What Is Sublingual (Compounded) Viagra?

Since the ‘90s, Viagra® (sildenafil citrate) has been a mainstay for the treatment of erectile dysfunction. But a lot has changed since the little blue pill’s debut. For instance, now there’s sublingual Viagra, a compounded formulation of the drug you place under your tongue.

Taking this medication sublingually means it absorbs faster, making it a good choice for spontaneous sex. It can also be easier to take if you have swallowing difficulties.

Despite these benefits, compounded Viagra isn’t regulated by the FDA (U.S. Food and Drug Administration) the same way standalone generic drugs and brand-name drugs are. Also, formulation quality can vary among compounding pharmacies.

Thinking of taking sublingual Viagra or sildenafil to treat erectile dysfunction (ED)? Here’s what to know about how these drugs work, how they compare to oral tablets, and potential risks.

Sildenafil belongs to a class of drugs known as phosphodiesterase 5 (PDE5) inhibitors. PDE5 inhibitors also include other well-known ED medications like tadalafil (generic Cialis®) and vardenafil (Levitra®). These drugs increase blood flow to your penis for longer-lasting, harder erections.

Compounded Viagra means it’s a custom-made formulation of sildenafil that’s been prepared by a compounding pharmacy for an individual patient.

Compounding a drug involves combining or altering its ingredients to meet a patient’s exact needs. For example, a pharmacist may combine sildenafil with tadalafil to make the medication work even faster. Or they might alter the ingredients to change how it’s administered (e.g., a liquid or lozenge over a pill).

Sublingual Viagra is compounded sildenafil you take under your tongue. It can come in the form of drops, sprays, wafers, films, or lozenges/troches. Unlike most other oral tablets, you don’t swallow sublingual sildenafil or chew the medication. It’ll disintegrate and dissolve on its own.

Before we get to what’s special about sublingual Viagra, here’s a quick rundown on how PDE5 inhibitors work and why they’re such an effective treatment for ED:

• PDE5 inhibitors block the action of the enzyme phosphodiesterase type 5, which lives in the walls of blood vessels.

• This enzyme interferes with your erections by breaking down a chemical compound called cyclic guanosine monophosphate, or cGMP, which regulates blood flow to the penis and relaxes smooth muscles of the blood vessels with the help of nitric oxide.

• By blocking PDE5, cGMP levels increase, blood vessels relax, blood flow increases, and it becomes easier to get and sustain an erection.

How does sublingual administration of sildenafil affect this process?

When you swallow a traditional Viagra or sildenafil pill, it has to pass through your digestive tract before delivering the results you want to see. On its way through your system, it can become degraded, especially if you’ve recently eaten a large, high-fat meal. That’s why it’s generally recommended to take Viagra an hour before sex on an empty stomach.

But when you place Viagra under the tongue, the active ingredient bypasses the digestive tract to meet your needs even faster.

There are a few unique benefits to sublingual Viagra you might not get from traditional oral tablets that you swallow.

We’ve already mentioned a faster onset of action and ease of use, but what does this mean for you? Keep reading to learn more about the benefits of taking sildenafil sublingually.

1. Less Planning, More Spontaneous Sex

With its faster onset of action and ability to bypass the digestive tract, sublingual Viagra helps you have more spontaneous sex — no matter when you take the medication or what you’ve eaten.

In a study comparing sildenafil tablets to sublingual sildenafil in the same set of patients, sublingual sildenafil worked notably faster and wasn’t affected by meal timing.

For three months, participants took oral sildenafil a half-hour before sex, then for the following three months, they took it sublingually 15 minutes before. Oral sildenafil took an average of 62.8 minutes to work, and sublingual sildenafil took around 29.3 minutes, making it more ideal for spontaneous sex.

2. Opportunity for Lower Doses

In a double-blind study of 40 male subjects with ED, researchers gave 20 patients 20 milligrams of sublingual sildenafil and the other 20 a placebo. The effects of low-dose sildenafil on erectile function were significantly higher, with 65 percent of patients reporting satisfying erections and sex, compared to just 15 percent in the placebo group.

Less dose means less cost — and potentially fewer side effects.

3. Potentially Fewer Side Effects

Due to sublingual Viagra’s ability to bypass the digestive tract and enter the bloodstream quickly, it might have better tolerability — meaning fewer side effects.

According to an in-vitro study comparing sublingual to oral sildenafil, the sublingual version led to fewer headaches, less flushing, and less nasal congestion. (These are some of the most common side effects of Viagra in clinical trials.)

The research suggests that the pharmacokinetics of sublingual sildenafil (how the drug moves throughout the body) enhances the medication’s tolerability. This could mean patients are more likely to stick with their prescription treatments.

4. Easy to Use

Another factor that may increase tolerability is that sublingual Viagra is easy to take. For those who have trouble swallowing pills, it can be a welcome alternative.

But this ease of use can also work in your favor if you’re trying to be discreet about taking ED medication. Just pop it in your mouth and let it work its magic — no water needed.

You already know sublingual Viagra may work faster, thanks to its ability to dissolve quickly and bypass the digestive tract. But does it work better than the oral variety?

By dissolving quickly and bypassing the digestive tract, sublingual tablets of sildenafil tend to have higher bioavailability. This means more of the drug is absorbed into your bloodstream after you take it, which can mean enhanced efficacy.

PDE5 inhibitors like sildenafil, in any form, have also been useful in treating conditions beyond erectile dysfunction, such as lower urinary tract symptoms (LUTS) and pulmonary arterial hypertension (PAH).

The fast onset of action, higher bioavailability, and tolerability of sublingual sildenafil may make it more effective for these uses in addition to ED, though more research is needed on this front.

Compounded drugs aren’t approved by the FDA, meaning the government agency can’t confirm their safety or effectiveness.

However, the FDA does explain that compounded drugs can be useful for patients who can’t take an FDA-approved medication. This can include folks with allergies to a particular ingredient or those who have trouble swallowing.

Viagra Sublingual: Safety and Other Considerations

Despite the convenience of these drugs, the FDA goes on to warn potential users that some compounding pharmacies put patients at risk by making false or misleading claims about a compounded drug’s safety or efficacy.

For instance, the pharmacist might exceed the maximum dose of sublingual Viagra 100mg or compound sildenafil with another PDE5 inhibitor like tadalafil to speed up the drug’s onset of action (how long it takes to kick in). This is because tadalafil works even faster than sublingual sildenafil, offering results in as little as 15 minutes.

But the drug label for Viagra discourages combining it with other PDE5 inhibitors due to a risk of low blood pressure. While a trustworthy pharmacist might be able to compound the drugs safely with the right proportionality (ratio) for your needs, trustworthiness and quality can’t always be verified without FDA regulation.

Other ED Medications to Consider

For now, as the research on sublingual sildenafil continues developing, it may be safer to stick with time-tested erectile dysfunction medications like oral sildenafil tablets or classic Viagra.

And you can still get that faster onset of action with tadalafil pills (Cialis) or Stendra® (avanafil).

Like the idea of a more discrete option? Check out Hims chewable hard mints, ED meds that contain the active ingredients in Cialis, Levitra, and Staxyn®.

Deciding whether to buy sublingual Viagra is a decision only you and your healthcare provider can make.

Here’s what to consider:

• Sublingual Viagra (sildenafil) has some impressive benefits. By dissolving under the tongue, it bypasses the digestive tract, working faster and potentially more effectively. This can be useful for spontaneous sex.

• Sublingual Viagra is easy to take. Healthcare providers may prescribe a sublingual dosage form for those who can’t swallow pills or want something more discrete.

• There are a few risks. Sublingual Viagra is a compounded drug, so it’s not regulated by the FDA in the same way as other time-tested medications like oral sildenafil tablets and tadalafil. Also, formulations can vary from pharmacy to pharmacy.

Can erectile dysfunction be reversed? Read our blog for answers, and explore the latest ED treatments available.