Clinical Information
Use as directed by your healthcare provider. Place one tablet under your tongue and let it dissolve completely without swallowing. If you miss a dose for a planned sexual activity, take it when remembered but never take more than one tablet in 24 hours. Do not double up on doses.
Sildenafil blocks an enzyme called phosphodiesterase-5 (PDE-5). This keeps blood vessels in the penis relaxed, letting more blood enter when you are sexually stimulated. Apomorphine is a dopamine D2 receptor stimulator that starts nerve signals from the brain to the penis, helping begin the erection process. Because the tablet melts under the tongue, some men feel effects in about 10-20 minutes. The action usually lasts up to 4 hours, though this can vary.
Do not use if you take nitrate drugs for chest pain (such as nitroglycerin) because this can cause a dangerous drop in blood pressure. Do not use if you have severe heart disease, recent heart attack or stroke (within the past 6 months), or uncontrolled high or low blood pressure. Do not use if you are allergic to sildenafil, apomorphine, or any ingredient in this medicine. Avoid if you have severe liver disease, severe kidney disease requiring dialysis, retinitis pigmentosa, or are under 18 years old. Do not use if you are a woman who is pregnant, may become pregnant, or breastfeeding.
Serious interaction with nitrate medications (Nitrostat, Isosorbide) and "poppers" (amyl nitrite) – may cause life-threatening low blood pressure. Use caution with alpha-blockers for prostate or blood pressure (tamsulosin, doxazosin) due to dizziness risk; separate dosing by at least 4 hours if approved by your prescriber. Strong CYP3A4 inhibitors like ketoconazole, ritonavir, and clarithromycin can raise sildenafil levels and side effects; dose adjustments may be needed. Blood pressure drugs, other erectile dysfunction drugs, and alcohol can add to blood-pressure-lowering effects. Grapefruit or grapefruit juice may increase sildenafil levels – limit or avoid. Tell your provider about all prescription drugs, over-the-counter medicines, herbal products (such as St. John’s wort or ginkgo), and recreational substances before starting.
Very common (more than 1 in 10 men): headache, flushing, stuffy nose. Common (1–10 in 100 men): dizziness, nausea, upset stomach, visual color tinge (blue/green), mild drop in blood pressure, sleepiness. Uncommon (1–10 in 1,000): fainting, ringing in ears, prolonged erection lasting more than 4 hours (priapism), sudden hearing decrease. Rare but serious: sudden vision loss in one or both eyes (NAION), severe allergic reaction (rash, swelling, trouble breathing), severe low blood pressure leading to fainting. Most mild side effects fade within a few hours. Seek immediate medical help for chest pain, vision or hearing changes, or an erection longer than 4 hours.
Store at room temperature 68-77°F (20-25°C). Keep tablets in the original blister or packet to protect from moisture and light. Do not store in bathroom or near the kitchen sink. Keep out of reach of children and pets. Do not use after the expiration date. Return unused or expired tablets to a pharmacy take-back program or seal in a plastic bag with coffee grounds before placing in household trash.
Frequently Asked Questions
Q:How fast will the rapid-dissolve tablet work?
A:Most men begin to feel effects in about 10-20 minutes because the tablet melts under the tongue and enters the bloodstream quickly. Eating a heavy meal right before may delay the start slightly.
Q:Can I swallow the tablet instead of letting it dissolve?
A:No. The medicine is designed to absorb through the lining under your tongue. Swallowing it whole may delay or reduce how well it works.
Q:Is it safe to drink alcohol with this medication?
A:Small amounts of alcohol are usually okay, but drinking more than two standard drinks can lower blood pressure and make dizziness or fainting more likely. Heavy drinking also makes it harder to achieve an erection.
Q:What if I take nitrates for chest pain?
A:Do not take this medicine. Combining it with nitrates can cause a sudden, dangerous drop in blood pressure. Talk to your doctor about other treatment options.
Q:Can I cut the tablet in half to use a smaller dose?
A:No. Cutting the rapid-dissolve tablet may affect how it breaks down and how much medicine you get. If you feel you need a lower dose, speak with your prescriber about making a new prescription strength.
Q:What should I do if I feel nauseous after taking it?
A:Mild nausea is common and often passes within an hour. Lying down for a short time may help. If nausea is severe or you vomit, call your healthcare provider; they may suggest an anti-nausea medicine or adjusting your dose.
Q:Can women use this medication?
A:No. This compounded product is intended only for adult men with erectile dysfunction. Safety and effectiveness in women have not been established.
Q:How should I store the tablets when traveling?
A:Keep them in their original blister or packet, inside a cool, dry place such as a carry-on bag. Avoid leaving them in a hot car or in checked luggage where temperatures can get very high or very low.
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