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Sildenafil + Tadalafil (Troche)
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Sildenafil + Tadalafil Troche: Two PDE5 Inhibitors in a Single Dissolving Lozenge
Fast onset from sildenafil paired with tadalafil’s long duration, in a dissolving troche.
This compounded troche combines sildenafil (fast onset, shorter duration) and tadalafil (slower onset, much longer duration) in a single dissolving lozenge. The combination is designed to deliver both the quick start of sildenafil and the long window of tadalafil from one dose, with sublingual absorption that can speed onset compared with swallowing a pill.
Physician-prescribed · Compounded by licensed US pharmacies · Combined onset and duration · Ongoing care team support
Sildenafil (Fast-onset PDE5 Inhibitor): Sildenafil typically begins working within 30 minutes and lasts about 4 hours.
Tadalafil (Long-acting PDE5 Inhibitor): Tadalafil typically begins working in 30 to 60 minutes and lasts up to 36 hours.
Best for: Adult men with erectile dysfunction who want both fast onset and a long window of effect, and prefer a dissolving format over a pill.
Not recommended for: Anyone taking nitrates or certain alpha-blockers, those with significant cardiovascular disease, severe liver or kidney disease, recent stroke, or a history of priapism.
Most common side effects reflect the combined PDE5 profile: headache, flushing, nasal congestion, back pain or muscle aches, mild stomach upset, and visual changes. Rare but more serious risks include priapism, significant blood pressure changes, and dangerous interactions with nitrates.
¹ Sildenafil: 84% of men reported improved erections (100 mg) Goldstein I, Lue TF, Padma-Nathan H, et al. Oral sildenafil in the treatment of erectile dysfunction. New England Journal of Medicine, 1998;338(20):1397-1404. → NEJM · PubMed
² Tadalafil: effective for up to ~36 hours per dose Porst H, Padma-Nathan H, Giuliano F, et al. Efficacy of tadalafil at 24 and 36 hours after dosing. Urology, 2003;62(1):121-125. With efficacy data: Brock GB, et al. Journal of Urology, 2002;168(4 Pt 1):1332-1336. → PubMed · PubMed
³ Pairs sildenafil’s fast onset with tadalafil’s long duration No adequately powered RCT of combined sildenafil + tadalafil therapy for general ED exists. Combining two PDE5 inhibitors is not FDA-approved and is not standard of care. (Component sources ¹ and ² are monotherapy trials.)
How it Works With EHRX
The entire process is online. No waiting rooms. Just straightforward, medically guided care.
Step 1
Choose your treatment and complete checkout
You'll receive a confirmation email with next steps.
Step 2
Complete a brief medical consultation
Check your email for a link to a short intake form and link to a virtual consult with a licensed physician.
Step 3
A licensed provider reviews your consultation
If approved, your prescription is written and sent to the pharmacy. If not, you receive a full refund.
Step 4
Your pharmacy ships within 3–5 business days
Your medication is shipped directly to your door in temperature-controlled packaging.
What to know before you start.
Sildenafil + Tadalafil (Troche) is a compounded medication prepared by a licensed pharmacy for individual patient use.
It has not been reviewed by the FDA for safety or efficacy, and is prescribed based on the clinical judgment of a qualified healthcare provider. Compounded drugs are permitted to be prescribed but are not FDA-approved for safety and efficacy.
Clinical Evidence
Each component has individual clinical support; combined sildenafil and tadalafil preparations are at the prescriber’s discretion. (Source: Hatzimouratidis et al., European Urology Supplements, 2015)
Frequently Asked Questions
We aim to provide absolute clarity regarding your biological data and personalized wellness protocols.
Dissolve one troche under your tongue or in your cheek pouch about 30 minutes before anticipated intimacy.
Sildenafil starts fast, tadalafil lasts long. Combining gives both quick onset and a long window.
Up to 36 hours from the tadalafil component, with peak effect during the first few hours from the sildenafil component.
Yes. A medication review is required because PDE5 inhibitors interact dangerously with nitrates.
You won’t be charged for the medication.
No. Compounded combination products are paid out of pocket.
Yes, at any time before your next shipment, with no long-term commitment.
Initial check-in at 4 to 6 weeks, then on a recurring cadence.
Seek emergency medical attention immediately.
No. Combination PDE5 troches are designed for as-needed use only.
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