Questions

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

A compounding pharmacy prepares a medication for an individual patient from its active ingredients, to a clinician's prescription, rather than dispensing a mass-produced product. It is a licensed and regulated practice in the US. It also means the finished product is not reviewed by the FDA the way an approved drug is, which is why we say so on every page.

Your clinician sets the dose and how often you may take it, and the pharmacy prints it on the label. Each vial is one dose; do not take more than one vial in the interval your clinician set, and do not combine it with any other erectile dysfunction medication.

Twist the cap off one vial and empty it under your tongue. Hold it there for a moment; the dose is absorbed through the lining of the mouth. No water needed. Each vial is a single dose, sealed by the pharmacy; use one vial per dose and discard it after. Your clinician tells you how often you may take one.

Sometimes, and only a clinician can say. Blood pressure medication, alpha-blockers taken for the prostate and some antifungals and antibiotics do not automatically rule The Quattro out, but they change the dose or the decision. List every medication and supplement you take in the intake, including the ones that seem unrelated; that is exactly what the review is for.

The ones known from the individual actives: headache, flushing, a stuffy nose, nausea, dizziness, indigestion and back or muscle aches. Most are mild and pass within hours. An erection that lasts longer than 4 hours is an emergency. Read the full safety information.

That is one of the main things the clinician checks. Nitrates and riociguat rule The Quattro out completely. Alpha-blockers, other blood-pressure medications, strong CYP3A4 inhibitors such as certain antifungals and HIV medications, and dopamine antagonists such as many antipsychotics and some anti-nausea drugs need a careful look and may lead to a lower dose or a decline. List everything you take, including supplements.

Keep it low. Alcohol adds to the blood-pressure-lowering effect of the actives and makes dizziness and fainting more likely; it also works against erections on its own. Do not take a dose when intoxicated.

Then you are not charged. The clinician will tell you the reason where it is appropriate to share it, and may suggest that you see your own doctor. Some reasons are temporary, such as a medication you can discuss changing with the doctor who prescribed it.

Yes, by secure message through the care platform, during the review and after you have received your medication. If a clinician needs to speak with you before deciding, they will arrange it.

Availability depends on where our clinicians and partner pharmacies are licensed. The intake asks for your state first and tells you before you spend any time on the health questions.

Message the care team or use your account, at any time. There is no membership fee and no minimum term. See the refund policy for what happens with an order that has already been compounded.

Yes. Orders ship in plain outer packaging that does not name the product or what it is for; inside, each vial is sealed and labelled by the pharmacy. Your health intake and messages with your clinician are handled under our HIPAA notice and privacy policy.

Your intake and your messages with clinicians are protected health information and are handled under our HIPAA notice of privacy practices. How we handle website data is described in the privacy policy. Packaging is plain and does not name the product.