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The Quattro

ED treatment for men. One dose, under the tongue.

Three erection medicines from the same family as Viagra and Cialis, plus a fourth that acts on the arousal signal from the brain, in one sealed single-dose vial for erectile dysfunction.1 Prescription only, made to your prescription by a licensed US pharmacy.

Check eligibility What's in it

Health questions only. No insurance needed.

A man's hand holds a small sealed 2 ml single-dose vial of The Quattro between thumb and forefinger, to the right of a wide dark frame; clear glass, graphite cap, label facing forward. A man's hand holds a small sealed 2 ml single-dose vial of The Quattro between thumb and forefinger; clear glass, graphite cap, label facing forward.
  1. 1 Based on the pharmacology of the individual actives; individual response varies. Compounded medications have not been evaluated by the FDA. The Quattro is not a generic version of Viagra or Cialis and has not been shown to be equivalent to them. Viagra and Cialis are trademarks of their owners; Vyro Health is not affiliated with them.

Rx only. A US-licensed clinician, a doctor or nurse practitioner licensed in your state, reviews your health history and prescribes only if The Quattro is appropriate for you. Compounded means a licensed pharmacy makes it to your prescription instead of taking it off a shelf. Compounded medications are not approved or evaluated by the FDA.

  • Reviewed by US-licensed clinicians
  • Compounded by a licensed US pharmacy
  • Discreet shipping in plain packaging
  • Ongoing messaging with your clinician
  • Not charged if you do not qualify

A pill acts on blood flow. The Quattro also acts on the arousal signal.

After 45, erectile dysfunction is common and usually physical: the vessels do not relax enough for blood to flow in.4 Three PDE5 inhibitors act on that; apomorphine acts on arousal pathways in the brain, which a PDE5 inhibitor does not touch.1

Close-up of a man's hand holding the small clear glass vial of The Quattro between thumb and forefinger, its graphite cap and the off-white print on the glass in focus: The Quattro, Sublingual solution, 2 ml, single dose.

  1. Sildenafil

    Blood flow

    A PDE5 inhibitor. It relaxes the smooth muscle in the penis so that, with arousal, more blood flows in and stays there.1

    The core of the dose, in clinical use since 1998.

  2. Vardenafil

    Onset

    A PDE5 inhibitor with a fast onset of its own, one reason the dose is absorbed under the tongue and not in the gut.1

    Helps the dose get going: onset from about 10 minutes, typically within 10 to 20.6

  3. Tadalafil

    Window

    A longer-acting PDE5 inhibitor. Its half-life is what extends the window to approximately 36 hours.1

    One dose keeps the window open for about a day and a half, so sex is not timed to the hour.1

  4. Apomorphine

    Arousal

    It acts on dopamine pathways in the brain involved in sexual arousal, not on blood flow.1 Despite the name, it is not an opioid.

    The part of the response the three PDE5 inhibitors do not act on.

Dose set by your clinician. One sealed vial per dose.

  1. 1 Based on the pharmacology of the individual actives; individual response varies. Compounded medications have not been evaluated by the FDA. The Quattro is not a generic version of Viagra or Cialis and has not been shown to be equivalent to them. Viagra and Cialis are trademarks of their owners; Vyro Health is not affiliated with them.
  2. 4 Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Massachusetts Male Aging Study. Journal of Urology, 1994;151(1):54-61. In this community sample of men aged 40 to 70, about half reported some degree of erectile dysfunction; complete erectile dysfunction rose from 5 percent at age 40 to 15 percent at age 70.
  3. 6 Onset figures are approximate and describe the individual actives, not a study of The Quattro. In a randomised, placebo-controlled trial of oral vardenafil, some men responded as early as 10 minutes after dosing and about half within 25 minutes: Montorsi F, Padma-Nathan H, Buvat J et al., Journal of Sexual Medicine, 2004;1(2):168-178. In a small study of sublingual sildenafil 20 mg, the mean onset was about 15 minutes: Deveci S, Peskircioglu L, Aygun C, Tekin MI, International Journal of Urology, 2004;11(11):989-992. Individual response varies.

Under the tongue, not through the stomach.

One vial, opened fresh. Emptied under the tongue and held there a moment. No glass of water, no waiting on dinner.

~10min onset from6
4 actives in one dose
~36h typical window1
A man and a woman in a close embrace, lips meeting in a kiss, rendered in a single deep blue tone against black.

Then the rest of the evening.

onset from
10 min
actives in one dose
4
typical window
36 h

A swallowed tablet is absorbed in the gut and passes through the liver before it reaches the bloodstream. A dose held under the tongue is absorbed through the lining of the mouth, so it largely skips that first pass and a heavy dinner matters less.1 Sex is rarely planned an hour ahead around an empty stomach. The dose should not have to be.

Onset figures are approximate and based on the pharmacology of the individual actives; they describe formats in general, not a head-to-head study.6 Individual response varies. Compounded medications have not been evaluated by the FDA.
The Quattro Pill Injection
Route Under the tongue Swallowed Injected
Onset 10 min 30 to 60 min 5 to 15 min
Heavy meal Largely no Yes, can delay onset No
Needle No No Yes
  1. 1 Based on the pharmacology of the individual actives; individual response varies. Compounded medications have not been evaluated by the FDA. The Quattro is not a generic version of Viagra or Cialis and has not been shown to be equivalent to them. Viagra and Cialis are trademarks of their owners; Vyro Health is not affiliated with them.
  2. 6 Onset figures are approximate and describe the individual actives, not a study of The Quattro. In a randomised, placebo-controlled trial of oral vardenafil, some men responded as early as 10 minutes after dosing and about half within 25 minutes: Montorsi F, Padma-Nathan H, Buvat J et al., Journal of Sexual Medicine, 2004;1(2):168-178. In a small study of sublingual sildenafil 20 mg, the mean onset was about 15 minutes: Deveci S, Peskircioglu L, Aygun C, Tekin MI, International Journal of Urology, 2004;11(11):989-992. Individual response varies.
A small sealed glass vial of The Quattro stands at the front of a wooden nightstand in morning light; behind it, out of focus, a half-used blister pack of plain tablets has been pushed to the back.

For men whose pill has become unreliable, and for men who have never taken one.

Or who would rather not move to injections.

That is common. In the Massachusetts Male Aging Study, about half of men between 40 and 70 reported some degree of erectile dysfunction, and the share rose with each decade.4 After 45 the cause is most often physical, usually blood flow, and it shares its risk factors with the heart: blood pressure, cholesterol, diabetes, smoking.5 That is why the intake asks about all of them, and why the clinician's review is not a formality.

If your partner is part of this conversation, fill in the intake together. The decision stays between you and your clinician. If you have never taken anything for it, the questions are the same and so is the review.

  1. 4 Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Massachusetts Male Aging Study. Journal of Urology, 1994;151(1):54-61. In this community sample of men aged 40 to 70, about half reported some degree of erectile dysfunction; complete erectile dysfunction rose from 5 percent at age 40 to 15 percent at age 70.
  2. 5 Erectile dysfunction and cardiovascular disease share risk factors, and erectile dysfunction can appear before cardiovascular symptoms: Burnett AL et al., Erectile Dysfunction: AUA Guideline, Journal of Urology, 2018;200(3):633-641 (erectile dysfunction is a risk marker for underlying cardiovascular disease); Nehra A et al., The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease, Mayo Clinic Proceedings, 2012;87(8):766-778.

Three online steps. A licensed clinician decides.

Every intake is read by a US-licensed clinician who is licensed in your state. They can and do decline; a declined intake costs nothing.2

  1. Answer medical questions online

    Health history, current medications and supplements, what you have tried and what happened. Honest answers make the review faster.

    About 3 minutes

  2. A doctor or nurse practitioner reviews, and prescribes if appropriate

    They check your answers and your medication list against the contraindications, set your dose if The Quattro is appropriate, or decline and tell you why.

    Typically within 24 hours2

  3. Discreet delivery, and a clinician you can message

    You see your price and confirm. A compounding pharmacy prepares your prescription and ships it in plain packaging. Questions afterwards go to your clinician by message.

    Typically 3 to 5 business days after approval2

  1. 2 Timing depends on clinician availability and intake completeness.

One price, no membership fee. Not prescribed, not charged.

$99.99per month

Billed $299.97 every 3 months. Or $129.99 billed monthly.

A clinician sets your dose and a compounding pharmacy prepares it to that prescription, one sealed vial per dose. Nothing is charged until a clinician has prescribed, and you confirm the price before anything ships.

Included

  • Clinician review of your intake
  • A month's supply of The Quattro, if prescribed. Your prescription sets the number of doses.
  • Dosing guidance from your clinician
  • Discreet shipping in plain packaging
  • Ongoing messaging with your clinician

No membership fee.

If you are not prescribed, you are not charged.

Cancel at least 48 hours before your next billing date and there is no further charge.

Check eligibility

Compounded medications are not approved or evaluated for safety, effectiveness, or quality by the FDA. Prescription products require an online consultation with a licensed healthcare provider who will determine if a prescription is appropriate. Individual results may vary.

Questions men ask

What is The Quattro?

The Quattro is a compounded prescription liquid for erectile dysfunction. It combines three PDE5 inhibitors (sildenafil, vardenafil and tadalafil) with apomorphine, which acts on arousal signalling in the brain, in one sealed single-dose vial you empty under the tongue.1 It is prepared for you by a compounding pharmacy after a US-licensed clinician has reviewed your health intake and decided that it is appropriate.

Is The Quattro approved by the FDA?

No. The Quattro is a compounded medication, and compounded medications are not approved or evaluated for safety, effectiveness, or quality by the FDA. Its four actives are drug substances the FDA has approved in other medicines: sildenafil, vardenafil and tadalafil in tablets for erectile dysfunction, and apomorphine in medicines for Parkinson's disease. The FDA has not approved apomorphine for erectile dysfunction, and neither this combination nor this sublingual form has been evaluated by the FDA. The Quattro is prepared for you by a licensed compounding pharmacy to your clinician's prescription. That is why a clinician reviews every intake before anything is prescribed.

How fast does it work, and how long does it last?

Because it is absorbed under the tongue, onset can begin from about 10 minutes and is typically within 10 to 20 minutes, and the tadalafil component keeps the window open for approximately 36 hours.16 These figures describe the pharmacology of the actives, not a promise: your response depends on your health, your dose and the situation.

Who should not take it?

Men taking nitrates for chest pain, or riociguat, must not take The Quattro. That includes nitroglycerin in any form and "poppers". It is also not for men with unstable cardiovascular disease, a stroke or heart attack in the last six months, severe liver or kidney disease, or an allergy to any of the actives. The intake asks about all of this, and a clinician can decline to prescribe. Read the full safety information.

Is there a video call?

The intake is written; you answer on your phone or computer and the clinician messages you if anything is unclear. If your state requires a live visit before a prescription can be written, you are told before you pay anything.

Is my regular doctor told?

No. Your intake and your messages stay with your clinician and the pharmacy under our HIPAA notice. We share them only if you ask us to, or where the law requires it.

What if it does not work for me?

Message your clinician. Adjusting the dose is part of the plan and the review costs nothing extra. If you cancel at least 48 hours before your next billing date, there is no further charge; the refund policy explains what applies to medication already prepared.

I had prostate surgery. Does that matter?

Tell the clinician in the intake. It is one of the questions, it does not automatically rule The Quattro out, and it changes what the clinician looks at.

How many doses do I get each month?

Your prescription sets it. Each dose is one sealed vial; the clinician who prescribes tells you the number of vials in each shipment, and you see it before you pay anything.

How much does it cost, and when am I charged?

The Quattro is $99.99 a month, billed $299.97 every 3 months, or $129.99 billed monthly. There is no membership fee and no charge for the review itself: if you are not prescribed, you are not charged. You confirm the price before you pay. Cancel at least 48 hours before your next billing date and there is no further charge.

What happens after I click "Check eligibility"?

You answer a health intake that takes about 3 minutes. A US-licensed clinician reviews it, typically within 24 hours, and may message you with questions.2 If The Quattro is prescribed, you see your price, confirm, and the compounding pharmacy prepares your vials and ships them in plain packaging, typically 3 to 5 business days after approval.2

Do I have to see a doctor in person?

No. The clinician who reviews your intake is a doctor or a nurse practitioner licensed in your state, and the review happens online. If the clinician needs more information, they message you. If they decide an in-person examination is needed before prescribing, they will tell you so, and you are not charged.

A pill did not work well for me. Is this different?

It is a different format and a different combination. A swallowed pill is a single PDE5 inhibitor that passes through the gut and liver first; The Quattro combines three PDE5 inhibitors with apomorphine, which acts on arousal signalling in the brain rather than on blood flow, and it is absorbed under the tongue.1 Whether that matters for you is a clinical question. Tell the clinician what you took and what happened; that is exactly what the review is for.

All questions

  1. 1 Based on the pharmacology of the individual actives; individual response varies. Compounded medications have not been evaluated by the FDA. The Quattro is not a generic version of Viagra or Cialis and has not been shown to be equivalent to them. Viagra and Cialis are trademarks of their owners; Vyro Health is not affiliated with them.
  2. 2 Timing depends on clinician availability and intake completeness.
  3. 6 Onset figures are approximate and describe the individual actives, not a study of The Quattro. In a randomised, placebo-controlled trial of oral vardenafil, some men responded as early as 10 minutes after dosing and about half within 25 minutes: Montorsi F, Padma-Nathan H, Buvat J et al., Journal of Sexual Medicine, 2004;1(2):168-178. In a small study of sublingual sildenafil 20 mg, the mean onset was about 15 minutes: Deveci S, Peskircioglu L, Aygun C, Tekin MI, International Journal of Urology, 2004;11(11):989-992. Individual response varies.

See if The Quattro is right for you.

About 3 minutes of questions. A US-licensed clinician decides. You are not charged unless prescribed.

The Quattro $99.99 a month, billed $299.97 every 3 months

Check eligibility

Health questions only. No insurance needed.

  • Clinician review included
  • Not charged if you do not qualify
  • Plain packaging

Not charged unless prescribed

Check eligibility