ED Medications
Beyond the standard prescription. Custom-compounded ED medications — including PDE5 inhibitors combined with oxytocin, testosterone, and sermorelin — delivered as sublingual troches for faster absorption and multi-pathway efficacy.
How ED Medications Work
When sexual stimulation occurs, nerve endings in the penis release nitric oxide (NO). Nitric oxide activates guanylate cyclase, which produces cyclic guanosine monophosphate (cGMP) — the key molecule that relaxes smooth muscle cells in the penile arteries and erectile chambers, allowing blood to flow in and create an erection.
Under normal circumstances, phosphodiesterase type 5 (PDE5) breaks down cGMP, ending the erection. 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, 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
Sildenafil (Viagra)
FDA Approved 1998- Onset: 30 to 60 minutes
- 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. Best taken on an empty or light stomach.
- Efficacy: Approximately 70% of men with ED respond to sildenafil
Tadalafil (Cialis)
FDA Approved 2003- Onset: 30 to 60 minutes
- Duration: Up to 36 hours
- Best For: Patients who prefer spontaneity — no need to time dose precisely
- Daily Dosing: Available as a daily low-dose option (2.5-5 mg) for continuous readiness and BPH benefits
- Food Interaction: Minimal — can be taken with or without food
- Efficacy: Approximately 70 to 80% of men with ED respond to tadalafil
Sublingual Troche Delivery
We prescribe many of our ED medications as sublingual troches — small, flavored tablets that dissolve under the tongue, delivering active ingredients directly into the bloodstream.
Faster Onset
Sublingual absorption bypasses the GI tract and first-pass liver metabolism. Many patients report onset within 15 to 20 minutes rather than 30 to 60 minutes.
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 — no 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
This is where Rewind goes beyond standard ED prescriptions. Our compounded formulations combine PDE5 inhibitors with additional active ingredients for multi-pathway efficacy. For patients seeking alternatives to oral medications, PT-141 peptide therapy offers a neurological approach to sexual health.
Sildenafil + Oxytocin
Combines the proven blood flow enhancement of sildenafil with oxytocin's arousal, bonding, and anti-anxiety effects. Addresses both the physical mechanics and the emotional experience of sexual function.
Sildenafil + Testosterone
PDE5 inhibition plus direct sublingual testosterone for men who benefit from hormonal support alongside blood flow enhancement. Particularly effective for men with borderline or low testosterone.
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.
Tadalafil + Oxytocin + Sermorelin + Testosterone
Our most comprehensive compound — long-acting PDE5 inhibition, arousal and bonding effects, growth hormone peptide for tissue health, and direct hormonal support. Addresses vascular, hormonal, neuroendocrine, and emotional dimensions in a single dose.
Daily vs. On-Demand Dosing
The right dosing strategy depends on your lifestyle, frequency of sexual activity, and preferences.
On-Demand
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
Take a low dose of tadalafil (2.5 to 5 mg) every day at the same time, regardless of anticipated sexual activity. Maintains continuous readiness without planning. Ideal for men who are frequently active, dislike planning around a pill, or have 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 & Safety
PDE5 inhibitors have been used safely by millions of men worldwide for over 25 years. Most 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.
Back Pain / 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.
The Rewind Process
From consultation to custom compound — every step is personalized to you.
Confidential Consultation
We review your medical history, symptoms, current medications, and cardiovascular health to ensure safe prescribing.
Medication Selection
We recommend the right medication and formulation — standard PDE5 inhibitor, custom compound blend, or combination approach.
Dosing Strategy
On-demand or daily? Sildenafil or tadalafil base? We match the dosing strategy to your lifestyle and sexual activity patterns.
Compounding & Dispensing
Custom compounds are prepared by licensed compounding pharmacies to our specifications, meeting USP quality standards.
Follow-Up & Adjustment
We check in to assess results, manage any side effects, and adjust formulations or dosing for optimal outcomes.
Related Treatments
Erectile Dysfunction Treatment
Comprehensive ED evaluation and treatment including PDE5 inhibitors, TriMix, and hormone optimization.
Learn more →PT-141 Therapy
Bremelanotide peptide that works through brain melanocortin receptors to enhance sexual desire and arousal.
Learn more →Testosterone Therapy
Testosterone replacement that restores libido, energy, and sexual function in men with low T.
Learn more →Frequently Asked Questions
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.
Beyond the Standard Prescription
Our custom-compounded ED medications address sexual function from multiple pathways. Schedule a confidential consultation to discuss which formulation is right for you.
⚕ Medical Disclaimer
The information on this page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. All treatments at Rewind Anti-Aging of Miami are performed under the supervision of licensed medical professionals. Individual results may vary. Consult your physician before beginning any new treatment protocol.
Meet our clinical team →Areas We Serve in Miami & South Florida
Our Wynwood clinic at 24 NW 29th Street serves patients across the Miami metro in person and the entire state of Florida via telehealth.