Balanced information belongs beside every treatment option.

Never take sildenafil or tadalafil with nitrate medications — including nitroglycerin, isosorbide, and recreational “poppers” (amyl nitrite). The combination can cause a sudden, dangerous drop in blood pressure.

Alpha-blockers and other blood pressure medications can also interact, lowering blood pressure further. Your clinician must know about every medication you take before any prescription decision.

Sildenafil and tadalafil are both PDE5 inhibitors. Their FDA approved labels say combined use with other PDE5 inhibitors has not been studied. Taking them together may lower blood pressure further. Sildenafil labeling does not recommend such combinations.

This compounded formula is not FDA approved. Use it only if prescribed after an individual clinical review. Follow your clinician and pharmacy instructions exactly.

Review the current sildenafil labeling and tadalafil labeling.

• Priapism: an erection lasting more than 4 hours is a medical emergency and can cause permanent damage. Seek emergency care immediately.
• Vision changes: sudden vision loss in one or both eyes, which may be a sign of NAION, has been reported with PDE5 inhibitors. Stop use and seek care immediately.
• Hearing changes: sudden decrease or loss of hearing, sometimes with ringing or dizziness, has been reported. Stop use and seek care immediately.
• Cardiovascular risk: sexual activity places demand on the heart. Anyone with cardiovascular disease, recent heart attack or stroke, uncontrolled blood pressure, or chest pain during activity needs careful evaluation before treatment.

PDE5 inhibitors commonly cause headache, facial flushing, nasal congestion, indigestion, back pain, or muscle aches. Most effects are temporary; tell your clinician about anything persistent or concerning.

Oxytocin’s effects in a sublingual ED formulation are not established, and its side effect profile in this use has not been characterized in large studies. Your clinician should discuss this uncertainty with you.

Compounded sublingual oxytocin / sildenafil / tadalafil is not FDA approved. FDA does not verify compounded drugs for safety, effectiveness, or quality before marketing.

Compounded products can carry risks related to strength, consistency, storage, and administration. Your clinician should explain why a compounded option is being considered for you.

Read the FDA’s questions and answers on drug compounding

• Tell the clinician about all medications and supplements — especially nitrates, alpha-blockers, and blood pressure medicines.
• Share allergies, reactions, heart conditions, and prior treatments.
• Ask about evidence, uncertainty, risks, and alternatives.
• Confirm the dispensing pharmacy and its contact information.
• Understand storage, administration, and follow up instructions.

Follow the final pharmacy and clinician instructions. Contact the care team promptly for concerning or unexpected symptoms.

Call 911 or go to the nearest emergency room for a medical emergency, including an erection lasting more than 4 hours, chest pain, or sudden vision or hearing loss. This website does not provide emergency care.