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Men's sexual healthSildenafil and tadalafil, prescribed online
Compounded sildenafil and tadalafil tablets for erectile dysfunction, from $49 a month. You start with a short health assessment on our patient portal. A licensed provider in your state reviews your health history and decides whether a prescription is appropriate. If it is, our pharmacy partner ships it in discreet packaging.
Treatments
Sildenafil
Taken as needed, 30 to 60 minutes ahead
6, 12, or 18 tablets a month · $49, $69, or $89
Start my assessmentSildenafil 80 mg with pycnogenol 50 mg in one tablet. Your provider sets the dose.
Compounded, not FDA-approved.*
Tadalafil
Taken as needed, or as a low daily dose
6, 12, or 18 tablets a month · $49, $69, or $89
Start my assessmentTadalafil 20 mg with pycnogenol 25 mg in one tablet. Your provider sets the dose.
Compounded, not FDA-approved.*
If prescribed, your medication will be dispensed by Rush Pharmacy, a licensed pharmacy.
*Compounded medications are prepared by state-licensed compounding pharmacies pursuant to a prescription. They are not FDA-approved, and the FDA does not verify the safety, effectiveness, or quality of compounded drugs before marketing. Both medications are prescription-only. Nothing is dispensed until a licensed provider reviews your intake and determines that treatment is appropriate. No prescription is guaranteed. If a provider does not prescribe, you are not charged for medication, though the consultation fee covering their review still applies. If a prescription is issued, your order ships within 2 to 3 business days of the pharmacy processing it and typically arrives 4 to 5 business days later. Viagra® and Cialis® are trademarks of their respective owners. Row Telehealth is not affiliated with or endorsed by those manufacturers.
What you are actually buying. These are compounded tablets: sildenafil or tadalafil combined with pycnogenol, a pine-bark extract, prepared for you pursuant to a prescription. The combined tablets are not FDA-approved. They are dispensed by our pharmacy partner, Rush Pharmacy, a U.S. state-licensed pharmacy. Your monthly price covers the medication, your provider's ongoing review, and shipping.
A licensed provider in our network, LocumTele, reviews your intake and decides whether a prescription is appropriate for you. Nothing ships without one. Row Telehealth serves patients in 49 states, not California.
How they differ
Sildenafil
Sildenafil is the active ingredient in Viagra®. In our compounded tablet it is combined with pycnogenol. It belongs to a class called PDE5 inhibitors, which relax the blood vessels supplying the penis so blood flow improves in response to sexual stimulation. It does not create arousal on its own. Arousal still has to be there. It is taken as needed, roughly 30 to 60 minutes before activity, and typically works for about four to six hours. Your provider decides the starting dose and adjusts it based on how you respond and what else you take.
- Timing Roughly 30 to 60 minutes before activity. Effect generally lasts about 4 to 6 hours
- Dose A typical starting dose is chosen by your provider and revisited at follow-up
- Food A large or high-fat meal can slow how quickly it takes effect
- Never with Nitrates such as nitroglycerin, or riociguat. The combination can cause a dangerous drop in blood pressure
- Common side effects Headache, flushing, nasal congestion, indigestion, back or muscle ache
Tadalafil
Tadalafil is the active ingredient in Cialis®, combined with pycnogenol in our compounded tablet, and works through the same PDE5 pathway. The practical difference is duration: taken as needed, a single dose can remain active for up to about 36 hours, so the timing of the dose matters less. Some patients are instead prescribed a low daily dose, which keeps a steady level of medication rather than planning around a single tablet. Your provider decides which approach fits your situation.
- Timing Taken as needed ahead of activity. A single dose can stay active up to about 36 hours
- Daily option Some patients are prescribed a low daily dose instead of as-needed dosing
- Dose Chosen by your provider and adjusted based on response and tolerance
- Never with Nitrates such as nitroglycerin, or riociguat. The combination can cause a dangerous drop in blood pressure
- Common side effects Headache, flushing, nasal congestion, indigestion, back or muscle ache
What both medications share
Never take either medication with nitrates or with riociguat. Nitrates include nitroglycerin tablets, sprays and patches, isosorbide, and amyl nitrite poppers. Riociguat is prescribed for pulmonary hypertension. Combined with sildenafil or tadalafil, either can cause a sudden, dangerous drop in blood pressure. Tell your provider about every medication and supplement you take, including anything you use only occasionally.
Use caution with alpha-blockers and with significant cardiovascular disease. Alpha-blockers prescribed for blood pressure or an enlarged prostate add to the blood-pressure effect and may require separated dosing. If you have had a recent heart attack or stroke, unstable angina, uncontrolled blood pressure or a significant arrhythmia, or if a clinician has advised you against sexual activity, your provider will weigh that carefully before prescribing.
Get emergency care right away for an erection lasting more than four hours, or for sudden loss of vision or sudden loss of hearing. These reactions are uncommon, and they are urgent.
The most common side effects are headache, flushing, nasal congestion, indigestion, and back or muscle ache. They are usually mild and often settle once your provider has landed on the right dose. Message your care team if something is bothering you, and call 911 for a medical emergency.
ED is often a signal, not only a symptom
The small blood vessels involved in an erection are affected early by problems with blood pressure, blood sugar, and cholesterol. Difficulty that comes on gradually is sometimes the first thing a man notices.
- Cardiovascular. High blood pressure, high cholesterol, and vascular disease are common contributors.
- Metabolic. Type 2 diabetes and insulin resistance affect both nerves and blood vessels.
- Hormonal. Low testosterone and thyroid problems can play a part, and are worth checking rather than assuming.
- Medications and habits. Some blood-pressure drugs and antidepressants, heavy alcohol use, smoking, and poor sleep all matter.
That is why the intake asks about your heart and your medication list, not just the symptom. Your provider may recommend labs or an in-person visit if something needs a closer look, and treating the underlying cause often matters more than the tablet.
Start with the assessment
About five minutes, answered privately. A licensed provider reviews it and tells you whether sildenafil or tadalafil is appropriate for you.
Start my assessment