Order ED Injectable Prescriptions

Prescribers may submit ED injection prescriptions to Bayview Pharmacy by faxing the completed order form, e-prescribing through their EHR, or calling the prescription directly into the pharmacy.

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Fastest Way to Prescribe

Use the ED Injection Order Form or include the Bayview formulation code when e-prescribing.

For the clearest workflow, download the ED Injection Order Form, choose the Bayview formulation code, complete the directions/SIG, and fax the signed order. If e-prescribing, include the formulation code plus the full formulation, quantity, refills, syringe request if needed, and complete directions.

Prescribing Options

Bayview Pharmacy accepts ED injectable prescriptions by faxed order form, e-prescribe, or direct phone call from the prescriber’s office. If your patient declines or cannot use an injection, see the needle-free urethral gels below.

Fax Workflow

Fax the Order Form

Download the ED injection prescription order form, complete all required sections, and fax the signed order to Bayview Pharmacy.

Download Order Form

EHR Workflow

E-prescribe

Search for Bayview Pharmacy, Warwick, RI in your EHR. Enter the full compound formulation, quantity, refills, syringes if needed, and complete directions.

View E-prescribe Instructions

Direct Support

Call It In

Prescribers or authorized office staff may call Bayview Pharmacy directly for prescription submission, clarification, titration questions, or refill coordination.

Call 401-284-4505

Fax Order Form

Download the ED injection prescription order form, complete all required sections, and fax the signed order to Bayview Pharmacy.

The order form should include patient information, prescriber information, medication selection, quantity, refills, syringe selection if needed, directions/SIG, prescriber signature, and date.

Fax Order Form

Download ED Injection Order Form

Download the ED injection prescription order form, complete all required sections, and fax the signed order to Bayview Pharmacy.

Download PDF

Pharmacy name and fax number must be completed by the prescriber’s office. They cannot be pre-printed on the order form.

E-prescribing

Prescribers may also send ED injectable prescriptions electronically through their EHR. Because compounded medications may not appear as a standard drug selection, the prescription should be entered using the compound, custom medication, or free-text prescription option available in the EHR.

In your EHR, search for:

Bayview Pharmacy
Warwick, RI
NCPDP: 4106882

When e-prescribing a compounded ED injectable, include the same core information shown on the fax order form: medication group, specific formulation and strength, quantity, refills, syringe selection if needed, complete directions/SIG, maximum dose, and maximum weekly frequency when titration instructions are used.

To speed up e-prescribing, prescribers may include the Bayview Pharmacy formulation code from the order form. Codes run A1–A2 for Alprostadil, B1–B3 for Bimix, T1–T10 for Trimix, Q1–Q5 for Quadmix, and AT1–AT2 for Atropine Trimix — the full list with concentrations is in the formulation codes table below. The code should be included with the full formulation details so the pharmacy can verify the intended medication and strength.

Recommended Format

What to Include When E-prescribing

Formulation code

Include the Bayview Pharmacy order code when available, such as A1, B1, T1, T2, Q1, Q2, or AT1.

Medication group

Alprostadil, Bimix, Trimix, Quadmix, Atropine Trimix, or custom ED injectable formulation

Specific formulation/strength

List each active ingredient and strength exactly as intended.

Quantity

Specify vial size and number of multi-dose vials.

Refills

Specify number of refills, PRN, or no refills.

Syringes

Specify 30 gauge syringes and preferred size if syringes are needed.

Directions/SIG

Include starting dose, titration increment, maximum dose, and maximum weekly frequency.

Additional notes

Include any patient-specific clarification, counseling notes, or special instructions.

Formulation Codes

Use the Bayview code to speed up EHR entry.

Bayview formulation codes are shorthand identifiers tied to the ED injection options on the order form. The code helps the pharmacy identify the intended formula quickly, but the full formulation details should still be included so the prescription can be verified before compounding. Every standard code is listed below — select a medication group to jump to its concentrations, or open the formulation page for full prescribing detail, storage, and counseling notes.

Alprostadil

Bimix

Trimix

Quadmix

Atropine Trimix

Alprostadil

Single-active prostaglandin. The most widely studied intracavernosal option.

View Alprostadil formulation page

Enter as **ALPROSTADIL** followed by the concentrations below. All options are dispensed in 2.5 mL multi-dose vials.
Code	Alprostadil
A1	20 mcg/mL
A2	40 mcg/mL

Bimix

Alprostadil-free. Often chosen when alprostadil causes penile pain.

View Bimix formulation page

Enter as **BI-MIX** followed by the concentrations below. All options are dispensed in 2.5 mL multi-dose vials.
Code	Papaverine	Phentolamine
B1	30 mg/mL	1 mg/mL
B2	30 mg/mL	2 mg/mL
B3	30 mg/mL	4 mg/mL

Trimix

The most commonly prescribed combination. Ten concentrations for titration.

View Trimix formulation page

Enter as **TRI-MIX** followed by the concentrations below. All options are dispensed in 2.5 mL multi-dose vials.
Code	Alprostadil	Papaverine	Phentolamine
T1	5 mcg/mL	30 mg/mL	1 mg/mL
T2	10 mcg/mL	30 mg/mL	1 mg/mL
T3	20 mcg/mL	30 mg/mL	1 mg/mL
T4	20 mcg/mL	30 mg/mL	2 mg/mL
T5	30 mcg/mL	30 mg/mL	2 mg/mL
T6	40 mcg/mL	30 mg/mL	1 mg/mL
T7	40 mcg/mL	30 mg/mL	2 mg/mL
T8	40 mcg/mL	30 mg/mL	3 mg/mL
T9	60 mcg/mL	30 mg/mL	6 mg/mL
T10	100 mcg/mL	30 mg/mL	6 mg/mL

Quadmix

Typically reserved for an inadequate response to Trimix.

View Quadmix formulation page

Enter as **QUAD-MIX** followed by the concentrations below. All options are dispensed in 2.5 mL multi-dose vials.
Code	Alprostadil	Atropine	Papaverine	Phentolamine
Q1	20 mcg/mL	0.15 mg/mL	30 mg/mL	2 mg/mL
Q2	30 mcg/mL	0.15 mg/mL	30 mg/mL	2 mg/mL
Q3	40 mcg/mL	0.15 mg/mL	30 mg/mL	2 mg/mL
Q4	60 mcg/mL	0.15 mg/mL	30 mg/mL	2 mg/mL
Q5	120 mcg/mL	0.4 mg/mL	30 mg/mL	6 mg/mL

Atropine Trimix

Alprostadil-free three-drug option with atropine added.

View Atropine Trimix formulation page

Enter as **ATROPINE TRI-MIX** followed by the concentrations below. All options are dispensed in 2.5 mL multi-dose vials.
Code	Atropine	Papaverine	Phentolamine
AT1	0.15 mg/mL	30 mg/mL	2 mg/mL
AT2	0.3 mg/mL	30 mg/mL	4 mg/mL

Best practice: Include both the code and the full formulation. Example: T4 TRI-MIX: Alprostadil 20 mcg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL. Concentrations not shown above may still be compounded as a custom order — see the custom formulation notice below.

EHR Ordering Tips

Because each EHR handles compounded prescriptions differently, the exact screen names may vary. In most systems, the office should look for a compound medication, custom medication, miscellaneous medication, or free-text prescription option.

To help Bayview Pharmacy process the prescription quickly, include the Bayview formulation code from the formulation codes table, such as A1, B2, T4, Q1, or AT1, along with the full formulation details.

Quick rule: If the EHR does not have a clean compound medication workflow, use the free-text or notes field to enter the Bayview formulation code, full formulation, quantity, refills, syringe request, and complete SIG.

Select your EHR below for practical tips on entering compounded ED injectable prescriptions. Screen names vary by practice setup, but the same prescription elements should be included in every system.

Epic / Hyperspace +

Suggested Epic workflow

Open the patient chart and start a new outpatient medication order.
Select Bayview Pharmacy, Warwick, RI as the destination pharmacy.
Search for a compound, custom medication, miscellaneous medication, or free-text medication option available in your Epic build.
If Epic allows a medication name field, enter the Bayview formulation code first, followed by the full formulation.
Use the SIG field for the injection directions, titration increment, maximum dose, and maximum weekly frequency.
Use pharmacy notes or comments for syringe request, vial count, and clarification notes if those fields do not fit in the SIG.

Medication name example:
T4 TRI-MIX: Alprostadil 20 mcg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL

SIG example:
Inject ____ mL intracavernosally as directed. If desired result is not achieved, may increase by ____ mL per dose. Do not exceed ____ mL per dose or ____ times per week.

Pharmacy notes example:
Dispense ____ x 2.5 mL multi-dose vial(s). Include 30 gauge syringes: _____. Bayview formulation code: T4.

Epic workflows vary widely by health system build. If compound/free-text medication ordering is unavailable, fax the completed ED Injection Order Form or call Bayview Pharmacy.

eClinicalWorks +

Suggested eClinicalWorks workflow

Open the patient chart and go to the medication or eRx workflow.
Select Bayview Pharmacy, Warwick, RI as the pharmacy.
Look for a compound, custom, miscellaneous, or free-text medication option.
In the medication field, enter the formulation code and full formulation together.
Use the directions field for dose, titration, max dose, and max weekly frequency.
Use notes for vial quantity, syringe size, and any patient-specific clarification.

Medication field example:
B2 BI-MIX: Papaverine 30 mg/mL + Phentolamine 2 mg/mL

Quantity/refills example:
Quantity: ____ x 2.5 mL multi-dose vial(s). Refills: ____.

Directions example:
Inject ____ mL intracavernosally as directed. May increase by ____ mL if needed. Do not exceed ____ mL per dose or ____ times weekly.

If eClinicalWorks does not allow the full compound to be sent cleanly, enter the full details in the notes field or use the fax order form.

athenahealth +

Suggested athenahealth workflow

Open the patient chart and start a new prescription.
Search for Bayview Pharmacy, Warwick, RI.
Use the custom medication, unlisted medication, or free-text entry option if available.
Enter the Bayview formulation code and full formulation in the medication name or prescription notes field.
Include quantity, refills, syringe request, dose, titration increment, max dose, and max weekly frequency.
If the system restricts compound entry, fax the completed ED Injection Order Form instead.

Medication text example:
Q1 QUAD-MIX: Alprostadil 20 mcg/mL + Atropine 0.15 mg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL

Notes field example:
Dispense ____ x 2.5 mL multi-dose vial(s). Refills: ____. Include 30 gauge syringes if requested. Follow SIG below.

SIG example:
Inject ____ mL intracavernosally as directed. If desired result is not achieved, increase in increments of ____ mL. Max ____ mL per dose. Use no more than ____ times per week.

Athena workflows may restrict compound or unlisted medication entry depending on configuration. If the prescription cannot be entered clearly, use fax or call-in.

AdvancedMD +

Suggested AdvancedMD workflow

Open the patient chart and select the e-prescribing workflow.
Choose Bayview Pharmacy, Warwick, RI as the pharmacy.
Use compound, custom, miscellaneous, or free-text medication entry if available.
Enter the Bayview code at the start of the medication name.
Use notes or SIG to include the complete formulation, quantity, refills, syringes, titration directions, max dose, and max weekly frequency.

Medication name example:
T2 TRI-MIX: Alprostadil 10 mcg/mL + Papaverine 30 mg/mL + Phentolamine 1 mg/mL

Dispense example:
Dispense ____ x 2.5 mL multi-dose vial(s). Refills: ____.

Directions example:
Inject ____ mL intracavernosally as directed. May increase by ____ mL as needed. Do not exceed ____ mL per dose or ____ uses per week.

If the medication field is too restrictive, put the full compound details in the notes field and call Bayview Pharmacy if clarification is needed.

Tebra / Kareo +

Suggested Tebra / Kareo workflow

Open the patient chart and create a new prescription.
Select Bayview Pharmacy, Warwick, RI.
Use custom medication, compound, or free-text entry if available.
Start the medication entry with the Bayview formulation code.
Include the full formulation, quantity, refills, syringes, dose, titration, max dose, and max weekly frequency.

Medication example:
A1 ALPROSTADIL: Alprostadil 20 mcg/mL

Complete entry example:
A1 ALPROSTADIL: Alprostadil 20 mcg/mL. Dispense ____ x 2.5 mL multi-dose vial(s). Refills: ____. Syringes: 30 gauge, ____.

SIG example:
Inject ____ mL intracavernosally as directed. If inadequate response, increase by ____ mL. Max ____ mL per dose. Use no more than ____ times weekly.

If Tebra/Kareo does not permit the compounded entry, fax the order form or call the prescription into Bayview Pharmacy.

DrChrono +

Suggested DrChrono workflow

Open the patient chart and go to the Send eRx workflow.
Select the compound prescription type if available.
Select Bayview Pharmacy, Warwick, RI.
Enter the Bayview formulation code and each ingredient/strength.
Enter SIG, quantity, refills, and syringe request before previewing and sending.

Compound name example:
AT1 ATROPINE TRI-MIX: Atropine 0.15 mg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL

Ingredient structure example:
Atropine 0.15 mg/mL
Papaverine 30 mg/mL
Phentolamine 2 mg/mL

SIG example:
Inject ____ mL intracavernosally as directed. Increase by ____ mL if needed. Max ____ mL per dose. Use no more than ____ times per week.

DrChrono has documented compound prescription workflows, but configuration may vary by practice. If the compound workflow is not available, use free-text, fax, or call-in.

NextGen +

Suggested NextGen workflow

Open the patient chart and start a new medication prescription.
Select Bayview Pharmacy, Warwick, RI.
Look for compound, custom, miscellaneous, or free-text medication entry.
Enter the formulation code at the start of the medication name.
Add complete formulation, quantity, refills, syringe request, SIG, titration limits, and max weekly frequency.

Medication name example:
T1 TRI-MIX: Alprostadil 5 mcg/mL + Papaverine 30 mg/mL + Phentolamine 1 mg/mL

Notes example:
Dispense ____ x 2.5 mL vial(s). Refills: ____. Syringes: 30 gauge, ____ size if needed.

SIG example:
Inject ____ mL intracavernosally as directed. May titrate upward by ____ mL. Do not exceed ____ mL per dose or ____ injections per week.

If the compound cannot be transmitted cleanly, use the fax order form for the clearest prescription record.

ModMed +

Suggested ModMed workflow

Open the patient chart and start an e-prescription.
Choose Bayview Pharmacy, Warwick, RI.
Use custom, compound, or free-text medication workflow if available.
Enter the Bayview formulation code and complete ED injection formulation.
Include directions, quantity, refills, syringe request, titration, max dose, and max weekly frequency.

Medication text example:
B1 BI-MIX: Papaverine 30 mg/mL + Phentolamine 1 mg/mL

Directions example:
Inject ____ mL intracavernosally as directed. If desired result is not achieved, increase by ____ mL. Do not exceed ____ mL per dose or ____ times weekly.

Pharmacy note example:
Bayview formulation code: B1. Dispense ____ x 2.5 mL vial(s). Refills: ____. Include syringes if selected.

If the office cannot locate a compound entry option, fax the completed ED Injection Order Form.

Practice Fusion +

Suggested Practice Fusion workflow

Open the patient chart and select the prescription/eRx workflow.
Choose Bayview Pharmacy, Warwick, RI.
Use custom medication or free-text medication entry if available.
Enter the Bayview formulation code and full formulation details.
Include full SIG, quantity, refills, syringe request, maximum dose, and maximum weekly frequency.

Medication text example:
Q2 QUAD-MIX: Alprostadil 30 mcg/mL + Atropine 0.15 mg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL

SIG example:
Inject ____ mL intracavernosally as directed. Increase by ____ mL if needed. Max ____ mL per dose. Use no more than ____ times per week.

Dispense/refill example:
Dispense ____ x 2.5 mL multi-dose vial(s). Refills: ____. Syringes: 30 gauge, ____ if needed.

If the eRx does not allow the full compound details, fax the order form or call Bayview Pharmacy.

Veradigm / Allscripts +

Suggested Veradigm / Allscripts workflow

Open the patient chart and create a new prescription.
Select Bayview Pharmacy, Warwick, RI.
Look for compound, custom, miscellaneous, or free-text medication entry.
Enter the Bayview formulation code and complete formulation.
Include quantity, refills, syringes if needed, complete directions, max dose, and max weekly frequency.

Medication name example:
T6 TRI-MIX: Alprostadil 40 mcg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL

Pharmacy notes example:
Bayview formulation code T6. Dispense ____ x 2.5 mL vial(s). Refills: ____. Syringes requested: ____.

SIG example:
Inject ____ mL intracavernosally as directed. If inadequate response, increase by ____ mL. Do not exceed ____ mL per dose or ____ injections weekly.

If the compound cannot be sent cleanly, fax the ED Injection Order Form to avoid delay.

E-prescribe Examples

Use the examples below as formatting guides when entering ED injectable compounds in an EHR. The Bayview formulation code helps identify the intended formula quickly, but the full formulation details should still be included for verification.

Alprostadil Example

Code: A1

Medication: ALPROSTADIL: Alprostadil 20 mcg/mL

Quantity: ____ x 2.5 mL multi-dose vial(s)

Refills: ____

Syringes: 30 gauge, specify syringe size if needed

Directions: Inject ____ mL intracavernosally as directed. If desired result is not achieved, dose may be increased in increments of ____ mL, not to exceed ____ mL. Use no more than ____ times per week.

All Alprostadil Injection strengths & prescribing details

Bimix Example

Code: B2

Medication: BI-MIX: Papaverine 30 mg/mL + Phentolamine 2 mg/mL

Quantity: ____ x 2.5 mL multi-dose vial(s)

Refills: ____

Syringes: 30 gauge, specify syringe size if needed

All Bimix Injection strengths & prescribing details

Trimix Example

Code: T4

Medication: TRI-MIX: Alprostadil 20 mcg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL

Quantity: ____ x 2.5 mL multi-dose vial(s)

Refills: ____

Syringes: 30 gauge, specify syringe size if needed

All Trimix Injection strengths & prescribing details

Quadmix Example

Code: Q1

Medication: QUAD-MIX: Alprostadil 20 mcg/mL + Atropine 0.15 mg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL

Quantity: ____ x 2.5 mL multi-dose vial(s)

Refills: ____

Syringes: 30 gauge, specify syringe size if needed

All Quadmix Injection strengths & prescribing details

Atropine Trimix Example

Code: AT1

Medication: ATROPINE TRI-MIX: Atropine 0.15 mg/mL + Papaverine 30 mg/mL + Phentolamine 2 mg/mL

Quantity: ____ x 2.5 mL multi-dose vial(s)

Refills: ____

Syringes: 30 gauge, specify syringe size if needed

All Atropine Trimix Injection strengths & prescribing details

Custom Strength Example

Code: Custom, if not listed on the order form

Medication: ED INJECTION COMPOUND: [Active ingredient] ____ + [Active ingredient] ____ + [Active ingredient] ____

Quantity: ____ x 2.5 mL multi-dose vial(s)

Refills: ____

Syringes: 30 gauge, specify syringe size if needed

Verification note: The Bayview formulation code is intended to speed up prescription entry. The full formulation, quantity, directions, and refill information should still be included so the pharmacy can verify the prescription before compounding.

Custom Formulation Cost Notice

Formulations listed with a Bayview Pharmacy order code are standard ED injection options. Prescriptions for custom strengths, non-listed formulations, or formulations submitted without an order code may require additional review and may have an increased cost.

To help avoid delays or unexpected pricing changes, include the closest applicable formulation code when possible, along with the full formulation, quantity, directions, and refill information.

Needle-Free Alternatives

For patients who decline or cannot use intracavernosal injection, Bayview Pharmacy also compounds two urethral gels. These are prescribed and submitted the same way as the injectables — by fax order form, e-prescribe, or phone — but each gel has its own order form and its own strengths.

Needle-Free · Intraurethral

Bimix Urethral Gel

The same two actives as Bimix injection — papaverine and phentolamine — in a gel. Alprostadil-free. Dosed as a single 0.25 mL application.

Formulation	Papaverine	Phentolamine
Bimix Gel 1	7.5 mg/mL	1 mg/mL
Bimix Gel 2	7.5 mg/mL	2 mg/mL

Download Order Form Prescribing details

Needle-Free · Intraurethral

Triple-P Urethral Gel

Alprostadil, papaverine, and phentolamine in a gel, in four alprostadil strengths. Dosed as a single 0.25 mL application.

Formulation	Alprostadil	Papaverine	Phentolamine
Triple-P 250	250 mcg/mL	7.5 mg/mL	1 mg/mL
Triple-P 500	500 mcg/mL	7.5 mg/mL	1 mg/mL
Triple-P 750	750 mcg/mL	7.5 mg/mL	1 mg/mL
Triple-P 1000	1000 mcg/mL	7.5 mg/mL	1 mg/mL

Download Order Form Prescribing details

SIG example: Instill 0.25 mL into the urethral opening 10–15 minutes before intercourse. Do not exceed 1 dose per 24 hours. Include the formulation name and full concentrations, quantity as number of doses, refills, and an ICD-10 diagnosis code.

Avoid Delays

Avoid Clarification Delays

Before sending the prescription, check for these common missing items.

Complete prescriptions allow Bayview Pharmacy to review, prepare, and coordinate the medication more efficiently. Missing details may require pharmacist clarification before compounding.

Missing patient date of birth or contact information

Missing prescriber signature or date on faxed orders

No quantity, vial size, or number of vials specified

No refill authorization or unclear refill instructions

No starting dose, titration increment, or maximum dose

No maximum weekly frequency included in the SIG

Formulation code included without full formulation details

Custom strength submitted without enough clarification

Syringe size not specified when syringes are requested

Prefer the Fax Form?

Download the ED Injection Order Form

The fax order form is often the clearest option for ED injection prescriptions because it prompts for the medication code, formulation, quantity, refills, syringe selection, directions/SIG, signature, and date.

Download Order Form

Ordering FAQ

Can a prescriber e-prescribe a compounded ED injection? +

Yes. Prescribers may e-prescribe when their EHR allows a compound, custom medication, miscellaneous medication, or free-text prescription entry. The prescription should include the Bayview formulation code when available, plus the full formulation, quantity, refills, syringe request if needed, and complete directions/SIG.

Do I still need the full formulation if I use a Bayview code? +

Yes. The code helps speed up identification, but the full formulation details should still be included so Bayview Pharmacy can verify the intended medication, strength, quantity, and directions before compounding.

What if the prescriber wants a custom strength? +

Custom strengths may be prescribed when clinically appropriate for an individual patient. Custom or non-listed formulations may require additional pharmacist review and may have an increased cost.

Can office staff call in the prescription? +

Prescribers or authorized office staff may call Bayview Pharmacy directly for prescription submission, clarification, titration questions, or refill coordination. Bayview Pharmacy can be reached at 401-284-4505.

What should the office do if the EHR will not accept the compound? +

Use the fax order form or call Bayview Pharmacy. The fax form is often the clearest option because it prompts for the formulation code, medication selection, quantity, refills, syringe selection, directions/SIG, signature, and date.

Direct Prescription Support

Call the Prescription Into the Pharmacy

Prescribers or authorized office staff may call Bayview Pharmacy directly for prescription submission, clarification, titration questions, or refill coordination.

Call 401-284-4505

Phone

401-284-4505

Fax

401-284-4506 Alternate fax: 401-210-2757

E-prescribe

Bayview Pharmacy Warwick, RI

NCPDP

4106882

Compounded Medication Disclosure

Compounded medications are prepared pursuant to a valid prescription for an individual patient and are not FDA-approved.