Troche
Apomorphine / Sildenafil / Tadalafil / Vardenafil Troches
Quad-mix troche combining three PDE5 inhibitors with apomorphine dopamine agonist for maximum potency and comprehensive mechanism.
4, 8 or 12 troches per month
Starting at $69/mo
Sexual healthErectile dysfunctionSublingual
Sildenafil SL Troches
RxPrescription onlyDissolved under the tongue · As needed, 20–30 min before · 125 mg · Sexual health · Erectile dysfunction · Sublingual
Starting at $59/mo
Sublingual sildenafil citrate troches (125 mg, mint) placed under the tongue as needed before sex. A higher-strength dissolving option for men who need more.
How many troches per month?
MonthlyEvery 3 months
4 trochesper month
8 trochesper month
12 trochesper month
You'll receive 8 troches per month. $89 billed monthly. Cancel anytime.
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- Under-the-tongue absorption for a quicker start
- Higher strength for men who did not respond to lower doses
- As needed, no more than once a day
Every plan includes
- Personalized, physician-guided plan
- 4, 8 or 12 troches per month, monthly and 3-month
- Dispensed by a US-licensed compounding pharmacy
- Unlimited protocol adjustments and messaging
- Ongoing support and check-ins
- Pause or cancel anytime
- Reviewed by our in-house physicians
- Physician-guided care
- Ongoing, expert support
- 100% online
- Free, discreet shipping
What is the SL troche?
(sublingual)
The same sildenafil citrate, in a troche designed to dissolve under the tongue, where the mucosa is thin and absorption is faster.
- How it is taken
- Dissolved under the tongue
- How often
- As needed, 20–30 min before
- Dose range
- 125 mg
- Form
- Sexual health · Erectile dysfunction · Sublingual
125 mg
strength of this compounded troche
Above the standard 100 mg maximum for tablets; used only when a physician judges it appropriate.
How it works,
week by week.
Day 1
A US-licensed physician reviews your health, medications (especially nitrates and blood pressure drugs) and goals, and chooses the dose and form.
First doses
Take it 30 to 60 minutes before intimacy, on a light stomach. Arousal is still needed; the medicine helps the response, it does not create it.
Week 2
You know how your body responds. Timing, dose and food effects are clear, and confidence builds.
Month 1
Check-in with your physician: the dose is adjusted up or down, or the form is changed, based on your response and side effects.
Beyond
It works for as long as you use it. Your physician reviews your health at least yearly, including blood pressure and heart health.
What you may notice,
and when.
Firmer erections
when aroused, with a reliable response
Predictable timing
you know when it starts and how long it lasts
Confidence
less performance worry, more presence
Physician oversight
dose and form adjusted to you
Individual results vary. Benefits reflect what Zepym Health members commonly report to their physician at check-ins; they are not the results of a clinical trial.
Safety first:
what to know before you start.
Important safety information and common side effects
PDE5 inhibitors are generally well tolerated. Common effects are flushing, headache, nasal congestion, indigestion and, with sildenafil, a temporary blue tint to vision. CRITICAL: never combine with nitrates or poppers (dangerous drop in blood pressure). Use with care alongside alpha-blockers. Seek emergency care for an erection lasting more than 4 hours, sudden vision or hearing loss, or chest pain. Tell your physician about heart disease, low blood pressure, liver or kidney problems and retinal disease before starting.
The research behind
sildenafil.
Sildenafil is a PDE5 inhibitor, the class that includes the best-known erectile dysfunction tablet. Its evidence is large: several randomized, placebo-controlled trials in men with erectile dysfunction. The troche and dissolving-tablet forms have much less direct trial data.
- Erections69% vs 22%
In the final four weeks of a 12-week flexible-dose trial of 329 men with erectile dysfunction (up to 100 mg as needed), 69% of intercourse attempts succeeded on sildenafil and 22% on placebo.
Goldstein et al., Sildenafil Study Group, NEJM 1998 - Dissolving strips120 men
A randomized crossover trial in 120 men gave 8 weeks of sildenafil strips and 8 weeks of tablets. Both significantly improved IIEF-5 and erection hardness, with comparable side effects. The strip is an oral dissolving film, not a sublingual troche.
Sangkum et al., Sexual Medicine 2021 - Under the tongueno direct trial
We found no published trial of sublingual sildenafil troches for erectile dysfunction. The troche rests on the same drug and its pharmacology, not on its own outcome data.
PubMed search, sildenafil sublingual erectile dysfunction (2026)
What the studies found
- Erections that work on demand: 69% of attempts succeeded vs 22% on placebo in a 12-week trial of 329 men (Goldstein et al., NEJM 1998)
- Successful intercourse averaged 5.9 times a month vs 1.5 on placebo (Goldstein et al., NEJM 1998)
- Across 50 to 100 mg, group success was about 66% vs about 20% on placebo, per the controlled studies summarized in the US label (VIAGRA prescribing information)
- Dissolving strips improved erection hardness and IIEF-5 scores as well as tablets did, in 120 men (Sangkum et al., Sexual Medicine 2021)
- Works within 30 minutes to 4 hours of a dose, with a half-life of about 4 hours (VIAGRA prescribing information)
Trial results are for sildenafil tablets at 25 to 100 mg, averaged across the men in each group. They are not predictions for you. The troches, dissolving tablets and capsules sold here are not the tablets studied in these trials. Your physician sets your dose.
What this does not say
- The figures come from tablet trials, not from troches or dissolving forms.
- Sildenafil is contraindicated with any nitrate medicine; the prescriber checks for this before every prescription.
- Long-term data for the troche and dissolving forms are limited to small studies.
The research
behind it.
Efficacy data come from sildenafil tablets; the sublingual troche is a compounded delivery form.
Higher strength means more chance of headache, flushing and blood pressure effects. Your physician screens for heart disease first.
Erections as a vital sign:
what the cohorts showWhy a change in erections is worth a heart check, what the numbers say, and what they do not.Read the researchPDE5 inhibitors:
what the trials showSildenafil, tadalafil and vardenafil compared, daily and as-needed use, and the rule on nitrates.Read the research
what the cohorts showWhy a change in erections is worth a heart check, what the numbers say, and what they do not.Read the researchPDE5 inhibitors:
what the trials showSildenafil, tadalafil and vardenafil compared, daily and as-needed use, and the rule on nitrates.Read the research
Getting started
takes a few minutes.
- 1
Connect with a physician
Answer a few questions online and a US-licensed physician reviews your health, history and goals to make sure treatment is right for you. 100% online. No in-person visit required.
- 2
Get your discreet shipment
If approved, your treatment is compounded by a US-licensed, LegitScript-certified pharmacy, inspected for quality, and shipped discreetly to your door.
- 3
Receive continuous support
Start with one goal, then keep building over time. Unlimited physician messaging, easy refills and dose adjustments, all from the Zepym Health app.
Frequently asked questions
Contact supportHow do I take Sildenafil SL Troches?
Dissolved under the tongue, as needed, 20–30 min before. The starting prescription is one troche (125 mg) each time. Your physician sets your own dose and it is printed on your label.
How much arrives in each shipment?
8 troches at the starting strength, shipped to your door from a licensed US pharmacy.
Why 125 mg?
Some men do not respond fully to 100 mg. A physician may prescribe 125 mg after ruling out heart problems and interactions.
Can I take it with other medications?
Never with nitrates (nitroglycerin, isosorbide) or recreational poppers: the combination can drop blood pressure dangerously. Tell your physician about alpha-blockers, blood pressure medicines, antifungals and HIV medicines, which change how the drug is processed.
What if it does not work the first time?
Arousal is still required, and a heavy or fatty meal can delay absorption. Most men need two or three attempts at a given dose before judging it. If it still falls short, your physician adjusts the dose or the formulation.
What are the warning signs?
An erection lasting more than 4 hours, sudden loss of vision or hearing, chest pain or fainting need immediate care. Stop the medication and go to the emergency room.
Is a compounded version as reliable as the brand?
Compounded troches, capsules and ODTs contain the same active ingredient, prepared by a US-licensed pharmacy, but they have not gone through FDA review as a finished product. Your physician chooses the form that fits how you want to use it.
Sildenafil SL educational content reviewed by our physician
Scott Nass, MD Doctor of Medicine, board-certified in Family Medicine
Charles R. Drew University and David Geffen School of Medicine at UCLA. Family Medicine residency at Ventura County Medical Center.
More options
in this area.
Injection
Bi-Mix Injection
Combination of papaverine and phentolamine for intracavernosal injection. Vasodilator mix for erectile dysfunction. Priapism risk and rescue requirements.
Starting at $171/mo
Cream
Climax Cream
Topical cream for female sexual enhancement and orgasm support. Combination of arginine, ergoloid, pentoxifylline, sildenafil, and theophylline.
Starting at $116/mo
Cream
Ecstasy Cream for Her
Topical cream for female sexual arousal and pleasure. Contains oxytocin, theophylline, arginine, and sildenafil for enhanced sensation and response.
Starting at $138/mo
References
- 1.Sildenafil citrate for erectile dysfunction: a systematic review of randomized controlled trials. Arch Intern Med, 2002
- 2.Tadalafil 5 mg once daily for erectile dysfunction: pooled analysis of randomized trials. Transl Androl Urol, 2020
Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Products are compounded by a licensed pharmacy. The FDA has not reviewed or approved compounded products for any use for safety, efficacy, or quality. Compounded medications are not FDA-approved brand-name products.