Compounded ED Treatment
Compounded — troche or tablet, as needed or daily
A troche or tablet for erectile dysfunction, prescribed only after your heart health and medications are reviewed.
From $179 One-time supply $32 consultation included, not refunded · medication and shipping if prescribed
Choose supply length
Price
$179 for this supply, if prescribed
Includes your $32 provider consultation (non-refundable). If your provider decides treatment isn’t appropriate, the medication portion is refunded automatically.
Paying books a visit with a licensed provider, who decides whether to prescribe and which strength is appropriate. If nothing is prescribed, the medication portion is refunded automatically; a higher strength costs more only if you approve that charge.
How it works
Compounded ED treatment is prepared for you by a licensed compounding pharmacy in our clinical partner's network and is not FDA-approved. Depending on your prescription it contains sildenafil, tadalafil, vardenafil, avanafil, apomorphine or oxytocin. It is not a brand-name or generic product, and the FDA has not reviewed it for safety, effectiveness or quality.
Most formulas in this package are PDE5 inhibitors. Sexual stimulation releases nitric oxide in the penis, which raises cGMP, the messenger that relaxes smooth muscle so blood vessels widen and blood flows in. The enzyme PDE5 breaks cGMP down; sildenafil, tadalafil, vardenafil and avanafil inhibit PDE5 so cGMP persists. Arousal is still required, because the medication acts on what happens after it. A compounding pharmacy prepares the ingredient your provider chooses as a troche that dissolves in the mouth or as a tablet, sometimes combining two ingredients, and in some formulas adding apomorphine (a dopamine agonist that acts in the brain) or oxytocin. Which molecule, which form and which dose is your provider's decision, made and documented for you specifically.
The full mechanismWho it’s for
A provider may consider it when
- You want a provider to choose between as-needed and daily options rather than picking a molecule yourself
- Your cardiovascular history and medication list have been reviewed and are clear for a PDE5 inhibitor
- You would rather have a troche that dissolves in the mouth than swallow a tablet, or your provider has a documented reason for a compounded formulation
Reasons it may not be prescribed
- Anyone taking nitrates for chest pain — nitroglycerin, isosorbide and related medications, in any form. The combination can drop blood pressure to a life-threatening degree and is an absolute stop
- Anyone taking riociguat or another guanylate cyclase stimulator — the same absolute contraindication on every PDE5 label
- Recent heart attack or stroke, unstable angina, uncontrolled or very low blood pressure, or a heart condition where sexual activity itself is inadvisable — these need in-person care
- Anyone taking ondansetron or a related anti-nausea medication, if apomorphine is part of the formula — that combination has caused profound drops in blood pressure and loss of consciousness
- Anyone on alpha-blockers, strong CYP3A4 inhibitors such as ritonavir or ketoconazole, or with severe liver or kidney disease, without a full medication review
- A history of priapism, sickle cell disease, multiple myeloma or leukaemia, retinitis pigmentosa, or previous sudden vision loss in one eye
These are the same checks your provider runs in the visit. If one applies, they will tell you plainly — and the medication portion of what you paid comes back automatically.
What to expect
Before you take it
A troche is held in the mouth to dissolve rather than swallowed; a tablet is taken with water. Sildenafil-type formulas are taken about an hour ahead, avanafil-type ones sooner, and a daily tadalafil dose at the same time each day. A heavy, high-fat meal can slow an as-needed dose.
The window
A few hours for sildenafil and vardenafil, longer for tadalafil. None of them produce an erection on their own — arousal is still part of it.
After the first try
Providers often adjust the dose or switch the ingredient after you report back. A first attempt that disappoints is information, not a verdict.
Important safety information
Headache, flushing, indigestion, nasal congestion, back or muscle ache and a temporary blue tinge to vision are the common PDE5 effects; a troche can also numb or irritate the mouth. Apomorphine adds nausea, drowsiness and dizziness on standing. Seek emergency care for an erection lasting more than four hours, or for sudden loss of vision or hearing — all three are on every PDE5 label.
- FDA prescribing information: Viagra (sildenafil citrate) tablets — DailyMed, label revised 2017-12, SPL published 2026
- FDA prescribing information: Cialis (tadalafil) tablets — DailyMed, label revised 2026-06
- FDA prescribing information: Stendra (avanafil) tablets — DailyMed, label revised 2022-10
- FDA prescribing information: Apokyn (apomorphine hydrochloride) injection — DailyMed, label revised 2022-06 (contraindicated with 5-HT3 antagonists such as ondansetron)
- PDE5 Inhibitors — StatPearls, NCBI Bookshelf, updated 2023
Complete safety information is provided during your visit and with every prescription. This page is a summary, not a substitute for your provider's advice.
Questions
Will I definitely be prescribed this?
No. A consultation does not guarantee a prescription. The provider reviews your heart health, blood pressure and every medication you take, and if a PDE5 inhibitor is not safe for you they will say so and explain why. If they decline, the medication portion of what you paid is refunded; the consultation is not.
Why compounded instead of the generic tablet?
Because the formulation is the point: a troche that dissolves in the mouth, two ingredients in one dose, or a strength that is not sold commercially. Under FDA's rules a compounding pharmacy may only prepare something that differs from an available product when your prescriber documents why that difference matters for you. If a plain generic tablet would do the same job, a provider may send you to a regular pharmacy instead, and that is the right outcome.
How is this different from Viagra or Cialis?
They are different products. Viagra and Cialis are tablets made by their manufacturers and approved by the FDA. This is prepared by a compounding pharmacy to your prescription, and the FDA has not reviewed it. The brand-name tablets are FDA-approved; the compounded troche or tablet is not, and we say so on every surface.
Why do you ask so much about my heart?
Because ED medication and certain heart conditions or medications, nitrates above all, are a dangerous combination. A provider who doesn't ask isn't protecting you. If it isn't safe, we won't prescribe it, and we'll tell you why.
Also for sexual health
$32 consultation included, not refunded · medication and shipping if prescribed
See whether Compounded ED Treatment is right for you.
A licensed provider reviews your visit and decides. You receive medication only if prescribed, and that portion of your payment is refunded automatically if they say no.