Epiq Quad
A four-active compounded formulation combining three PDE5 inhibitors at lower individual doses with apomorphine.
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Overview
A four-active compounded formulation combining three PDE5 inhibitors at lower individual doses with apomorphine.
This formulation is compounded by a licensed 503A pharmacy pursuant to an individual prescription following a physician evaluation.
How It's Used
Your prescribing physician will determine the appropriate starting dose and tier based on your health history, current medications, and treatment goals. Follow your physician's specific instructions — do not adjust dose or frequency on your own.
Safety & Considerations
PDE5 inhibitors (the class that includes sildenafil, tadalafil, and vardenafil) must never be combined with nitrate medications (including nitroglycerin) or recreational “poppers,” as this combination can cause a sudden, severe, and potentially fatal drop in blood pressure. Patients taking alpha-blockers for blood pressure or prostate symptoms should disclose this to their prescriber, as the combination can also cause significant blood pressure drops. Seek immediate medical attention for an erection lasting longer than 4 hours (priapism), or for sudden vision or hearing loss/changes. Use with caution in patients with cardiovascular disease — a physician must assess whether sexual activity is safe for the patient's heart health before prescribing.
This formulation contains apomorphine in addition to a PDE5 inhibitor. Apomorphine's only FDA-approved use is for Parkinson's disease — its use here for sexual health is off-label. It can cause nausea, drowsiness, and a drop in blood pressure (including fainting), and this risk is compounded when combined with other blood-pressure-lowering medications, including the PDE5 inhibitor in this same formulation. Patients should remain seated or lying down at the first sign of dizziness and avoid driving until they know how this medication affects them. Apomorphine must never be combined with certain anti-nausea medications (ondansetron and related 5-HT3 antagonists), which can cause profound hypotension and loss of consciousness.
Compounded Medication Disclosure
These statements have not been evaluated by the Food and Drug Administration. This product is not FDA-approved, has not been evaluated by the FDA for safety, effectiveness, or quality, and is not represented as a generic or equivalent version of any FDA-approved drug.
References
This is a compounded, multi-ingredient formulation and, as such, has not itself been studied in dedicated clinical trials. The references below are the FDA prescribing information (or, where noted, peer-reviewed literature) for each individual active ingredient in this formulation. Ask your physician for further ingredient-specific information.
- Sildenafil Tablets — FDA Prescribing Information (erectile dysfunction indication)
DailyMed, National Library of Medicine - Tadalafil Tablets — FDA Prescribing Information
DailyMed, National Library of Medicine - Vardenafil Tablets — FDA Prescribing Information
DailyMed, National Library of Medicine - KYNMOBI (apomorphine hydrochloride) Sublingual Film — FDA Prescribing Information (Parkinson's disease indication; use in ED products is off-label)
U.S. FDA