Bi-Mix Injection
Combination of papaverine and phentolamine for intracavernosal injection. Vasodilator mix for erectile dysfunction. Priapism risk and rescue requirements.
Injection
from $171/mo
Dissolved under the tongue · As needed, 20–30 min before
Sexual healthCombinationCompounded
Apomorphine + Sildenafil + Tadalafil + Vardenafil Troches
A four-ingredient troche (mint) for men who have not responded to standard options: three PDE5 inhibitors plus apomorphine, dissolved in the mouth as needed.
- Central and local action together
- For men who did not respond to single agents
- As needed, no more than once a day
- Monthly$99/mo
- Every 3 months$267 billed up front$89/mo
- Every 6 monthsBest value$474 billed up front$79/mo
- Free, discreet shipping
- Licensed U.S. pharmacy
- Board-certified physicians
Disclaimer: 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.
- How
- Dissolved under the tongue
- How often
- As needed, 20–30 min before
- Each shipment
- 8 troches
- Strength
- 2 mg / 40 mg / 5 mg / 25 mg Troche
What is the four-ingredient troche?
(quad troche)
It combines the blood-flow effect of three PDE5 inhibitors with apomorphine, which acts in the brain. Apomorphine acts on dopamine receptors in the brain that help start an erection, so it adds a central push to the local effect of the PDE5 inhibitor. It commonly causes nausea, yawning, dizziness or drowsiness; do not drive until you know how it affects you.
What's in it
- ApomorphineArousal signal in the brain
- SildenafilPDE5 inhibitor: blood flow, about 4 hours
- TadalafilPDE5 inhibitor: blood flow, up to 36 hours
- VardenafilPDE5 inhibitor: fast onset
4
active ingredients in one troche
Off-label compounded combination for refractory cases; no trials of this exact product.
Is it right for you?
Who it's for
Men who did not respond to combinations of two.
What sets it apart
Three PDE5 medicines plus apomorphine, which acts on arousal in the brain.
Worth knowing before you start
Apomorphine causes nausea and never goes with ondansetron.
Results you can rely on
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
How combination therapy works
Day 1
A US-licensed physician reviews your health, medications (especially nitrates and blood pressure drugs) and goals, and chooses the dose and form.
1First doses
Take it 20 to 30 minutes before intimacy, on a light stomach. Arousal is still needed; the medicine helps the response, it does not create it.
2Week 2
You know how your body responds. Timing, dose and food effects are clear, and confidence builds.
3Month 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.
4Beyond
It works for as long as you use it. Your physician reviews your health at least yearly, including blood pressure and heart health.
5
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.
How you use it
This is the starting dose the pharmacy prints on the label. Your physician sets yours and adjusts it with you.
- How
- Dissolved under the tongue
- Dose
- one troche
- How often
- As needed, 20–30 min before
- Each shipment
- 8 troches
- Pharmacy label
- Dissolve one troche under the tongue 20 to 30 minutes before sexual activity as needed. Do not use more than one dose in 24 hours.
The science of combination therapy
Each ingredient has evidence alone; the combination is based on clinical experience in men who did not respond to one medicine.
More ingredients mean more side effects. Your physician starts it only after reviewing your heart, blood pressure and medications.
Learn moreImportant 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. Apomorphine adds nausea, yawning, dizziness and drowsiness; avoid driving until you know how you react.
Every plan includes
- Personalized, physician-guided plan
- Monthly, 3-month and 6-month plans
- 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
How it works
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.
Quad troche educational content reviewed by our physician
Scott Nass, MDDoctor 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.
Frequently asked questions
How do I take Apomorphine / Sildenafil / Tadalafil / Vardenafil Troches?
Dissolved under the tongue, as needed, 20–30 min before. The starting prescription is one troche each time. Your physician sets your own dose and it is printed on your label.
What exactly is in it?
Apomorphine, Sildenafil, Tadalafil, Vardenafil.
How much arrives in each shipment?
8 troches at the starting strength, shipped to your door from a licensed US pharmacy.
When is this used?
Only after standard PDE5 inhibitors at adequate doses did not work. It is not a first choice.
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.
More options, same care.
Climax Cream
Topical cream for female sexual enhancement and orgasm support. Combination of arginine, ergoloid, pentoxifylline, sildenafil, and theophylline.
Cream
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Ecstasy Cream for Her
Topical cream for female sexual arousal and pleasure. Contains oxytocin, theophylline, arginine, and sildenafil for enhanced sensation and response.
Cream
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Female Desire Troches
Sublingual troche for female sexual desire and arousal. Combines apomorphine, bremelanotide, oxytocin, and L-theanine for comprehensive support.
Troche
from $69/mo
The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Individual results vary.
Sources
- 1
Sildenafil citrate for erectile dysfunction: a systematic review of randomized controlled trials.
Arch Intern Med, 2002 - 2
Apomorphine SL for erectile dysfunction: randomized, placebo-controlled trials.
Urology, 2000
Apomorphine + Sildenafil + Tadalafil + Vardenafil Trochesfrom $79/mo