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Apomorphine / Sildenafil / Tadalafil / Vardenafil is a compounded oral suspension designed to support erectile function through complementary mechanisms. The combination pairs central nervous system stimulation of sexual arousal (apomorphine) with three phosphodiesterase-5 (PDE5) inhibitors to enhance penile blood flow. It is intended for patients with erectile dysfunction who require an individualized formulation under the direction of a licensed clinician.

This combination works through multiple complementary pathways:

1. Central Dopamine Activation

• Apomorphine stimulates dopamine receptors in the brain to enhance sexual arousal and initiate erectile signaling.

2. PDE5 Inhibition

• Sildenafil, tadalafil, and vardenafil inhibit PDE5, increasing nitric oxide-mediated blood flow to the penis during sexual stimulation.

3. Complementary Duration

• Sildenafil and vardenafil provide relatively rapid onset, while tadalafil offers a longer duration of action for extended responsiveness.

Your provider will review your medical history, current medications, blood pressure, and cardiovascular health to determine whether this therapy is appropriate. A virtual consultation is completed before the prescription is issued.

✓ Supports erectile function
✓ May improve rigidity and maintenance of erections
✓ Multi-mechanism approach
✓ Convenient compounded oral suspension
✓ Individualized dosing under clinician supervision

Possible Side Effects and Precautions:

• Headache
• Facial flushing
• Nasal congestion
• Dyspepsia
• Dizziness

• Hypotension or dizziness
• Vision or hearing changes (rare)
• Priapism (seek immediate care)
• Avoid concurrent nitrates.

• Use exactly as prescribed.
• Onset and duration vary by patient.
• Sexual stimulation is still required for PDE5 inhibitors to be effective.
• Follow up regularly for dose adjustments and monitoring.
• If an erection lasts longer than 4 hours, seek emergency medical care.