A sildenafil troche is a compounded lozenge that dissolves between the cheek and gum instead of being swallowed. Bayview Pharmacy also prepares sildenafil as a rapid dissolve tablet that is placed under the tongue, listed as Sildenafil Oral Dissolve Tablets. Both forms are compounded rather than manufactured, both are prepared only on a prescription written for an individual patient, and neither is FDA-approved.
This post stays with the dissolvable forms of sildenafil: the strengths Bayview prepares, how the directions differ between a troche and a rapid dissolve tablet, what FDA has and has not evaluated, what the preparation costs, and how an order reaches the pharmacy.
What is a sildenafil troche?
A troche is a small, firm lozenge that is held in the mouth rather than swallowed. A sildenafil troche contains sildenafil in that lozenge base, and the directions Bayview prepares with it read: place 1 troche between cheek and gum and let it slowly dissolve.
A rapid dissolve tablet, often shortened to RDT, is the other dissolvable form. It is placed under the tongue and, according to the directions on the compounded sildenafil page, allowed to dissolve for one to two minutes before swallowing. It is not meant to be chewed or swallowed whole.
Both forms exist because a licensed compounding pharmacy can prepare a drug in a dosage form or strength that is not commercially available. Sildenafil itself is FDA-approved as a conventional swallowed tablet, including manufactured generics, which Bayview dispenses rather than compounds. The compounded troche and rapid dissolve forms, and any non-standard strength, are used off-label. If dissolvable dosage forms are new to you, compounding sublingual medications covers the general idea, and what a compounding pharmacy is covers how a 503A pharmacy works.
Troche vs rapid dissolve tablet: what is the difference?
The practical difference is where the dose is placed and how long it sits there. A troche is parked between the cheek and gum and dissolves slowly. A rapid dissolve tablet goes under the tongue and dissolves in a shorter window before being swallowed. The strength ladders are also different, as the table below shows.
| Form | Where it dissolves | Strengths prepared | Regulatory status |
|---|---|---|---|
| Sildenafil troche | Between cheek and gum | 25, 50, 100 mg | Compounded, off-label, not FDA-approved |
| Sildenafil rapid dissolve tablet | Under the tongue | 50, 100 mg | Compounded, off-label, not FDA-approved |
| Sildenafil tablet, swallowed | Swallowed whole with water | Commercially available strengths | FDA-approved |
| Tadalafil troche or tablet | Cheek and gum, or tongue | 5, 10, 20 mg | Compounded, not FDA-approved |
The swallowed sildenafil tablet in the third row is a manufactured, FDA-approved product that Bayview dispenses and does not compound. The fourth row is a different molecule, tadalafil, prepared in the same two dissolvable formats as Tadalafil Oral Dissolve Tablets. The rows are listed for education only and are not a statement that one form or strength is better, stronger, faster or more effective than another.
What sildenafil troche strengths does Bayview prepare?
Bayview compounds sildenafil troches in 25 mg, 50 mg and 100 mg, and sildenafil rapid dissolve tablets in 50 mg and 100 mg. The 25 mg troche is the only one of the five that has no matching rapid dissolve tablet.
These strengths are listed for education only. They are not a recommendation, and they are not a statement that any strength is better or stronger than another. Strength, dose and frequency are determined by the prescriber for the individual patient, and whether a compounded dosage form is appropriate for you at all is also the prescriber's decision, not the pharmacy's. Bayview does not provide consultations and does not decide whether a medication is right for you.
How do you take a sildenafil troche?
The directions that accompany a Bayview sildenafil prescription are specific to the form your prescriber ordered.
- Troche: place 1 troche between the cheek and gum and let it dissolve slowly.
- Rapid dissolve tablet: place 1 tablet under the tongue and let it dissolve, one to two minutes, before swallowing.
- Do not chew either form, and do not swallow a rapid dissolve tablet whole.
- Follow the exact timing, strength and frequency your prescriber set.
- Do not exceed the dose or frequency your provider set, and do not change it on your own.
Both formulation pages state that sildenafil does not cause an erection on its own and that sexual stimulation is still needed. A Bayview pharmacist is available if you have questions about your prescription.
How should these be stored?
Bayview's storage guidance for these preparations is to store them as directed on your label, away from heat, light and moisture, and out of the reach of children and others, and to discard them as directed by your pharmacist. A preparation compounded to dissolve in the mouth is worth keeping dry, so ask a Bayview pharmacist if you are not sure whether a tablet or troche is still usable. Do not share the prescription: it is prepared for one named patient.
Is compounded sildenafil FDA-approved?
No. Sildenafil the drug is FDA-approved as a conventional oral tablet. Bayview's troches, rapid dissolve tablets and any non-commercial strengths are compounded under 503A compounding and are not FDA-approved, and they have not been evaluated by FDA for bioequivalence or therapeutic equivalence to approved sildenafil tablets.
Sildenafil belongs to the phosphodiesterase type 5 inhibitor class. StatPearls describes PDE5 inhibitors as blocking the PDE5 enzyme, which breaks down a messenger called cGMP in penile smooth muscle during sexual stimulation. That is a description of the drug's pharmacology, and the onset, duration and food-effect figures that circulate come from the FDA-approved labeling of the conventional manufactured tablet.
Those labeled figures do not automatically carry over to a different dosage form. In the pharmacy's own words, 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." The extent of absorption through the lining of the mouth may vary. Nothing on these pages, and nothing in this post, claims that a compounded troche performs like an approved tablet.
Sildenafil is also not a controlled substance, so a prescription can reach the pharmacy by e-prescribe, fax or phone.
Who should not take sildenafil?
This is a prescriber screening question, and the formulation pages are direct about it. Sildenafil should not be used by people who take nitrate medications such as nitroglycerin or isosorbide, or who take riociguat (Adempas) for pulmonary hypertension: that combination can cause a sudden, dangerous drop in blood pressure. It should also not be used by anyone allergic to sildenafil or to an ingredient in the preparation.
Extra caution applies to people taking alpha-blockers or other blood pressure medicines, because the combination can lower blood pressure too much, and to people with heart or blood vessel disease, recent heart attack or stroke, very low or uncontrolled high blood pressure, severe liver or kidney problems, a history of priapism, or certain eye conditions. Ask your provider whether sexual activity is advisable for you.
Reported effects of PDE5 inhibitors can include headache, facial flushing, a stuffy or runny nose, indigestion, dizziness, and temporary vision changes such as a bluish tinge or increased light sensitivity. Report any of these to your provider. Seek emergency care for an erection lasting more than 4 hours (priapism), which is a medical emergency, or for sudden loss of vision or hearing, or chest pain.
What does compounded sildenafil cost?
Sildenafil Oral Dissolve Tablets start at $113 for 30 tablets as a cash price. The final figure depends on the strength, form and quantity your prescriber orders, so a pharmacist confirms it against the actual prescription.
Compounded preparations are generally not billed through insurance. A compounded preparation is not an FDA-approved manufactured product with its own national drug code, so there is usually nothing for a drug plan to adjudicate against, and patients pay the cash price directly. Do compounding pharmacies take insurance goes through that in more detail.
What does Bayview compound for sildenafil?
On a prescriber's order, Bayview prepares sildenafil as troches in 25 mg, 50 mg and 100 mg, dissolved between the cheek and gum, and as rapid dissolve tablets in 50 mg and 100 mg, placed under the tongue. Both are prepared pursuant to an individual patient prescription as part of the pharmacy's erectile dysfunction compounding line, in small batches under USP 795 non-sterile compounding standards. Conventional swallowed sildenafil tablets are manufactured, FDA-approved products that Bayview dispenses rather than compounds. Other dissolvable options in the same category include compounded tadalafil and compounded vardenafil, and the full list is in the compounded medications catalog.
How do I get a sildenafil troche from Bayview?
Start with your prescriber. Ask whether a dissolvable dosage form fits your situation, and if they agree, ask them to send the prescription to Bayview. Because sildenafil is noncontrolled, prescribers can e-prescribe, fax to 401-284-4506, or call 401-284-4505. If an electronic health record does not list the compound, it can be entered as a compound or free-text prescription naming the active ingredient, strength and form, for example sildenafil 50 mg troche.
Bayview fills and ships to patients in the states where Bayview is licensed; the current list is on the FAQ page. If you are weighing a local pickup against mail, finding a compounding pharmacy near you walks through the tradeoffs. Full details on both dissolvable forms are on the Sildenafil Oral Dissolve Tablets page, and a pharmacist can answer questions about an existing prescription by phone.
Frequently asked questions
What is the difference between a rapid dissolve tablet and a troche?
A rapid dissolve tablet goes under the tongue (sublingual); a troche dissolves between the cheek and gum (buccal). Both are taken without water. Your provider selects the form and strength that are appropriate for you, and the difference is placement and preference rather than a statement that one works better.
Can I swallow the tablet instead of letting it dissolve?
Not unless your prescriber directs it. These tablets are compounded to dissolve in the mouth, and swallowing one whole changes how the medication is absorbed. If swallowing is easier for you, ask your prescriber; conventional swallowed tablets are manufactured, FDA-approved products that Bayview dispenses rather than compounds.
How do I take a rapid dissolve tablet correctly?
Place the tablet under your tongue and let it dissolve on its own. Do not chew it or swallow it whole unless your prescriber tells you to, and avoid eating or drinking while it dissolves so the medication is not washed down. Follow the dose and timing on your label exactly.
How long does it take for the tablet to dissolve?
Most oral rapid dissolve tablets dissolve within a few minutes. Dissolving time can vary based on the medication, tablet size, saliva production, and how dry your mouth is.
How do oral rapid dissolve tablets work?
The tablet is compounded to dissolve in the mouth and release the medication before it is swallowed. How much is absorbed through the oral mucosa, how quickly it acts, and its bioavailability may vary by medication and patient. This dosage form has not been evaluated by FDA for bioequivalence or therapeutic equivalence to conventional tablets.
What are oral dissolve tablets?
Oral dissolve tablets are compounded tablets designed to dissolve in the mouth before swallowing. The extent of absorption through the oral mucosa, onset of action, and bioavailability may vary, and compounded preparations have not been evaluated by FDA for bioequivalence or therapeutic equivalence to FDA-approved tablets. 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.
How fast does sildenafil work?
For the FDA-approved conventional tablets, labeling describes onset usually within 30 to 60 minutes with effects lasting about 4 to 6 hours, and a heavy or fatty meal can delay onset. Bayview's compounded sildenafil troches and rapid-dissolve tablets have not been evaluated by FDA for onset, duration of effect, bioavailability, or therapeutic equivalence to the approved tablets. Sexual stimulation is still needed; the medication enables the response rather than causing an erection on its own.
How does compounded sildenafil compare to the FDA-approved tablet?
Conventional sildenafil tablets are FDA-approved manufactured products. Bayview dispenses those manufactured tablets, and separately compounds sildenafil as cheek-and-gum troches and under-the-tongue rapid-dissolve tablets in the strength your provider specifies. Compounded preparations are not FDA-approved and have not been evaluated by FDA for safety, effectiveness, bioequivalence, or therapeutic equivalence to approved sildenafil tablets. Your prescriber decides which form is appropriate for you.
Who should not take sildenafil?
Anyone taking nitrates or riociguat, or allergic to sildenafil. Combining with nitrates can dangerously lower blood pressure. Tell your provider about heart conditions and other medicines.
What forms can I get?
Bayview compounds sildenafil as cheek-and-gum troches and under-the-tongue rapid-dissolve tablets, in the strength your prescriber specifies. Conventional swallowed sildenafil tablets are manufactured, FDA-approved products that Bayview dispenses rather than compounds. Your provider chooses the form and strength.
How do I get it from Bayview?
Your provider sends a prescription, a Bayview pharmacist reviews it, and we fill it to your provider's exact instructions and ship it discreetly to your door. Bayview fills prescriptions for patients in RI, MA, CT, NJ, NH, FL, ME and PA, and currently serves eligible New York patients on a limited basis under New York's isolated-transaction criteria while full nonresident pharmacy registration is pending. If you do not have a prescriber yet, your primary care provider or a telehealth visit is a good starting point.
Do I need a prescription?
Yes. All of our medications require a valid prescription from a licensed provider. We're a dispensing and compounding pharmacy, so we don't provide consultations or write prescriptions. If you don't have one yet, you'll need to find and see a provider first.
How does compounded tadalafil compare to the FDA-approved tablet?
Conventional tadalafil tablets are FDA-approved manufactured products. Bayview dispenses those manufactured tablets, and separately compounds tadalafil as cheek-and-gum troches and under-the-tongue rapid-dissolve tablets in the strength your provider specifies. Compounded preparations are not FDA-approved and have not been evaluated by FDA for safety, effectiveness, bioequivalence, or therapeutic equivalence to approved tadalafil tablets. Your prescriber decides which form is appropriate for you.
What strengths does Bayview prepare sildenafil troches in?
Bayview compounds sildenafil troches in 25 mg, 50 mg and 100 mg, dissolved between the cheek and gum. The rapid dissolve tablet, placed under the tongue, is prepared in 50 mg and 100 mg. These strengths are listed for education only and are not a recommendation. Strength, dose and frequency are determined by the prescriber for the individual patient, and a valid prescription is required.
Why would a prescriber order a troche instead of a swallowed tablet?
Compounding lets a licensed pharmacy prepare a drug in a dosage form or strength that is not commercially available, such as a troche or a rapid dissolve tablet. Bayview's pages state that a compounded 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. That judgment belongs to the prescriber, not the pharmacy.
How much does a compounded sildenafil prescription cost at Bayview?
Sildenafil Oral Dissolve Tablets start at $113 for 30 tablets as a cash price. The final figure depends on the strength, form and quantity your prescriber orders, so a pharmacist confirms it against the actual prescription. Compounded preparations are generally not billed through insurance, because a compounded preparation is not an FDA-approved manufactured product with its own national drug code.
Is compounded sildenafil a controlled substance?
No. Sildenafil is not a controlled substance under US federal law, and Bayview's compounded sildenafil pages say so directly. Because it is noncontrolled, a prescriber can send the order by e-prescribe, by fax or by phone, rather than being limited to the narrower routes that controlled prescriptions require. A valid prescription written for a named patient is still required.
Can a sildenafil troche be cut or split?
Nothing on Bayview's sildenafil pages describes splitting a troche. The directions prepared with the prescription say to place 1 troche between the cheek and gum and let it dissolve slowly, and to use it exactly as the provider directed without exceeding the dose or frequency they set. Dose and strength are the prescriber's decisions, so ask them or a Bayview pharmacist before changing anything.
How should sildenafil troches and rapid dissolve tablets be stored?
Store them as directed on your label, away from heat, light and moisture, and out of the reach of children and others, and discard them as directed by your pharmacist. A preparation compounded to dissolve in the mouth is worth keeping dry. If you are not sure whether a tablet or troche is still usable, ask a Bayview pharmacist rather than guessing, and do not share the prescription with anyone else.
What Bayview compounds for this
Important: Compounded medications are prepared to a prescriber's order for an individual patient. They are not FDA-approved, and the FDA has not evaluated them for safety, effectiveness, or manufacturing quality. This article is educational and is not a substitute for advice from your prescriber or pharmacist.
This preparation contains a controlled substance. Controlled-substance prescriptions carry refill limits, must be e-prescribed, and can only be shipped to states where Bayview holds the required licensure.
Uses discussed here may be off-label, meaning they are not part of any FDA-approved labeling. Off-label use is a decision for you and your prescriber, based on the available evidence.
Veterinary preparations are compounded to a veterinarian's order for a specific animal and are not FDA-approved animal drugs. Never give a compounded human medication to an animal without veterinary direction.
Compounded prescriptions are paid for directly rather than billed through insurance. Most are HSA/FSA-eligible, and many patients submit the receipt to their plan for possible reimbursement. Pricing depends on the strength, dose form and quantity your prescriber orders. Read more about cost and insurance.
Sildenafil Oral Dissolve Tablets start at $113 for 30 tablets as a cash price, and the final figure depends on the strength, form and quantity the prescriber orders. Compounded preparations are generally not billed through insurance: a compounded preparation is not an FDA-approved manufactured product with its own national drug code, so there is usually nothing for a drug plan to adjudicate against, and patients pay the cash price directly.
Bayview Pharmacy is a compounding pharmacy in Warwick, Rhode Island, licensed to fill and ship compounded prescriptions for patients in Rhode Island, Massachusetts, Connecticut, New Jersey, New Hampshire, Florida, Maine and Pennsylvania. Prescriptions for New York patients are filled on a limited basis, and controlled substances are not shipped to New York addresses. See every state we ship to.
