Sildenafil / Tadalafil / Apomorphine / B12 Quad Formula — Comprehensive ED Treatment | Newfield Health
Premium ED Treatment · Provider Review Required

Quad Formula
Sildenafil + Tadalafil + Apomorphine + B12

The most comprehensive ED formulation — dual PDE5 inhibition for enhanced vascular support, apomorphine for central arousal activation, and B12 for neurological support.

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Compounded formula Cardiology clearance may be required Provider review required
40/20/3/2mg / mg / mg / mg
4Active ingredients
2FDA-approved
30 tabsMonthly supply
Why four pathways

When a single PDE5 inhibitor
isn't enough

Standard ED treatment centers on one active ingredient targeting one mechanism. For many men, that single pathway is sufficient. For others, the situation is more complex.

The Quad formula addresses four dimensions simultaneously: dual PDE5 inhibition for enhanced vascular response, dopaminergic arousal activation via apomorphine, and neurological support via methylcobalamin (B12).

This is the most comprehensive compounded ED formulation in the program — physician-selected for men whose situation warrants a broader approach.

The distinction
"The Quad formula is not about more powerful vascular response. It is about addressing multiple dimensions simultaneously — vascular, arousal, and neurological — when the situation calls for it."
Compounded medication — not FDA-approved. Provider review and cardiology clearance for significant cardiovascular disease are required.
Four pathways · Four ingredients

Comprehensive support
for complex needs

Each ingredient in the Quad formula serves a distinct function — from vascular support to central arousal activation.

FDA-Approved
Sildenafil · 40 mg
Fast-onset vascular support
PDE5 inhibitor with faster onset — typically effective within 30–60 minutes. Provides the rapid-onset component of dual PDE5 inhibition.
FDA-Approved
Tadalafil · 20 mg
Extended duration support
PDE5 inhibitor with longer half-life — extending the duration window beyond what sildenafil alone provides.
Compounded
Apomorphine · 3 mg
Central arousal activation
Dopamine agonist acting on the central nervous system — addresses the central arousal signal that PDE5 inhibitors cannot reach.
Compounded
Methylcobalamin (B12) · 2 mg
Neurological support
Active form of B12 supporting nerve function and neurological health relevant to sexual response pathways.

About this formulation: Sildenafil and tadalafil are FDA-approved. Apomorphine and B12 are compounded components. The exact four-ingredient combination has not been FDA-evaluated. Provider review required.

Compare options

Other ED treatments

Not sure which option is right for you? Your physician will help determine the best fit based on your health history and goals.

Tadalafil Daily

Daily low-dose · No timing required · Most popular for spontaneity

Learn more →

Tadalafil / PT-141 Combo

Multi-pathway · Desire + blood flow + connection

Learn more →

Quad Formula

Four pathways · Dual PDE5 + arousal + neurological

Current selection
Questions

What men ask about
the Quad formula

Why combine sildenafil and tadalafil?
Sildenafil has faster onset (30–60 min); tadalafil has longer duration (up to 36 hours). Combining both provides coverage across a broader time window — faster initial response with extended support.
What does apomorphine do?
Apomorphine works centrally — acting on dopamine receptors in the brain involved in arousal activation. It addresses the gap that peripheral PDE5 inhibition alone cannot reach.
Why is cardiology clearance required?
The combination of dual PDE5 inhibitors and apomorphine has a complex cardiovascular profile. For men with significant cardiac history, cardiologist assessment is required before prescribing.
Will I feel nauseous?
Nausea is a possible side effect of apomorphine, typically mild and transient. Taking with a light meal may help. If significant, contact your provider.
Is this a first-line option?
Not typically. Your provider may recommend starting with daily tadalafil or the combo formula before escalating to the Quad, depending on your clinical profile.
What side effects should I watch for?
Common: headache, flushing, nasal congestion, back pain, nausea. Seek immediate care for chest pain, sudden vision/hearing changes, or erection >4 hours.

Four pathways addressed
in a single physician-reviewed formula

For men whose ED situation calls for comprehensive multi-ingredient support — dual vascular, central arousal, and neurological.

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Important Safety Information

Compounded multi-ingredient prescription — not FDA-approved. Do not take with nitrates. Cardiology clearance may be required. Common side effects: headache, flushing, nasal congestion, nausea. Seek immediate care for chest pain, sudden vision/hearing changes, or erection >4 hours. No prescription guaranteed without provider approval.