A physician-guided combination option for ED.

It refers to a customized formulation containing two PDE5 inhibitor active ingredients — tadalafil and sildenafil — that a physician may consider for a specific patient when clinically appropriate. It is not a separate FDA-approved combination medication.

The two ingredients have different pharmacokinetic characteristics, including differences in duration of action. In specific circumstances, a physician may consider whether a customized approach using both is appropriate for an individual patient based on their history, health and previous treatment response.

No. Tadalafil and sildenafil are individually FDA-approved as separate prescription drug products. A formulation combining them is not an FDA-approved combination drug product and is not a generic version of one.

If a combination formulation is dispensed, it is a compounded (customized) preparation rather than an FDA-approved combination product. Your physician and pharmacy confirm exactly what is prescribed and dispensed for you.

No. Compounded medications are not FDA-approved. The FDA does not review them for safety, effectiveness or manufacturing quality before they are marketed in the same way it reviews FDA-approved drugs.

NORBU MD does not claim that combination treatment is stronger, more effective or better than sildenafil. It is a different treatment approach that a physician may consider for certain patients. More medication is not automatically better medicine.

No such claim is made. Combination treatment is not established as superior to tadalafil or to any single-ingredient treatment. Which option may be appropriate depends on the individual patient and is a clinical decision.

Only patients for whom a board-certified physician determines it is clinically appropriate after evaluating their medical history, previous treatment, current medications, cardiovascular health and other individual factors. It is not a starting point and not appropriate for everyone.

No. Combining PDE5 inhibitors is not appropriate for everyone and can be unsafe for some patients. Nitrate use, certain cardiovascular conditions, blood-pressure concerns and various medications can make it inappropriate.

Combining ED medications can affect the safety profile of treatment and requires physician evaluation and oversight. Never combine ED medications on your own or add a medication to a prescription without your physician's direction.

Commonly reported effects of PDE5 inhibitors may include headache, flushing, indigestion, nasal congestion, dizziness, back or muscle discomfort and visual changes. Serious risks include significant drops in blood pressure, fainting, priapism and sudden vision or hearing changes. Review the full prescribing information for anything prescribed to you and discuss symptoms with your physician.

PDE5 inhibitors can cause a dangerous drop in blood pressure when used with nitrate medications such as nitroglycerin or isosorbide. If you take nitrates in any form, tell your physician — PDE5 inhibitors should not be used when contraindicated.

Yes. PDE5 inhibitors can lower blood pressure, and that effect can be amplified by nitrates, alpha-blockers and certain other medications. Give your physician a complete list of everything you take, including supplements.

Tell your physician. How it was used, the response you had and any side effects are useful clinical information. Previous experience with one medication does not automatically make combination treatment appropriate — it is one of several factors your physician weighs.

The same applies. Your physician reviews how it was used, your response and tolerability, and considers whether a different approach — including a single-ingredient treatment — may make sense.

Tadalafil alone is a single active ingredient, generally associated with a longer duration of action. A combination approach adds sildenafil for patients where a physician determines that may be appropriate; it is not a stronger version of tadalafil, and most patients are not candidates for it.

Sildenafil alone is a single active ingredient with a shorter, more on-demand treatment profile. A combination approach adds tadalafil for patients where a physician determines that may be appropriate; it is not a stronger version of sildenafil, and most patients are not candidates for it.

Using more than one PDE5 inhibitor can affect the safety profile of treatment, including interactions with nitrates and certain cardiovascular conditions. That is why combination treatment is considered only after physician evaluation and is never something to attempt independently.

Yes. Tadalafil and sildenafil are prescription medications in the United States, individually and in any customized formulation.

Yes. A licensed physician must evaluate you before any ED treatment can be prescribed, and combination treatment in particular requires individualized medical judgment.

The physician visit is $29. It covers your private online visit with a licensed NORBU MD physician.

No. The $29 fee covers the physician visit only. Medication, laboratory testing and other services, if applicable, are separate.

Yes, and often will. Many patients are appropriately treated with a single medication. Your physician recommends the option they consider most appropriate for you, which may be tadalafil, sildenafil, another treatment or no medication at all.

Yes. Your visit takes place online with a board-certified physician, and your medical information is handled confidentially as part of your care.