What is the difference between sildenafil and tadalafil?

Both are PDE5 inhibitors that work through the same mechanism — blocking the enzyme that breaks down cGMP to allow blood to fill the erectile chambers. The key difference is duration. Sildenafil (Viagra) works within 30-60 minutes and lasts 4-6 hours, making it best for on-demand use. Tadalafil (Cialis) works within 30-60 minutes but lasts up to 36 hours, and is also available as a daily low-dose option for continuous readiness. Tadalafil's longer half-life means more spontaneity and less need to time your dose precisely.

What are sublingual troches and why do you use them?

A sublingual troche is a small tablet that dissolves under the tongue, delivering medication directly into the bloodstream through the highly vascular sublingual mucosa. This bypasses the digestive system and first-pass liver metabolism, resulting in faster onset (often 15-20 minutes versus 30-60 minutes for oral tablets) and potentially better bioavailability. Our custom compound troches also allow us to combine multiple active ingredients — such as sildenafil with oxytocin or testosterone — in a single dose, something you cannot get from a standard pharmacy pill.

What is oxytocin and why is it in your ED compounds?

Oxytocin is a hormone naturally released during physical intimacy, orgasm, and emotional bonding. When included in an ED compound, supplemental oxytocin enhances arousal, reduces performance anxiety, increases emotional connection during intimacy, and may improve orgasm intensity. It addresses the psychological and emotional dimensions of sexual function that a PDE5 inhibitor alone does not. Many patients report that the addition of oxytocin makes the overall experience feel more natural and connected.

Can I take ED medication every day?

It depends on the medication. Tadalafil is FDA-approved for daily use at a low dose (2.5-5 mg), providing continuous readiness without the need to plan around a pill. Daily tadalafil also has benefits for prostate health and urinary symptoms. Sildenafil is typically used on demand rather than daily due to its shorter duration. Our compound blends are prescribed with specific dosing instructions — some are designed for on-demand use, while others may be taken on a regular schedule depending on the ingredients.

What are the side effects of PDE5 inhibitors?

The most common side effects are headache, facial flushing, nasal congestion, and mild indigestion — all caused by the vasodilating effects of the medication. These are usually mild and temporary. Less common side effects include visual changes (a blue-green tint, particularly with sildenafil), back pain or muscle aches (more common with tadalafil), and dizziness. PDE5 inhibitors are contraindicated with nitrate medications (nitroglycerin, isosorbide) due to the risk of dangerous blood pressure drops. Always disclose all medications to your provider.

Do I need a prescription for your custom ED compounds?

Yes. All of our ED medications — both standard PDE5 inhibitors and custom compound blends — are prescribed by our medical providers after a consultation and review of your medical history, current medications, and cardiovascular health. We source all compounds from licensed compounding pharmacies that meet USP quality standards. A proper medical evaluation ensures that the medication is safe and appropriate for you, and that any underlying causes of ED are identified and addressed.

ED Medications in Miami, FL | Rewind Anti-Aging

How ED Medications Work: The Science of PDE5 Inhibitors

To understand how ED medications work, you need to understand the erection process at a molecular level. When sexual stimulation occurs, nerve endings in the penis release nitric oxide (NO). Nitric oxide activates an enzyme called guanylate cyclase, which produces cyclic guanosine monophosphate (cGMP). cGMP is the key molecule — it relaxes smooth muscle cells in the penile arteries and the erectile chambers (corpora cavernosa), allowing blood to flow in and create an erection.

Under normal circumstances, another enzyme called phosphodiesterase type 5 (PDE5) breaks down cGMP, ending the erection after sexual activity is complete. In men with ED, PDE5 is often overactive — breaking down cGMP too quickly, before adequate blood flow and rigidity can be achieved.

PDE5 inhibitors block this enzyme, allowing cGMP to accumulate and sustain its vasodilating effect. The result: improved blood flow into the penis, firmer erections, and longer-lasting rigidity. Importantly, PDE5 inhibitors require sexual stimulation to work — they do not produce spontaneous erections. They enhance your body's natural response to arousal.

Sildenafil vs. Tadalafil: Understanding Your Options

Sildenafil (Viagra)

Sildenafil was the first PDE5 inhibitor, originally developed by Pfizer and approved by the FDA in 1998. It is the most widely recognized ED medication in the world.

Onset: 30 to 60 minutes after administration
Duration: 4 to 6 hours
Best for: On-demand use when sexual activity is anticipated within a specific window
Food interaction: High-fat meals can delay absorption and onset. Best taken on an empty or light stomach.
Efficacy: Approximately 70% of men with ED respond to sildenafil

Tadalafil (Cialis)

Tadalafil was approved in 2003 and distinguished itself with a significantly longer duration of action, earning it the nickname "the weekend pill."

Onset: 30 to 60 minutes after administration
Duration: Up to 36 hours
Best for: Patients who prefer spontaneity. With tadalafil, you do not need to time your dose as precisely — a single dose provides a wide window of readiness.
Daily dosing: Tadalafil is also available as a daily low-dose option (2.5 to 5 mg), providing continuous readiness without planning around a pill. Daily tadalafil also benefits prostate health and urinary symptoms (BPH).
Food interaction: Minimal. Tadalafil can be taken with or without food.
Efficacy: Approximately 70 to 80% of men with ED respond to tadalafil

Sublingual Troche Delivery: Faster and More Effective

At Rewind Anti-Aging, we prescribe many of our ED medications as sublingual troches rather than traditional oral tablets. A troche is a small, flavored tablet that dissolves under the tongue, delivering the active ingredients directly into the bloodstream through the highly vascular sublingual mucosa.

The advantages of sublingual delivery:

Faster onset — sublingual absorption bypasses the GI tract and first-pass liver metabolism. Many patients report onset within 15 to 20 minutes rather than the 30 to 60 minutes typical of oral tablets.
Improved bioavailability — bypassing the liver means less of the active ingredient is metabolized before reaching the bloodstream, potentially improving efficacy.
No food interaction — sublingual delivery is not affected by stomach contents, so you do not need to worry about what or when you have eaten.
Multi-ingredient capability — troches allow us to combine multiple active ingredients in a single dose, something not possible with standard pharmacy tablets.

Custom Compound Blends: Multi-Pathway ED Treatment

This is where Rewind Anti-Aging goes beyond what a standard ED prescription provides. Our custom-compounded blends combine PDE5 inhibitors with additional active ingredients that address sexual function from multiple pathways simultaneously. These formulations are prepared by licensed compounding pharmacies to our specifications.

Sildenafil + Oxytocin

Combines the proven blood flow enhancement of sildenafil with oxytocin, the hormone naturally released during intimacy and orgasm. Oxytocin enhances arousal, reduces performance anxiety, promotes emotional bonding, and may improve orgasm intensity. This blend addresses both the physical mechanics and the emotional experience of sexual function.

Sildenafil + Testosterone

Combines sildenafil with sublingual testosterone for men who benefit from direct hormonal support alongside PDE5 inhibition. Testosterone enhances libido, supports nitric oxide production, and improves overall sexual confidence. Particularly effective for men with borderline or low testosterone who want on-demand support.

Tadalafil + Testosterone

The long-acting PDE5 inhibitor paired with testosterone for extended readiness plus hormonal support. Ideal for men who prefer the 36-hour window of tadalafil and want added testosterone benefits in a single sublingual dose.

Tadalafil + Oxytocin + Sermorelin + Testosterone

Our most comprehensive ED compound. This formulation combines:

Tadalafil — long-acting PDE5 inhibition for sustained blood flow enhancement
Oxytocin — arousal, bonding, and anti-anxiety effects
Sermorelin — a growth hormone-releasing hormone (GHRH) peptide that supports tissue health, recovery, and overall vitality
Testosterone — direct hormonal support for desire and erection quality

This four-ingredient blend addresses vascular function, hormonal support, neuroendocrine enhancement, and emotional experience in a single sublingual dose. It represents the most aggressive multi-pathway approach to ED treatment available outside of injectable therapy.

Daily vs. On-Demand Dosing

The right dosing strategy depends on your lifestyle, frequency of sexual activity, and preferences:

On-demand dosing — take the medication 30 to 60 minutes before anticipated sexual activity. Best for men who are sexually active a few times per week or less and prefer to use medication only when needed. Sildenafil and our sildenafil-based compounds are typically used on demand.
Daily dosing — take a low dose of tadalafil (2.5 to 5 mg) every day at the same time, regardless of anticipated sexual activity. This maintains a constant baseline of PDE5 inhibition, providing continuous readiness without planning. Daily dosing is ideal for men who are sexually active frequently, who dislike the need to plan, or who also have benign prostatic hyperplasia (BPH) symptoms that tadalafil can address simultaneously.

Your provider will recommend the optimal approach during your consultation based on your symptom severity, sexual activity patterns, and overall health profile.

Side Effects and Safety

PDE5 inhibitors have been used safely by millions of men worldwide for over 25 years. The most common side effects are related to their vasodilating mechanism:

Headache — the most common side effect, caused by blood vessel dilation. Usually mild and temporary.
Facial flushing — warmth and redness in the face, neck, or chest. Typically mild and short-lived.
Nasal congestion — caused by vasodilation of nasal blood vessels.
Indigestion — more common with sildenafil, especially when taken on a full stomach.
Visual changes — a blue-green tint to vision, more commonly associated with sildenafil. Temporary and resolves as the medication wears off.
Back pain or muscle aches — more commonly reported with tadalafil, particularly at higher doses.

Critical contraindication: PDE5 inhibitors must never be combined with nitrate medications (nitroglycerin, isosorbide mononitrate, isosorbide dinitrate) or recreational nitrates (amyl nitrite / "poppers"). The combination can cause a dangerous, life-threatening drop in blood pressure. During your consultation, we review all current medications to ensure safe prescribing.

ED Medications in Miami, FL