Sildenafil is a prescription medication for erectile dysfunction (ED). It belongs to a class of drugs called PDE5 inhibitors. Bayview compounds sildenafil as patient-specific rapid-dissolve tablets and troches. Conventional swallowed sildenafil tablets in commercially available strengths are manufactured, FDA-approved products that Bayview dispenses rather than compounds.
Sildenafil is FDA-approved as a standard oral tablet. The compounded troche and rapid-dissolve forms, and any non-standard strengths, are prepared by a licensed pharmacy and are used off-label. A valid prescription is required, and only your provider can decide whether sildenafil is appropriate for you. Bayview's compounded sildenafil troches and rapid dissolve tablets are part of our erectile dysfunction compounding line.
How does it work?
An erection happens when nerve signals and sexual stimulation release nitric oxide in the penis, which raises a messenger called cGMP and relaxes the smooth muscle so blood flows in. An enzyme called PDE5 breaks cGMP back down. Sildenafil blocks PDE5, so cGMP lasts longer and blood flow is easier to achieve and maintain (StatPearls, PDE5 Inhibitors). It does not cause an erection on its own. Sexual stimulation is still needed.
What is it used for?
Sildenafil is prescribed for erectile dysfunction, difficulty getting or keeping an erection firm enough for sex. PDE5 inhibitors are recommended as a first-line treatment for ED when they are not contraindicated (AUA Erectile Dysfunction Guideline). Only a licensed provider can decide whether it is right for you; Bayview Pharmacy does not provide consultations or determine appropriateness, and a valid prescription is required.
How does it compare to other ED treatments?
Sildenafil, tadalafil and vardenafil are all PDE5 inhibitors that work with sexual stimulation. Differences in onset and duration described in the FDA-approved labeling of the conventional tablets do not automatically apply to compounded dosage forms. Bayview's compounded troches and rapid-dissolve tablets have not been evaluated by FDA for onset, duration of effect, bioavailability, or therapeutic equivalence to the approved tablets. Your provider selects the medication, form, and dose that are appropriate for you.
This is for education only and is not a statement that one medication is better or stronger. Your provider selects the medication, form, and dose that are appropriate for you.
How is it used?
Strength, dose, and frequency are determined by the prescriber for the individual patient. Take it exactly as your prescription directs. Sexual stimulation is needed for it to work. For the compounded forms: place a rapid dissolve tablet (RDT) under the tongue and let it dissolve for one to two minutes before swallowing; dissolve a troche between the cheek and gum. Your provider sets your strength and form.
Side effects & safety
Common side effects include headache, facial flushing, a stuffy or runny nose, indigestion, dizziness, and temporary changes in vision such as a blue tinge or light sensitivity. Tell your provider about your heart health and all medications you take.
Who should not use it?
Sildenafil is not for everyone. Do not use it if you take nitrates or riociguat, or if you are allergic to sildenafil. Talk with your provider first if you have heart or blood-vessel disease, have had a recent heart attack or stroke, have very low or uncontrolled high blood pressure, take alpha-blockers or other blood-pressure medicines, have severe liver or kidney problems, or have a history of priapism or certain eye conditions. Your provider will confirm that sexual activity and this medication are safe for you.
How should it be stored?
Store as directed on your label, at room temperature away from heat and moisture, and keep it out of the reach of children and others. Do not share it, do not use it after the beyond-use date, and dispose of unused medication as directed.
Why is this compounded?
Compounding lets a licensed pharmacy prepare sildenafil in a dosage form or strength that is not commercially available, such as a troche or rapid-dissolve tablet. This dosage form may be prescribed when a clinician determines that an FDA-approved manufactured product is not appropriate for an identified patient's medical needs. As a 503A compounding pharmacy, Bayview prepares each order pursuant to an individual patient prescription under USP standards. Compounded preparations are not FDA-approved and have not been evaluated by FDA for bioequivalence or therapeutic equivalence to approved sildenafil tablets. Other compounded options include Sildenafil Oral Dissolve Tablets, Tadalafil, and Vardenafil. Bayview also dispenses manufactured Sildenafil Tablets, which are not compounded. The full list is in our compounded medications catalog.
Clinical details for prescribers
Regulatory status. Sildenafil is not a controlled substance. It is FDA-approved as an oral tablet (manufactured tablets, including generics); compounded troche, rapid-dissolve, and non-commercial strengths are prepared via 503A compounding and are not FDA-approved.
Mechanism & PK. Selective PDE5 inhibitor; potentiates NO-cGMP signaling in the corpus cavernosum with sexual stimulation (StatPearls, PDE5 Inhibitors). Published onset, duration and food-effect data derive from FDA-approved conventional tablets; the compounded troche and rapid-dissolve forms have not been evaluated by FDA for duration of effect, bioavailability, or therapeutic equivalence. Strength, dose and frequency are determined by the prescriber for the individual patient.
Compounded forms available:
- Troches: 25, 50, 100 mg, dissolve between cheek and gum
- Rapid dissolve tablets (RDT): 50, 100 mg, under the tongue, dissolve 1 to 2 min before swallowing
Contraindications / cautions. Absolute contraindication with nitrates and guanylate cyclase stimulators (riociguat); caution with alpha-blockers and antihypertensives, significant cardiovascular disease, hepatic/renal impairment, and predisposition to priapism. Advise patients to seek care for priapism >4 h, sudden vision loss (NAION), or sudden hearing loss (AUA ED Guideline).
Non-controlled; e-prescribe or use the ED Orals order form. Licensed to dispense in RI, MA, CT, NJ, NH, FL, ME, and PA. Account setup, licensing, and ordering are covered on our for providers page.
This is a prescription compounded medication and is not FDA-approved. This information is educational and is not medical advice. Your provider determines whether it is appropriate and sets the formulation and dose.
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