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
Men's healthErectile dysfunctionSexual health
Tadalafil
RxPrescription onlyTaken by mouth · Once a day · 5.5 mg · Men's health · Erectile dysfunction · Sexual health
Starting at $149/mo
A PDE5 inhibitor taken daily or as-needed to improve blood flow for erectile dysfunction and lower urinary tract symptoms. Compounded capsule, 5.5 mg daily or higher doses when needed; arousal still required.
How many capsules per month?
MonthlyEvery 3 months
30 capsulesper month
You'll receive 30 capsules per month. $199 billed monthly. Cancel anytime.
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- Works for 24 hours, giving you flexibility without planning around dosing
- Arousal-dependent—requires sexual interest to work, no spontaneous erections
- Also improves urinary symptoms (hesitancy, weak flow, frequency) if present
Every plan includes
- Personalized, physician-guided plan
- 30 capsules 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 tadalafil?
(ta-DA-la-fil)
Tadalafil is a phosphodiesterase-5 (PDE5) inhibitor, an enzyme that regulates blood flow in the penis. When you block PDE5, nitric oxide (the body's natural relaxant) stays active longer, widening blood vessels and increasing blood flow to erectile tissue. This is why arousal and sexual stimulation are still needed—the drug enhances the response to arousal, it does not create it. The effect builds over several days of daily dosing; a single dose works for about 24 hours, though some men take higher doses as needed rather than daily.
- How it is taken
- Taken by mouth
- How often
- Once a day
- Dose range
- 5.5 mg
- Form
- Men's health · Erectile dysfunction · Sexual health
~36
hours: how long one dose can keep working, which earned tadalafil the nickname 'the weekend pill'. It does not cause a continuous erection
Tadalafil is most effective for erectile dysfunction when arousal is present. It also improves lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH), a use approved by the FDA for tadalafil.
How it works,
week by week.
Day 1
A US-licensed physician reviews your erectile function, medical history, all medications, and any symptoms. If daily dosing is chosen, you start 5.5 mg once daily; if as-needed, a higher dose is prescribed for 30 min to 2 hours before sex.
Days 1–7
With daily dosing, effects improve as levels build. As-needed users should test the dose privately before relying on it; effects vary by person and food.
Week 2–4
For daily dosing, erections become more spontaneous; sexual confidence typically improves. For as-needed, your response is clear and your physician can adjust the dose if needed.
Month 2
Check-in with your physician. If daily dosing, discuss spontaneity and any side effects. Dose adjustments are common in the first month.
Beyond
Tadalafil works as long as you take it and arousal is present. Your physician reviews your response and any changes in health at least yearly.
What you may notice,
and when.
Stronger erections
when aroused, with consistent response
Sexual confidence
knowing the medication will work when you need it
24-hour window
flexibility for daily or as-needed use
Urinary symptom relief
if you also have weak stream or frequency
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
Tadalafil is generally well tolerated. Common side effects are mild: flushing, headache, indigestion, back or muscle aches, and nasal congestion—these usually ease with continued use. CRITICAL: Do not take with nitrates (nitroglycerin, isosorbide) or poppers (alkyl nitrites) or with riociguat; this combination can cause dangerous drops in blood pressure. Do not take with most alpha-blockers without physician approval; some combinations require timing or dose adjustments. Seek immediate care for sudden vision loss, sudden hearing loss, chest pain, priapism (erection lasting more than 4 hours), or fainting. Use cautiously with heart conditions, blood pressure medications, or liver or kidney disease; your physician reviews this first.
The research behind
tadalafil.
Tadalafil is a long-acting PDE5 inhibitor, active for up to about 36 hours. It has been tested in many placebo-controlled trials for erectile dysfunction, both as needed and once daily, and it is also labeled for prostate-related urinary symptoms.
- Up to 36 hours59.2% vs 28.3%
In 348 men, 20 mg tadalafil was tested about 24 and 36 hours after dosing. At 36 hours, 59.2% of intercourse attempts succeeded on tadalafil and 28.3% on placebo (P below 0.001); at about 24 hours, 52.9% and 29.1%.
Porst et al., Urology 2003 - Once daily17.8% and 23.6%
Pooled data from six placebo-controlled trials of 1,913 men, 12 weeks at 2.5 mg or 5 mg once daily. Both doses improved intercourse success over placebo, with least-squares gains of 17.8% and 23.6%.
Porst et al., European Urology 2014 - Stopping, daily2.1% to 6.3%
In a 24-week placebo-controlled US trial of once-daily tadalafil, 2.1% of placebo patients, 6.3% on 2.5 mg and 4.1% on 5 mg stopped because of adverse events.
Rajfer et al., International Journal of Impotence Research 2007
What the studies found
- Works for up to 36 hours: 59.2% of attempts succeeded at 36 hours vs 28.3% on placebo in 348 men (Porst et al., Urology 2003)
- Once-daily 2.5 or 5 mg raised intercourse success by 17.8% and 23.6% over placebo in 1,913 men (Porst et al., European Urology 2014)
- On once-daily dosing, IIEF erectile function rose by 4.2 and 5.4 points in the same pooled trials (Porst et al., European Urology 2014)
- Once-daily erectile function improved significantly over placebo on all co-primary endpoints at 24 weeks (Rajfer et al., International Journal of Impotence Research 2007)
- Prostate symptoms: 5 mg once daily significantly improved urinary symptom scores at 12 weeks in 1,058 men with BPH (Roehrborn et al., Journal of Urology 2008), and it is labeled for BPH (CIALIS prescribing information)
Trial results are for tadalafil tablets, averaged across the men in each group. They are not predictions for you. The capsules, troches, dissolving tablets and the 5.5 mg product sold here are not the tablets studied in these trials, and they have not been tested on their own. Your physician sets your dose.
What this does not say
- The as-needed trial used 20 mg; the 36-hour effect is an average over the men in the trial, not a guarantee.
- The once-daily pooled analysis ran for 12 weeks; the longest placebo-controlled data are for 24 weeks.
- Tadalafil is contraindicated with any form of organic nitrate; the prescriber checks for this.
The research
behind it.
Large randomized trials show tadalafil significantly improves erectile function compared to placebo in men with ED of all severities, with benefits strongest in those taking it consistently.
Daily low-dose tadalafil also improves LUTS and reduces the symptoms of urinary hesitancy, weak flow and frequency in men with BPH, often used alongside alpha-blockers.
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 Tadalafil - Men?
Taken by mouth, once a day. The starting prescription is 1 capsule (5.5 mg) each time. Your physician sets your own dose and it is printed on your label.
How much arrives in each shipment?
30 capsules at the starting strength, shipped to your door from a licensed US pharmacy.
Do I take it daily or as-needed?
Both are options. Daily 5.5 mg or lower doses mean spontaneous erections are more likely, and you don't time dosing around sex. Higher doses (10–20 mg) are taken 30 minutes to 2 hours before sex as-needed. Your physician decides which fits your lifestyle and response.
When does tadalafil start working?
As-needed doses (10–20 mg) work within 30 minutes to 2 hours; effects peak around 2 hours and last about 24 hours. Daily low-dose (5.5 mg) builds over days; most men notice spontaneous erections by day 7–10. Food and alcohol can delay the effect; taking it on an empty stomach helps.
Can I take it with other medications?
This is critical. Never combine with nitrates (heart medications) or poppers; this causes dangerous blood pressure drops. Tell your physician about all medications, especially alpha-blockers (for urinary symptoms) or blood pressure drugs; some need dose or timing adjustments.
What if I have heart problems?
Tadalafil does lower blood pressure slightly. If you have a history of heart disease, stroke, or low blood pressure, your physician needs to review this carefully. Recent MI, unstable angina, or severe heart failure are contraindications.
What if it doesn't work?
Some men need a higher dose, daily use instead of as-needed, or a longer trial (4–6 weeks). Others benefit from counseling or checking medications that might interfere. Your physician can try other PDE5 inhibitors if tadalafil isn't the fit.
Tadalafil 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.
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References
- 1.Role of tadalafil 5 mg once-daily (≥6 months) in men with erectile dysfunction, from six randomized controlled trials. Transl Androl Urol, 2020
- 2.Tadalafil 5 mg once daily improves lower urinary tract symptoms and erectile dysfunction: a systematic review and meta-analysis. Low Urin Tract Symptoms, 2018
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.