FDA-approved generic sildenafil tablets ($29/month physician care; tablets paid to the pharmacy), or a compounded sublingual troche ($29/month care fee + compounded medication add-on) as an alternative dosage form — not FDA-approved, and onset data for compounded troches are limited. Troches are prepared by a licensed 503A compounding pharmacy (for example Hallandale Pharmacy or Valiant Compounding Pharmacy); the dispensing pharmacy is named on your prescription label. Prescribed by board-certified physicians after a free async consult.
Physician-verified manufacturer savings programs, copay cards and cash-price checks. Free, no sign-up. Program terms are set by the manufacturer or pharmacy.
Generic sildenafil tablets are FDA-approved and have the strongest evidence base; they usually take effect in about 30–60 minutes, and a high-fat meal can delay them. A sublingual troche dissolves under the tongue and is an alternative dosage form for patients who prefer not to swallow a tablet. Troches are compounded preparations, not FDA-approved; onset data for compounded troches are limited, and there are no head-to-head studies showing a troche works faster than a tablet. Troches are prepared by a licensed 503A compounding pharmacy (for example Hallandale Pharmacy or Valiant Compounding Pharmacy); the dispensing pharmacy is named on your prescription label. Your physician will help you choose.
Sildenafil blocks phosphodiesterase type 5 (PDE5), which normally breaks down cyclic GMP (cGMP) — the signaling molecule that relaxes smooth muscle and dilates blood vessels in the penile corpus cavernosum. By blocking PDE5, sildenafil allows cGMP to accumulate in response to sexual stimulation, producing and sustaining erection. Sexual arousal is still required; sildenafil enhances the body's natural response rather than creating one artificially.
Take as directed by your physician (tablets are usually taken about 30–60 minutes before anticipated activity). Do not exceed one dose per 24 hours.
Common, typically mild: headache, facial flushing, nasal congestion, indigestion, visual color changes (rare blue tint).
Seek emergency care for erection lasting more than 4 hours (priapism), sudden vision loss, sudden hearing loss, or chest pain.
Do NOT take sildenafil if you: take nitrate medications (nitroglycerin, isosorbide) or use “poppers” — the combination can cause life-threatening hypotension; take riociguat; have had a recent heart attack or stroke; have severe cardiovascular disease. Use caution with alpha-blockers. Make sure your heart is healthy enough for sexual activity. If you have sudden vision or hearing loss, stop the medication and seek urgent care.
Medical disclaimer: Educational content, not medical advice. Page medically reviewed by Teja V. Surapaneni, MD, MS — Board-Certified Internal Medicine (NV, WA, OR, WI). Last reviewed: April 17, 2026