Two timing profiles. One individualized prescription.
A clinician-selected compounded rapid-dissolve tablet that brings two familiar timing profiles into one individualized prescription.
About 10 minutes. No charge unless your clinician approves.
Combination therapy needs a reason.
Sildenafil and tadalafil are both PDE5 inhibitors. They support penile blood flow in response to sexual stimulation through the same drug class, but their pharmacokinetic profiles are different. Sildenafil is shorter acting. Tadalafil remains active much longer.
This compounded rapid-dissolve tablet puts both molecules into one individually prescribed formulation, bringing their different timing profiles into one dose form selected from your treatment history.
Your provider reviews what you have already tried and decides whether one individually compounded prescription fits your case.
The combination earns its place by addressing a trade-off patients already understand: a shorter timing profile versus a longer one. A clinician, not a cart, decides whether bringing both into one compounded prescription is justified.
Read the evidence →For the case that has already taught you something.
The Partial Responder
A standard single-agent approach helped but did not adequately answer the problem. You want the next step based on that history rather than simply repeating it.
The Timing-Fit Case
The different duration profiles of sildenafil and tadalafil are relevant to how treatment has worked for you. Your clinician can decide whether combining them has a rationale in your specific case.
The Individualized Patient
You are not looking for the strongest item on a menu. You want a provider to decide whether a compounded combination actually earns its place.
This is a medical decision with real trade-offs, and format preference comes second to safety. A licensed clinician screens your full history before prescribing anything.
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 blood pressure that is not adequately controlled
- Alpha-blocker therapy requires provider caution around dosing and timing
- Use of riociguat, or a prior serious reaction to either active ingredient
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.
Tadalafil + Sildenafil RDT, 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 PDE5 treatment
- Combination prescribed only when the provider identifies a clinical rationale
- Compounded rapid-dissolve tablet prepared by a licensed 503A pharmacy if approved
- Follow-up focused on response, tolerability, and whether the combination continues to earn its place
Prescription issued subject to provider judgment. Results vary. Not a guarantee of outcomes.
*Price reflects the smallest size. Other sizes are shown at checkout.
More in Sexual Vitality.
Sildenafil / Tadalafil / Oxytocin ODT
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.
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
Sildenafil alone raised successful intercourse attempts well above placebo.
The detail
Sildenafil alone has a large randomized record. In a systematic review and meta-analysis of 27 randomized trials covering 6659 men, results pooled from 14 parallel-group flexible-dose trials showed successful intercourse attempts of 57 percent on sildenafil versus 21 percent on placebo, weighted mean difference 33.7, 95 percent confidence interval 29.2 to 38.2, and at least one intercourse success in 83 percent of men versus 45 percent, relative benefit increase 1.8, 95 percent confidence interval 1.7 to 1.9. Every trial in that review tested sildenafil on its own.1
Tadalafil alone raised the erectile-function score and improved erections against placebo.
The detail
Tadalafil alone has its own. 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 improvement of 7.9 points 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. Each of those trials tested tadalafil on its own.2
Across 82 trials, every comparison was one PDE5 inhibitor at a time, never two together.
The detail
The two molecules have been compared against each other, one at a time. A network meta-analysis of 82 randomized trials covering 47,626 patients found sildenafil 50 mg the most efficacious starting dose with the highest overall adverse-event rate, and tadalafil 10 mg intermediate in efficacy with the lowest overall adverse-event rate. Every comparison in that analysis is one PDE5 inhibitor against placebo or against another, never two taken together.3
Head to head, tadalafil and sildenafil gave the same erectile-function result.
The detail
Where they have been compared head to head in an individual patient population, the erectile-function result was the same. In an open-label randomized study in 770 men new to PDE5 inhibitors assigned to tadalafil once daily, tadalafil on demand or sildenafil on demand, improvement in the erectile-function domain did not differ between arms, least-squares means 9.4 to 10.0, p equals 0.359. The difference between the molecules showed up in how long men stayed on treatment, not in how well they responded.4
What it does not show
No trial has tested this combination, and both labels advise against combining PDE5 inhibitors.
The detail
No trial has tested this combination as sold. There is no published randomized trial of sildenafil and tadalafil taken together in one product for erectile dysfunction, and the approved labeling for both ingredients says so directly. The sildenafil labeling states that the safety and efficacy of combinations with other PDE5 inhibitors or with other treatments for erectile dysfunction have not been studied and that such combinations are not recommended. The tadalafil labeling states that these combinations have not been studied and instructs patients not to take it with another PDE5 inhibitor.56
Every number above came from one molecule alone; none of them transfer to the pairing.
The detail
Because no trial of the pairing exists, none of the numbers above transfer to it. Every reported effect size was produced by one molecule used alone at a studied dose. Putting a second drug from the same class into the same tablet is an additive-pharmacology question rather than a demonstrated gain, and the sildenafil labeling notes specifically that such combinations may further lower blood pressure.125
There is no dose-response evidence for the tier strengths in this compounded formulation.
The detail
There is no dose-response evidence for the tier strengths in this compounded formulation. The doses studied in the trials above are the fixed strengths of the approved single-agent products, and no study has compared a sildenafil and tadalafil combination against either ingredient used alone at an adequate dose.1256
No trial has tested whether rapid-dissolve delivery changes the outcome for either ingredient.
The detail
The evidence and the product are not the same object. Sildenafil and tadalafil are active ingredients in FDA-approved prescription drug products, and the trials cited here were run on those products. This rapid-dissolve combination is compounded to an individual prescription, is not an FDA-approved drug product, and has not been through a trial programme of its own. No trial has tested whether rapid-dissolve delivery changes the outcome for either ingredient.56
- Fink HA, Mac Donald R, Rutks IR, Nelson DB, Wilt TJ. Sildenafil for male erectile dysfunction: a systematic review and… Arch Intern Med. 2002.
- 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.
- Buvat J, Buttner H, Hatzimouratidis K, Vendeira PA, Moncada I, Boehmer M, Henneges C, Boess FG. Adherence to initial PDE-5 inhibitor treatment: randomized open-label… J Sex Med. 2013.
- 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
Serious risks
- Approved labeling 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 rather than a wait-and-see approach
Commonly reported
- Headache
- Flushing
- Indigestion
- Nasal congestion
- Back pain
- Muscle aches
Reported effects come from the drug class both ingredients belong to, and are the reactions most often described in approved labeling for sildenafil and tadalafil. Because both molecules lower blood pressure through the same pathway, taking them together concentrates that effect rather than spreading it, which is why your provider reviews nitrates, riociguat, alpha-blockers, other blood-pressure medication and cardiovascular history before prescribing anything. Both active ingredients are well characterized in approved labeling, but this rapid-dissolve combination is compounded to your individual prescription by a licensed 503A pharmacy and is not an FDA-approved drug product. Whether two agents from one class belong in your plan is a decision for the licensed clinician who has your full history and your documented response.
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.
Sildenafil and tadalafil are both PDE5 inhibitors with different timing profiles. A clinician may consider a combined compounded formulation based on prior response and the specific case. Evidence does not establish that combining the two is inherently superior to appropriately prescribed single-agent therapy.
Sildenafil and tadalafil are active ingredients in FDA-approved prescription drug products. This specific combination and rapid-dissolve formulation are 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.