management of priapism.” J Urol. 2003;170(4 Pt 1):1318–1324.
Coombs PG, Heck M, Guhring P, Narus J, Mulhall JP. A review of outcomes of an intracavernosal injection therapy programme. BJU Int. 2012 Dec;110(11):1787-91. doi: 10.1111/j.1464-410X.2012.x. Epub 2012 May 7. PMID: 22564343.
Burnett AL, Nehra A, Breau RH et al: Erectile dysfunction: AUA guideline. J Urol 2018; 200:633.
United States Pharmacopeia. USP <797> Pharmaceutical Compounding – Sterile Preparations. The United States Pharmacopeial Convention; 2023.

Disclaimer

This sheet is a summary. It may not cover all possible drug information about this product. Call your doctor for medical advice and/or about side effects. You may report side effects to the FDA at 1-800-FDA-1088. A Wells Pharmacy Network pharmacist will be happy to answer any questions. For consultation, please call 1-800-622-4510.