Compounded Viagra: what is it?

Yael Cooperman, MD - Contributor Avatar

Reviewed by Yael Cooperman, MD, Ro, 

Written by Amelia Willson 

Yael Cooperman, MD - Contributor Avatar

Reviewed by Yael Cooperman, MD, Ro, 

Written by Amelia Willson 

LAST UPDATED: Dec 07, 2023

4 MIN READ

If you take Viagra to manage your erectile dysfunction (ED), you know how effective it is. Viagra (sildenafil), and similar ED drugs like Cialis (tadalafil), reliably help men get and stay hard once they’re aroused. 

But, just because Viagra is effective, it doesn’t mean you necessarily think the drug is perfect. You may wish there was something a little bit more convenient — something that didn’t require you to plan your meals or sex ahead of time. Something that truly allowed you to have spontaneous sex, while still being discreet.

Compounded Viagra might be the answer. Read on to learn about compounded Viagra, and how sublingual Viagra works in practice (or, should we say, in the bedroom).

Viagra Important Safety Information: Read more about serious warnings and safety info.

Cialis Important Safety Information: Read more about serious warnings and safety info.

Sildenafil (Generic Viagra)

The “Little Blue Pill” but for up to 95% less

What is compounded Viagra? 

By its simplest definition, compounded Viagra is the active ingredient in Viagra, known as sildenafil, produced by a compounding pharmacy to meet a particular patient’s needs. 

What is drug compounding, you might ask? Drug compounding refers to the practice of preparing a medication — by combining, mixing, or altering the ingredients in some way — to better suit the needs of an individual patient. Drug compounding is a common practice, and can be helpful for many people in various situations. 

For example, some people may not be able to swallow pills. A compounded version of a drug may change it from a pill into a liquid or sublingual form, so that a patient can still get their medication. By the same token, a person may have an allergy to one of the inactive ingredients in a medication. A compounding pharmacy can create a new version of the medication without that ingredient, so the person can still get the medication they need. 

Now that we’ve covered drug compounding, let’s get back to compounded Viagra. Compounded Viagra can be available in a sublingual (under the tongue) form, such as a spray or dissolvable tablet. You might also encounter compounded Viagra that combines sildenafil (the active ingredient in Viagra) with tadalafil (the active ingredient in Cialis) to offer increased convenience and spontaneity since the added tadalafil can work faster than sildenafil alone. 

What is sublingual Viagra?

Sublingual Viagra is compounded Viagra that you take sublingually, i.e. under your tongue. Sublingual medications come in a variety of formats, including dissolvable wafers, tablets, lozenges, as well as liquid drops or sprays. You don’t have to chew or swallow a sublingual medication; rather, you place it underneath your tongue and wait as it dissolves. 

One of the biggest selling points of sublingual medications, including sublingual Viagra, is that they are fast-acting. With an oral medication you swallow, like a pill or capsule, you have to wait for the drug to be absorbed through your gastrointestinal (GI) tract. But with sublingual medication, the active ingredients get absorbed under your tongue by the superior vena cava, your body’s largest vein. As a result, the medication enters your bloodstream within minutes

And because sublingual Viagra bypasses your GI tract altogether, you don’t have to worry about your last meal affecting the absorption of the medication, or try to time your dosage one hour before having sex, like you do with the traditional pill form of Viagra. 

Is sublingual Viagra more effective? 

Studies in rabbits have shown sublingual sildenafil to be just as effective as oral sildenafil. Plus, sublingual Viagra kicks in faster and lasts just as long. In general, sublingual ED medications offer certain advantages over traditional ED medications. For one, they are faster-acting, and, because they bypass the GI tract entirely, less of the drug gets degraded through the metabolic process. Also, many men (and their partners) find sublingual Viagra to be more discreet and convenient. Let’s take a closer look at these benefits.

Faster-acting than oral tablets in general

With sublingual Viagra, you simply place the medication under your tongue and let it dissolve. Rather than swallowing it and waiting for it to be absorbed by your GI tract, the sublingual method puts the medication directly into your bloodstream

Because it dissolves quickly, sublingual Viagra can start working within a matter of minutes — 15 minutes or less, according to some studies. In studies of rabbits, sublingual sildenafil started working within a few minutes, for example. With traditional oral sildenafil, on the other hand, it is recommended to take Viagra about 1 hour before having sex. Because it’s faster-acting than traditional oral ED medications, sublingual Viagra allows for more spontaneity as well. It’s important to remember though: fast-acting doesn’t mean automatic. You need to be aroused for it to work. 

Less scheduling of meals and sex required

Because it bypasses your GI tract, sublingual Viagra doesn’t get degraded during the digestive process, enabling a high bioavailability of the drug (essentially, the amount of the drug that actually enters your bloodstream after you take it). 

And, sublingual Viagra still works fast even with a full stomach because the active ingredients get absorbed under your tongue. With traditional oral Viagra, you have to pay a bit more attention to what you eat, since taking Viagra after a high-fat meal can delay how soon it starts working. 

Increased convenience over traditional ED medications

Many men find sublingual Viagra to be more discreet than traditional oral sildenafil. You don’t need to pop a pill and find some water to wash it down. Instead, you simply let it dissolve in your mouth under your tongue.

Together, these unique aspects of sublingual Viagra, from how fast it works to its discreet nature, offer increased convenience. Because of how fast the medication works, you don’t need to plan as far ahead and can be more spontaneous when having sex. You don’t have to worry about what or when you last ate, or find a glass of water. Sublingual Viagra is just as effective, and faster-acting, than traditional ED medications, allowing you to get hard in minutes and enjoy spur of the moment sex when you want it.

Sildenafil (Generic Viagra)

The “Little Blue Pill” but for up to 95% less

Can you mix sildenafil and tadalafil? 

Because they’re in the same drug family, combining sildenafil (Viagra) and tadalafil (Cialis) could increase your risk of experiencing side effects, such as headache, indigestion, nasal congestion, or back pain. You should not take Cialis within 24 hours of Viagra, or take Viagra within 36 hours of taking Cialis, unless otherwise directed by your healthcare provider. 

In their current formulation, both generic sildenafil and tadalafil, as well as their brand name counterparts, Viagra and Cialis, were not designed to be taken with each other. Also, there is currently no support that going above the maximum dose for either drug will increase its effectiveness

However, compounded drugs may combine sildenafil and tadalafil in different dosage amounts to achieve the same, or stronger efficacy, along with other benefits, such as added convenience. These compounded medications can be helpful for the 30%–40% of people who do not respond to either Viagra or Cialis on their own, as well as those with severe ED

To learn more about fast, effective treatment options for ED, check out Ro’s offerings.

DISCLAIMER

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

  • Andersson, K. E. (2018). PDE5 inhibitors - pharmacology and clinical applications 20 years after sildenafil discovery. British Journal of Pharmacology, 175(13), 2554–2565. doi:10.1111/bph.14205. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003652/

  • Cheung, M., Zhao, F., & Dave, V. S. (2021). Physical-chemical Stability of Compounded Sildenafil 100-mg Rapid-dissolving Tablets. International Journal of Pharmaceutical Compounding, 25(1), 82–87. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33503013/

  • Cui, H., Liu, B., Song, Z., et al. (2015). Efficacy and safety of long-term tadalafil 5 mg once daily combined with sildenafil 50 mg as needed at the early stage of treatment for patients with erectile dysfunction. Andrologia, 47(1), 20–24. doi:10.1111/and.12216. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24387078/

  • De Siati, M., Saugo, M., & Franzolin, N. (2003). The start of pharmacological activity after sublingual administration of sildenafil citrate in 30 patients affected by erectile dysfunction. Archivio Italiano di Urologia, Andrologia: Organo Ufficiale [di] Societa italiana di Ecografia Urologica e Nefrologica, 75(1), 18–20. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12741340/

  • Deveci, S., Peşkircioğlu, L., Aygün, C., et al. (2004). Sublingual sildenafil in the treatment of erectile dysfunction: faster onset of action with less dose. International Journal of Urology : Official Journal of the Japanese Urological Association, 11(11), 989–992. https://doi.org/10.1111/j.1442-2042.2004.00933.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15509203/

  • Gong, B., Ma, M., Xie, W., et al. (2017). Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis. International Urology and Nephrology, 49(10), 1731–1740. doi:10.1007/s11255-017-1644-5. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603624/

  • Hua, S. (2019). Advances in Nanoparticulate Drug Delivery Approaches for Sublingual and Buccal Administration. Frontiers in Pharmacology, 10, 1328. doi:10.3389/fphar.2019.01328. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848967/

  • Munk, N. E., Knudsen, J. S., Comerma-Steffensen, S., et al. (2019). Systematic Review of Oral Combination Therapy for Erectile Dysfunction When Phosphodiesterase Type 5 Inhibitor Monotherapy Fails. Sexual Medicine Reviews, 7(3), 430–441. doi:10.1016/j.sxmr.2018.11.007. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30711478/

  • Mykoniatis, I., Pyrgidis, N., Sokolakis, I., et al. (2021). Assessment of Combination Therapies vs Monotherapy for Erectile Dysfunction: A Systematic Review and Meta-analysis. JAMA Network Open, 4(2), e2036337. doi:10.1001/jamanetworkopen.2020.36337. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893498/

  • Sheu, M. T., Hsieh, C. M., Chen, R. N., et al. (2016). Rapid-Onset Sildenafil Sublingual Drug Delivery Systems: In Vitro Evaluation and In Vivo Pharmacokinetic Studies in Rabbits. Journal of Pharmaceutical Sciences, 105(9), 2774–2781. doi:10.1016/j.xphs.2016.01.015. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26987948/

  • Smith-Harrison, L. I., Patel, A., & Smith, R. P. (2016). The devil is in the details: an analysis of the subtleties between phosphodiesterase inhibitors for erectile dysfunction. Translational Andrology and Urology, 5(2), 181–186. doi:10.21037/tau.2016.03.01. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837309/

  • U.S. Food & Drug Administration (FDA). (2022). Compounding and the FDA: Questions and Answers. Retrieved from https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers

  • U.S. Food & Drug Administration (FDA). (2011). Highlights of Prescribing Information: Cialis® (tadalafil) tablets, for oral use. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021368s20s21lbl.pdf

  • U.S. Food & Drug Administration (FDA). (2017). Highlights of Prescribing Information: Viagra® (sildenafil citrate) tablets, for oral use. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020895s048lbl.pdf

  • Wang, Z. & Chow, M. S. (2014). Overview and appraisal of the current concept and technologies for improvement of sublingual drug delivery. Therapeutic Delivery, 5(7), 807–816. doi:10.4155/tde.14.50. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25287387/


How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

December 07, 2023

Written by

Amelia Willson

Fact checked by

Yael Cooperman, MD


About the medical reviewer

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.