When blood flow is only part of the picture.
A compounded three-part prescription for cases where vascular response may not be the only layer worth evaluating.
About 10 minutes. No charge unless your clinician approves.
Know which part of the formula carries the evidence.
Sildenafil and tadalafil are PDE5 inhibitors with decades of clinical use behind the drug class. They support penile blood flow in response to sexual stimulation. Their timing profiles differ, but they work through the same core vascular pathway.
Oxytocin is different. It is a hormone and neuropeptide involved in social and reproductive biology, and some prescribers include it in compounded sexual-health formulations. Here, it gives your clinician a separate connection and experience layer to evaluate alongside the vascular components.
The PDE5 components bring established vascular pharmacology, while oxytocin brings a distinct social and reproductive signal. Your clinician decides whether those ingredients belong together in your individual prescription.
The vascular components and the exploratory component do different jobs. Sildenafil and tadalafil carry the established blood-flow evidence; oxytocin gives the clinician a separate connection and experience question to evaluate.
Read the evidence →For the patient who wants the whole formula explained honestly.
The Step-Up Case
Standard single-agent therapy has already given your clinician useful information. You want the next decision based on that history rather than a generic escalation ladder.
The Evidence Reader
You want to know which ingredients are supported by established clinical pharmacology and which are more exploratory. You want that difference stated plainly.
The Individualized Patient
A compounded combination only interests you if a clinician can explain why this specific formulation belongs in your case.
Candidacy at these strengths is determined by a licensed provider from your full intake and your documented response, every time. This is not a formulation to escalate to on your own.
This might not be the right fit if:
- Any use of nitrate medications, including nitroglycerin and isosorbide; combining PDE5 inhibitors with nitrates can cause a dangerous drop in blood pressure
- Recent heart attack or stroke, or cardiac status your provider considers unstable
- Severe hypotension, or uncontrolled high blood pressure
- Alpha-blocker therapy requires particular provider caution at these strengths
- Use of riociguat, or a prior serious reaction to sildenafil or tadalafil
Your intake screens for all contraindications. Every candidate is evaluated by a licensed clinician before any prescription is issued. No prescription is issued without clearance.
Sildenafil / Tadalafil / Oxytocin ODT, prescribed with care.
Compounded by a licensed 503A pharmacy. Prescribed by a licensed provider after clinical review.
- Licensed clinician review of cardiovascular history, medications, and prior sexual-health treatment
- Combination prescribed only when the provider identifies a clinical rationale
- Compounded orally disintegrating tablet prepared by a licensed 503A pharmacy if approved
- Follow-up focused on response, tolerability, and whether every component continues to earn its place
Prescription issued subject to provider judgment. Results vary. Not a guarantee of outcomes.
More in Sexual Vitality.
Tadalafil + Sildenafil RDT
Two timing profiles. One individualized prescription.
A clinician-selected compounded rapid-dissolve tablet that brings two familiar timing profiles into one individualized prescription.
Tadalafil 5mg Daily
Ready when the moment is. Without timing the moment.
Once-daily tadalafil uses the same active ingredient as Cialis, prescribed as the FDA-approved generic, to move treatment out of the immediate moment. (Generic for Cialis (daily).)
Tadalafil 20mg On-Demand
One dose. A window measured in days, not minutes.
On-demand tadalafil pairs an established FDA-approved generic with a longer activity profile than sildenafil. (Generic for Cialis.)
What the research shows
On sildenafil alone, 69 percent of intercourse attempts succeeded versus 22 percent on placebo.
The detail
The sildenafil evidence is registration-grade and it is single-agent. In two sequential double-blind studies, 532 men were randomized to sildenafil 25, 50 or 100 mg or placebo over 24 weeks and 329 different men entered a 12-week flexible dose-escalation study; in the last four weeks of the dose-escalation study, 69 percent of intercourse attempts succeeded on sildenafil versus 22 percent on placebo, with 5.9 versus 1.5 successful attempts per month.1
Tadalafil alone improved erectile function scores by 7.9 points.
The detail
The tadalafil evidence is the same shape. In an integrated analysis of five randomized, double-blind, placebo-controlled 12-week trials in 1112 men of mean age 59, tadalafil 20 mg produced a mean 7.9 point improvement in the International Index of Erectile Function erectile-function domain, 75 percent of intercourse attempts were completed successfully on Sexual Encounter Profile question 3, and 81 percent reported improved erections versus 35 percent on placebo.2
Sildenafil 50 mg ranked most efficacious, and no trial combined two PDE5 inhibitors.
The detail
At class level the record is large and it is still single-agent. A network meta-analysis of 82 randomized trials covering 47,626 patients compared PDE5 inhibitors against placebo and against one another, finding sildenafil 50 mg most efficacious with the highest overall adverse-event rate and tadalafil 10 mg intermediate in efficacy with the lowest. No trial in that analysis combined two of them.3
Oxytocin’s sexual effects are animal findings; human studies did not confirm them.
The detail
The oxytocin evidence that exists is mostly preclinical, and the review literature says so. A 2021 review traces a laboratory-animal literature dating to the 1980s in which central oxytocin facilitates erection and sexual behaviour in male and female animals, and then reports that the human studies, conducted mainly with intranasal oxytocin, do not appear to confirm that facilitatory role in either men or women.4
What it does not show
No trial has tested this three-ingredient tablet as sold.
The detail
No trial has tested this three-ingredient tablet as sold. There is no published randomized trial of sildenafil, tadalafil and oxytocin given together for erectile dysfunction. The approved labeling for both PDE5 ingredients states that combinations with other PDE5 inhibitors or with other treatments for erectile dysfunction have not been studied and that such combinations are not recommended. The single-agent results above belong to the single agents and do not carry over.56
Intranasal oxytocin did not change sexual drive, arousal or erection in men.
The detail
The human oxytocin studies in men did not show the thing the ingredient is usually sold for. In a double-blind, placebo-controlled crossover experiment in 10 healthy men, 24 international units of intranasal oxytocin raised plasma oxytocin and epinephrine but did not alter appetitive, consummatory or refractory sexual behaviour on the scale used. In 29 heterosexual couples, 58 participants, the same intranasal dose did not alter sexual drive, arousal, penile erection or lubrication; the effects that did appear were on orgasm intensity, contentment after intercourse and partner interaction, with small to moderate effect sizes.78
The longest oxytocin trial was negative: placebo scored higher than oxytocin.
The detail
The longest randomized oxytocin trial in sexual dysfunction was negative. In a 22-week randomized, double-blind, placebo-controlled crossover trial in 30 premenopausal and postmenopausal women with sexual dysfunction, intranasal oxytocin 32 international units taken before intercourse raised Female Sexual Function Index scores by 26 percent while placebo raised them by 31 percent, with no significant treatment, sequence or interaction effect.9
Every human study used intranasal oxytocin; no trial tested an oral dose.
The detail
The route studied is not the route sold. Every human sexual-function study cited here used intranasal oxytocin, and the FDA-approved oxytocin products are sterile injections given by intravenous infusion or intramuscular injection for obstetric indications, not for sexual function. No controlled trial establishes what an orally disintegrating oxytocin dose does. The tablet itself is compounded to an individual prescription, is not an FDA-approved drug product, and has not been through a trial programme of its own.78910
- Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction Sildenafil… N Engl J Med. 1998.
- Brock GB, McMahon CG, Chen KK, Costigan T, Shen W, Watkins V, Anglin G, Whitaker S. Efficacy and safety of tadalafil for the treatment of erectile… J Urol. 2002.
- Chen L, Staubli SE, Schneider MP, Kessels AG, Ivic S, Bachmann LM, Kessler TM. Phosphodiesterase 5 inhibitors for the treatment of erectile… Eur Urol. 2015.
- Melis MR, Argiolas A. Oxytocin, erectile function and sexual behavior: last discoveries and… Int J Mol Sci. 2021.
- FDA-approved prescribing information, VIAGRA (sildenafil citrate) tablets, Pfizer Laboratories Div Pfizer Inc, label published February 2026.DailyMed
- FDA-approved prescribing information, CIALIS (tadalafil) tablets, Eli Lilly and Company, label published June 2026.DailyMed
- Burri A, Heinrichs M, Schedlowski M, Kruger TH. The acute effects of intranasal oxytocin administration on endocrine… Psychoneuroendocrinology. 2008.
- Behnia B, Heinrichs M, Bergmann W, Jung S, Germann J, Schedlowski M, Hartmann U, Kruger TH. Differential effects of intranasal oxytocin on sexual experiences and… Horm Behav. 2014.
- Muin DA, Wolzt M, Marculescu R, Sheikh Rezaei S, Salama M, Fuchs C, Luger A, Bragagna E, Litschauer B, Bayerle-Eder M. Effect of long-term intranasal oxytocin on sexual dysfunction in… Fertil Steril. 2015.
- FDA-approved prescribing information, PITOCIN (oxytocin injection, USP) for intravenous infusion or intramuscular injection, Par Health USA, LLC, label published May 2026.DailyMed
Serious risks
- Approved labeling for sildenafil and tadalafil also documents an erection lasting more than four hours
- Sudden decrease or loss of vision in one or both eyes
- Sudden decrease or loss of hearing
- Each of these needs urgent medical attention.
- Both molecules lower blood pressure through the same pathway, and taking them together concentrates that effect
- Antidiuretic activity with water retention and dangerously low blood sodium at high or prolonged exposure
Commonly reported
- Headache
- Flushing
- Indigestion
- Nasal congestion
- Back pain
- Muscle aches
Because it is an oral dissolving tablet
- Safety data for an oral dissolving route at these doses are limited
The PDE5 ingredients carry most of what people report, and all of those effects appear in approved labeling. Your provider reviews nitrates, riociguat, alpha-blockers, other blood-pressure medication and cardiovascular history before prescribing. Oxytocin is the least settled part of the formulation for this purpose: FDA-approved oxytocin products are injections used under obstetric supervision, and their labeling documents an antidiuretic effect. The three-ingredient tablet itself is compounded to your individual prescription by a licensed 503A pharmacy and is not an FDA-approved drug product. A licensed clinician decides whether each component earns its place at the start, and keeps deciding at follow-up.
Asked and answered.
You are not charged, and you are not left guessing. Your clinician explains the reasoning and, where it helps, what a better path might look like. Reviews are typically completed in under 24 hours.
The reason to consider the formulation is that vascular treatment may have addressed only part of the picture. Sildenafil and tadalafil carry the established blood-flow evidence. Oxytocin is the exploratory connection and experience layer, and human evidence for that use remains limited. A clinician decides whether the combination is medically reasonable for the individual case.
Both are PDE5 inhibitors with different timing profiles. A clinician may consider the combination based on prior response and the individual case. Evidence does not establish that combining them is inherently superior to appropriately prescribed single-agent therapy.
Sildenafil, tadalafil, and oxytocin are each used in FDA-approved prescription drug products for specific indications. This specific three-ingredient formulation is compounded to an individual prescription. No compounded medication is FDA-approved, including this one. Compounded medicines are made to your individual prescription by a licensed pharmacy rather than manufactured and approved as a finished drug product.
Common PDE5-inhibitor effects include headache, flushing, nasal congestion, indigestion, back pain, and muscle aches. Combining agents from the same class can increase blood-pressure and adverse-effect concerns. Nitrates are a major contraindication. An erection lasting more than four hours or sudden vision or hearing loss requires urgent medical attention.
Any time, before your renewal date. No phone calls required.