Important Safety Information

Semaglutide

Compounded medications may be prescribed by a licensed provider but are not FDA-approved for safety, effectiveness, or quality. FDA-approved medicines containing semaglutide are available.

Boxed warning — risk of thyroid C-cell tumors

GLP-1 medications are contraindicated in individuals with a personal or family history of medullary thyroid carcinoma (MTC) and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Do not use if you have ever had thyroid cancer. In rodent studies, GLP-1 medications caused thyroid tumors, including thyroid cancer; it is not known whether they cause thyroid tumors or cancer in humans. Notify your provider promptly if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.

When to seek care

Contact your provider as soon as possible and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea or vomiting leading to dehydration — stay well hydrated while on this medication.
• Kidney problems — dehydration from vomiting, nausea, or diarrhea can worsen pre-existing kidney conditions and, rarely, lead to kidney failure.
• Thyroid C-cell tumor signs — trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.
• Pancreatitis — severe pain in your abdomen or back that will not go away, with or without vomiting.
• Acute gallbladder disease — pain in the upper or right abdomen, fever, or yellowing of the eyes or skin.
• Elevated liver enzymes, hepatitis, or jaundice.
• Vision changes, particularly in those with a history of diabetic retinopathy.
• Signs of low blood sugar — dizziness, shakiness, headache, rapid heartbeat, confusion, or sweating (rare; more likely if combined with insulin or a sulfonylurea).
• Increasing heart rate.
• Worsening depression, behavior changes, or suicidal thoughts.

Common side effects

Many people experience no side effects. The most common include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal pain
• Indigestion
• Injection-site reactions
• Headache
• Dizziness
• Fatigue
• Decreased appetite

These symptoms often subside as your body adjusts. Notify your provider if side effects persist. This is not a complete list of side effects.

Drug interactions

Semaglutide can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of low blood sugar increases when combined with insulin or insulin secretagogues such as sulfonylureas. Semaglutide delays gastric emptying and may affect the absorption of oral medications. If you take thyroid hormone medication, review the timing with your prescriber, as it may need to be adjusted. Medications with narrow therapeutic windows (such as warfarin) should be monitored closely.

Important reminders

• Never share your medication or injection device with another person.
• Tell your provider your full medical history before starting, including any kidney, liver, or pancreas problems.
• Avoid alcohol while taking this medication.
• If you take diabetes medication, talk to your prescribing provider before starting — your doses may need to be adjusted as you lose weight.
• Use adequate contraception. Do not use if pregnant, trying to become pregnant, or breastfeeding; this medication may cause fetal harm. If you plan to become pregnant, it should be stopped at least 2 months beforehand.
• Stop and contact your provider immediately for severe stomach or abdominal pain that will not go away, with or without vomiting.
• Stop and get medical help right away for signs of a serious allergic reaction — swelling of the face, lips, tongue, or throat; trouble breathing or swallowing; severe rash; fainting; or very rapid heartbeat. Serious hypersensitivity reactions, including anaphylaxis and angioedema, have been reported.

Please consult the medication packaging for a full list of side effects, warnings, interactions, and additional information. To report suspected adverse reactions, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergency, call 911 or go to the nearest emergency room.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Tirzepatide

Compounded medications may be prescribed by a licensed provider but are not FDA-approved for safety, effectiveness, or quality. FDA-approved medicines containing tirzepatide are available.

Boxed warning — risk of thyroid C-cell tumors

GLP-1 medications are contraindicated in individuals with a personal or family history of medullary thyroid carcinoma (MTC) and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Do not use if you have ever had thyroid cancer. In rodent studies, GLP-1 medications caused thyroid tumors, including thyroid cancer; it is not known whether they cause thyroid tumors or cancer in humans. Notify your provider promptly if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.

When to seek care

Contact your provider as soon as possible and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea or vomiting leading to dehydration — stay well hydrated while on this medication.
• Kidney problems — dehydration from vomiting, nausea, or diarrhea can worsen pre-existing kidney conditions and, rarely, lead to kidney failure.
• Thyroid C-cell tumor signs — trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.
• Pancreatitis — severe pain in your abdomen or back that will not go away, with or without vomiting.
• Acute gallbladder disease — pain in the upper or right abdomen, fever, or yellowing of the eyes or skin.
• Elevated liver enzymes, hepatitis, or jaundice.
• Vision changes, particularly in those with a history of diabetic retinopathy.
• Signs of low blood sugar — dizziness, shakiness, headache, rapid heartbeat, confusion, or sweating (rare; more likely if combined with insulin or a sulfonylurea).
• Increasing heart rate.
• Worsening depression, behavior changes, or suicidal thoughts.

Common side effects

Many people experience no side effects. The most common include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal pain
• Indigestion
• Injection-site reactions
• Headache
• Dizziness
• Fatigue
• Decreased appetite

These symptoms often subside as your body adjusts. Notify your provider if side effects persist. This is not a complete list of side effects.

Drug interactions

Tirzepatide can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of low blood sugar increases when combined with insulin or insulin secretagogues such as sulfonylureas. Tirzepatide delays gastric emptying and may affect the absorption of oral medications. If you take thyroid hormone medication, review the timing with your prescriber, as it may need to be adjusted. Medications with narrow therapeutic windows (such as warfarin) should be monitored closely.

Important reminders

• Never share your medication or injection device with another person.
• Tell your provider your full medical history before starting, including any kidney, liver, or pancreas problems.
• Avoid alcohol while taking this medication.
• If you take diabetes medication, talk to your prescribing provider before starting — your doses may need to be adjusted as you lose weight.
• Use adequate contraception. Do not use if pregnant, trying to become pregnant, or breastfeeding; this medication may cause fetal harm. If you plan to become pregnant, it should be stopped at least 2 months beforehand.
• Stop and contact your provider immediately for severe stomach or abdominal pain that will not go away, with or without vomiting.
• Stop and get medical help right away for signs of a serious allergic reaction — swelling of the face, lips, tongue, or throat; trouble breathing or swallowing; severe rash; fainting; or very rapid heartbeat. Serious hypersensitivity reactions, including anaphylaxis and angioedema, have been reported.

Birth control

Tirzepatide may reduce the effectiveness of oral birth control pills. Talk with your provider before starting if you use birth control; they may recommend a non-oral method or a backup method for 4 weeks after you start and for 4 weeks after each dose increase.

Please consult the medication packaging for a full list of side effects, warnings, interactions, and additional information. To report suspected adverse reactions, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergency, call 911 or go to the nearest emergency room.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Oral Semaglutide

Compounded medications may be prescribed by a licensed provider but are not FDA-approved for safety, effectiveness, or quality. FDA-approved medicines containing semaglutide are available.

Oral semaglutide is a once-daily tablet in the same GLP-1 class as injectable semaglutide. Take it as directed by your provider, typically on an empty stomach with a small sip of water.

Boxed warning — risk of thyroid C-cell tumors

GLP-1 medications are contraindicated in individuals with a personal or family history of medullary thyroid carcinoma (MTC) and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Do not use if you have ever had thyroid cancer. In rodent studies, GLP-1 medications caused thyroid tumors, including thyroid cancer; it is not known whether they cause thyroid tumors or cancer in humans. Notify your provider promptly if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.

When to seek care

Contact your provider as soon as possible and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea or vomiting leading to dehydration — stay well hydrated while on this medication.
• Kidney problems — dehydration from vomiting, nausea, or diarrhea can worsen pre-existing kidney conditions and, rarely, lead to kidney failure.
• Thyroid C-cell tumor signs — trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.
• Pancreatitis — severe pain in your abdomen or back that will not go away, with or without vomiting.
• Acute gallbladder disease — pain in the upper or right abdomen, fever, or yellowing of the eyes or skin.
• Elevated liver enzymes, hepatitis, or jaundice.
• Vision changes, particularly in those with a history of diabetic retinopathy.
• Signs of low blood sugar — dizziness, shakiness, headache, rapid heartbeat, confusion, or sweating (rare; more likely if combined with insulin or a sulfonylurea).
• Increasing heart rate.
• Worsening depression, behavior changes, or suicidal thoughts.

Common side effects

Many people experience no side effects. The most common include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal pain
• Indigestion
• Headache
• Dizziness
• Fatigue
• Decreased appetite

These symptoms often subside as your body adjusts. Notify your provider if side effects persist. This is not a complete list of side effects.

Drug interactions

Oral Semaglutide can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of low blood sugar increases when combined with insulin or insulin secretagogues such as sulfonylureas. Oral Semaglutide delays gastric emptying and may affect the absorption of oral medications. If you take thyroid hormone medication, review the timing with your prescriber, as it may need to be adjusted. Medications with narrow therapeutic windows (such as warfarin) should be monitored closely.

Important reminders

• Never share your medication or injection device with another person.
• Tell your provider your full medical history before starting, including any kidney, liver, or pancreas problems.
• Avoid alcohol while taking this medication.
• If you take diabetes medication, talk to your prescribing provider before starting — your doses may need to be adjusted as you lose weight.
• Use adequate contraception. Do not use if pregnant, trying to become pregnant, or breastfeeding; this medication may cause fetal harm. If you plan to become pregnant, it should be stopped at least 2 months beforehand.
• Stop and contact your provider immediately for severe stomach or abdominal pain that will not go away, with or without vomiting.
• Stop and get medical help right away for signs of a serious allergic reaction — swelling of the face, lips, tongue, or throat; trouble breathing or swallowing; severe rash; fainting; or very rapid heartbeat. Serious hypersensitivity reactions, including anaphylaxis and angioedema, have been reported.

Please consult the medication packaging for a full list of side effects, warnings, interactions, and additional information. To report suspected adverse reactions, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergency, call 911 or go to the nearest emergency room.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Microdose Core

Compounded medications may be prescribed by a licensed provider but are not FDA-approved for safety, effectiveness, or quality. FDA-approved medicines containing semaglutide or tirzepatide are available.

Microdose Core pairs a low-dose GLP-1 (semaglutide or tirzepatide) with B12 and a methionine, inositol, and choline ("MIC") blend. The GLP-1 safety information below applies; lower doses are intended for tolerability but carry the same class warnings.

Boxed warning — risk of thyroid C-cell tumors

GLP-1 medications are contraindicated in individuals with a personal or family history of medullary thyroid carcinoma (MTC) and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Do not use if you have ever had thyroid cancer. In rodent studies, GLP-1 medications caused thyroid tumors, including thyroid cancer; it is not known whether they cause thyroid tumors or cancer in humans. Notify your provider promptly if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.

When to seek care

Contact your provider as soon as possible and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea or vomiting leading to dehydration — stay well hydrated while on this medication.
• Kidney problems — dehydration from vomiting, nausea, or diarrhea can worsen pre-existing kidney conditions and, rarely, lead to kidney failure.
• Thyroid C-cell tumor signs — trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.
• Pancreatitis — severe pain in your abdomen or back that will not go away, with or without vomiting.
• Acute gallbladder disease — pain in the upper or right abdomen, fever, or yellowing of the eyes or skin.
• Elevated liver enzymes, hepatitis, or jaundice.
• Vision changes, particularly in those with a history of diabetic retinopathy.
• Signs of low blood sugar — dizziness, shakiness, headache, rapid heartbeat, confusion, or sweating (rare; more likely if combined with insulin or a sulfonylurea).
• Increasing heart rate.
• Worsening depression, behavior changes, or suicidal thoughts.

Common side effects

Many people experience no side effects. The most common include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal pain
• Indigestion
• Injection-site reactions
• Headache
• Dizziness
• Fatigue
• Decreased appetite

These symptoms often subside as your body adjusts. Notify your provider if side effects persist. This is not a complete list of side effects.

Drug interactions

Microdose Core can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of low blood sugar increases when combined with insulin or insulin secretagogues such as sulfonylureas. Microdose Core delays gastric emptying and may affect the absorption of oral medications. If you take thyroid hormone medication, review the timing with your prescriber, as it may need to be adjusted. Medications with narrow therapeutic windows (such as warfarin) should be monitored closely.

Important reminders

• Never share your medication or injection device with another person.
• Tell your provider your full medical history before starting, including any kidney, liver, or pancreas problems.
• Avoid alcohol while taking this medication.
• If you take diabetes medication, talk to your prescribing provider before starting — your doses may need to be adjusted as you lose weight.
• Use adequate contraception. Do not use if pregnant, trying to become pregnant, or breastfeeding; this medication may cause fetal harm. If you plan to become pregnant, it should be stopped at least 2 months beforehand.
• Stop and contact your provider immediately for severe stomach or abdominal pain that will not go away, with or without vomiting.
• Stop and get medical help right away for signs of a serious allergic reaction — swelling of the face, lips, tongue, or throat; trouble breathing or swallowing; severe rash; fainting; or very rapid heartbeat. Serious hypersensitivity reactions, including anaphylaxis and angioedema, have been reported.

B12 + MIC blend

The added B12 and MIC components are generally well tolerated. Mild, temporary effects can include injection-site redness or discomfort, mild nausea, or mild swelling. Do not use the blend if pregnant, nursing, or planning to become pregnant. Stop and contact your provider for an irregular heartbeat or difficulty breathing.

Please consult the medication packaging for a full list of side effects, warnings, interactions, and additional information. To report suspected adverse reactions, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergency, call 911 or go to the nearest emergency room.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Microdose Energy & Focus

Compounded medications may be prescribed by a licensed provider but are not FDA-approved for safety, effectiveness, or quality. FDA-approved medicines containing semaglutide or tirzepatide are available.

Microdose Energy & Focus pairs a low-dose GLP-1 (semaglutide or tirzepatide) with NAD+ and B12. The GLP-1 safety information below applies; lower doses are intended for tolerability but carry the same class warnings.

Boxed warning — risk of thyroid C-cell tumors

GLP-1 medications are contraindicated in individuals with a personal or family history of medullary thyroid carcinoma (MTC) and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Do not use if you have ever had thyroid cancer. In rodent studies, GLP-1 medications caused thyroid tumors, including thyroid cancer; it is not known whether they cause thyroid tumors or cancer in humans. Notify your provider promptly if you develop trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.

When to seek care

Contact your provider as soon as possible and seek in-person care immediately if a side effect becomes problematic or you experience:

• Severe nausea or vomiting leading to dehydration — stay well hydrated while on this medication.
• Kidney problems — dehydration from vomiting, nausea, or diarrhea can worsen pre-existing kidney conditions and, rarely, lead to kidney failure.
• Thyroid C-cell tumor signs — trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath.
• Pancreatitis — severe pain in your abdomen or back that will not go away, with or without vomiting.
• Acute gallbladder disease — pain in the upper or right abdomen, fever, or yellowing of the eyes or skin.
• Elevated liver enzymes, hepatitis, or jaundice.
• Vision changes, particularly in those with a history of diabetic retinopathy.
• Signs of low blood sugar — dizziness, shakiness, headache, rapid heartbeat, confusion, or sweating (rare; more likely if combined with insulin or a sulfonylurea).
• Increasing heart rate.
• Worsening depression, behavior changes, or suicidal thoughts.

Common side effects

Many people experience no side effects. The most common include:

• Nausea
• Constipation
• Vomiting
• Diarrhea
• Abdominal pain
• Indigestion
• Injection-site reactions
• Headache
• Dizziness
• Fatigue
• Decreased appetite

These symptoms often subside as your body adjusts. Notify your provider if side effects persist. This is not a complete list of side effects.

Drug interactions

Microdose Energy & Focus can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of low blood sugar increases when combined with insulin or insulin secretagogues such as sulfonylureas. Microdose Energy & Focus delays gastric emptying and may affect the absorption of oral medications. If you take thyroid hormone medication, review the timing with your prescriber, as it may need to be adjusted. Medications with narrow therapeutic windows (such as warfarin) should be monitored closely.

Important reminders

• Never share your medication or injection device with another person.
• Tell your provider your full medical history before starting, including any kidney, liver, or pancreas problems.
• Avoid alcohol while taking this medication.
• If you take diabetes medication, talk to your prescribing provider before starting — your doses may need to be adjusted as you lose weight.
• Use adequate contraception. Do not use if pregnant, trying to become pregnant, or breastfeeding; this medication may cause fetal harm. If you plan to become pregnant, it should be stopped at least 2 months beforehand.
• Stop and contact your provider immediately for severe stomach or abdominal pain that will not go away, with or without vomiting.
• Stop and get medical help right away for signs of a serious allergic reaction — swelling of the face, lips, tongue, or throat; trouble breathing or swallowing; severe rash; fainting; or very rapid heartbeat. Serious hypersensitivity reactions, including anaphylaxis and angioedema, have been reported.

NAD+ and B12

The added NAD+ and B12 are generally well tolerated. Mild, temporary effects can include injection-site reactions, flushing or warmth, lightheadedness, or mild nausea — more likely if an injection is given too quickly, so administer slowly. Do not use if pregnant, nursing, or planning to become pregnant.

Please consult the medication packaging for a full list of side effects, warnings, interactions, and additional information. To report suspected adverse reactions, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergency, call 911 or go to the nearest emergency room.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

NAD+

NAD+ formulations are compounded and prescribed off-label by licensed providers and are not FDA-approved.

NAD+ is offered as a subcutaneous injection or a nasal spray. Side effects are generally mild and short-lived; rotate injection sites and follow your provider's guidance to reduce irritation.

Common side effects

• Injection: redness, tenderness, or soreness at the injection site; mild flushing or warmth; lightheadedness; temporary fatigue; mild nausea.
• Nasal spray: nasal dryness or irritation, sneezing or a transient burning sensation, headache, mild dizziness.

More serious side effects (less common)

• Allergic reaction (rash, swelling, shortness of breath).
• Dizziness or fainting, especially after an injection.
• Persistent fatigue or flu-like symptoms.
• Flushing with a rapid heartbeat.

If you have signs of an allergic reaction or severe discomfort, stop treatment and seek medical care immediately.

Warnings

• Do not exceed the dose prescribed by your provider.
• Inject subcutaneously using proper technique; improper technique may increase irritation.
• Use nasal formulations carefully to avoid irritation or overuse.
• Individuals with autoimmune, cardiovascular, or metabolic conditions should be monitored more closely.

Do not use if

• You have a known hypersensitivity to NAD+ or any formulation component.
• You are pregnant or breastfeeding.
• You have an active infection, uncontrolled chronic illness, or ongoing cancer treatment, without prior approval from your specialist.

Drug interactions

No widely reported drug interactions, but NAD+ may affect oxidative metabolism. Use caution with medications that affect energy metabolism, including insulin, metformin, or corticosteroids. Disclose all prescription medications, supplements, and herbal products to your provider.

Please consult the medication packaging for a full list of side effects, warnings, interactions, and additional information. To report suspected adverse reactions, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergency, call 911 or go to the nearest emergency room.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Sermorelin

Sermorelin is compounded and prescribed off-label by licensed providers and is not FDA-approved.

Side effects are typically mild and resolve over time.

Common side effects

• Pain, redness, or swelling at the injection site.
• Fatigue or mild dizziness.
• Flushing, headache, or transient restlessness.

Warnings

Sermorelin may affect hormone levels and metabolism, so periodic monitoring is important. Use caution if you have a history of metabolic or endocrine conditions. Though rare, allergic reactions are possible — seek care for rash, swelling, or trouble breathing.

Do not use if

• You have a known hypersensitivity to sermorelin or any of its ingredients.
• You are pregnant, planning to become pregnant, or breastfeeding.
• You have active cancer or a history of cancer that is not in remission.

Drug interactions

Sermorelin may interact with glucocorticoids (such as prednisone), which can blunt growth-hormone stimulation, and with thyroid medications, which may alter hormonal balance. Always tell your provider about all medications and supplements you take.

Please consult the medication packaging for a full list of side effects, warnings, interactions, and additional information. To report suspected adverse reactions, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergency, call 911 or go to the nearest emergency room.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

B12-MIC

B12-MIC is compounded and prescribed off-label by licensed providers and is not FDA-approved.

B12-MIC combines vitamin B12 with methionine, inositol, and choline. Side effects are typically mild and resolve over time.

Common side effects

• Discomfort or redness at the injection site.
• Itching or a sensation of mild swelling.
• Muscle cramps or weakness.
• Nausea or changes in urination.
• Swelling around the ankles or feet.
• Fatigue.

Precautions

• Do not use if you are pregnant, nursing, or planning to become pregnant or breastfeed.
• If itching or irritation persists, an over-the-counter hydrocortisone cream may help, or stop use.
• In the uncommon event of a more serious reaction such as an irregular heartbeat or difficulty breathing, stop use immediately and contact your provider.

Please consult the medication packaging for a full list of side effects, warnings, interactions, and additional information. To report suspected adverse reactions, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergency, call 911 or go to the nearest emergency room.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

2-in-1 Liquid (Double Powered Liposomal)

Compounded medications may be prescribed by a licensed provider but are not FDA-approved for safety, effectiveness, or quality. FDA-approved medicines containing sildenafil and tadalafil are available.

Double Powered Liposomal is a compounded liquid containing both sildenafil and tadalafil, held under the tongue rather than swallowed. Because it is absorbed through the lining of the mouth it bypasses the digestive tract, so the amount of each medication is lower than in a comparable tablet — do not assume a dose is weak because the number is smaller, and never take an extra dose to compensate. Take only as prescribed.

Do not take with nitrates

Never take this medication if you use any form of nitrate. Taking a PDE5 inhibitor with a nitrate can cause a sudden, severe, and potentially fatal drop in blood pressure. This includes nitroglycerin (tablets, sprays, patches, or ointments), isosorbide mononitrate and dinitrate, and recreational inhalants known as "poppers" (amyl, butyl, or isobutyl nitrite). If you take a nitrate only occasionally, you still cannot take this medication. If you develop chest pain after taking it, tell emergency responders when you last took it — you must not be given nitrates.

Do not take this medication if you use riociguat (Adempas) or another guanylate cyclase stimulator for pulmonary hypertension, as the combination can cause dangerously low blood pressure. Do not take it if you have been advised by a provider that sexual activity is inadvisable because of a heart condition, or if you are allergic to sildenafil or tadalafil.

When to seek emergency care

Stop taking this medication and get medical help right away if you experience:

• An erection lasting more than 4 hours (priapism) — this is a medical emergency and can permanently damage the penis if untreated. Do not wait to see whether it resolves on its own.
• Sudden loss of vision in one or both eyes, which may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION).
• Sudden decrease or loss of hearing, sometimes with ringing in the ears or dizziness.
• Chest pain, severe dizziness, or fainting — particularly during or after sexual activity.
• Signs of a serious allergic reaction: rash, hives, swelling of the face, lips, tongue, or throat, or difficulty breathing.

Common side effects

Many people experience no side effects. The most commonly reported are:

• Headache
• Flushing (warmth or redness in the face, neck, or chest)
• Indigestion or upset stomach
• Nasal congestion or a runny nose
• Back pain or muscle aches, more often with tadalafil and usually appearing 12–24 hours after a dose
• Dizziness or lightheadedness, especially when standing up quickly
• Changes in vision such as a blue tinge to your sight, blurred vision, or increased light sensitivity, more often with sildenafil

Drug interactions

Tell your provider about every medication and supplement you take. Alpha-blockers (such as tamsulosin or doxazosin) and other blood pressure medications can combine with this medication to lower blood pressure too far; your provider may need to separate the doses or adjust them. Medications that inhibit the CYP3A4 enzyme — including ketoconazole, itraconazole, clarithromycin, erythromycin, and HIV protease inhibitors such as ritonavir — raise the level of this medication in your blood and usually require a lower dose. Grapefruit and grapefruit juice have the same effect and are best avoided.

Do not combine this medication with other ED treatments, including other PDE5 inhibitors, without your provider's direction. Alcohol can add to the blood-pressure-lowering effect and increase dizziness; large amounts also make it harder to get an erection.

Important reminders

• This medication does not protect against HIV or any other sexually transmitted infection.
• It does not work on its own — sexual stimulation is required for it to have any effect.
• Prescribed for you only. Never share it with anyone else, and never take a dose prescribed for another person.
• Take no more than one dose in a 24-hour period unless your provider tells you otherwise.
• Tell your provider your full medical history before starting, including any heart disease, recent heart attack or stroke, irregular heartbeat, uncontrolled high or low blood pressure, liver or kidney problems, stomach ulcers, bleeding disorders, retinitis pigmentosa or other eye conditions, sickle cell anemia, leukemia, myeloma, or a deformity of the penis such as Peyronie's disease.
• Erectile dysfunction can be an early sign of heart disease, diabetes, or another underlying condition. Treating the symptom does not treat the cause — talk to your provider about the rest of your health.
• Not for use by anyone under 18, by women, or by anyone who is pregnant or breastfeeding.

Taking it correctly

Hold the liquid under your tongue for the full time your provider specifies before swallowing, and avoid eating or drinking during that period. Because this formulation contains two PDE5 inhibitors at once, the effects of both overlap — the combined blood-pressure-lowering effect is greater than either alone, so it is especially important that your provider knows about every other medication you take.

Please consult the medication packaging for a full list of side effects, warnings, interactions, and additional information. To report suspected adverse reactions, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergency, call 911 or go to the nearest emergency room.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

2-in-1 Pill (Double Powered Pill)

Compounded medications may be prescribed by a licensed provider but are not FDA-approved for safety, effectiveness, or quality. FDA-approved medicines containing sildenafil and tadalafil are available.

Double Powered Pill is a compounded tablet containing both sildenafil and tadalafil. Tadalafil stays active in the body far longer than sildenafil — up to about 36 hours — so the effects of a single dose, including the risk of interacting with a nitrate, can last well into the following day. Take only as prescribed and no more than one dose in 24 hours.

Do not take with nitrates

Never take this medication if you use any form of nitrate. Taking a PDE5 inhibitor with a nitrate can cause a sudden, severe, and potentially fatal drop in blood pressure. This includes nitroglycerin (tablets, sprays, patches, or ointments), isosorbide mononitrate and dinitrate, and recreational inhalants known as "poppers" (amyl, butyl, or isobutyl nitrite). If you take a nitrate only occasionally, you still cannot take this medication. If you develop chest pain after taking it, tell emergency responders when you last took it — you must not be given nitrates.

Do not take this medication if you use riociguat (Adempas) or another guanylate cyclase stimulator for pulmonary hypertension, as the combination can cause dangerously low blood pressure. Do not take it if you have been advised by a provider that sexual activity is inadvisable because of a heart condition, or if you are allergic to sildenafil or tadalafil.

When to seek emergency care

Stop taking this medication and get medical help right away if you experience:

• An erection lasting more than 4 hours (priapism) — this is a medical emergency and can permanently damage the penis if untreated. Do not wait to see whether it resolves on its own.
• Sudden loss of vision in one or both eyes, which may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION).
• Sudden decrease or loss of hearing, sometimes with ringing in the ears or dizziness.
• Chest pain, severe dizziness, or fainting — particularly during or after sexual activity.
• Signs of a serious allergic reaction: rash, hives, swelling of the face, lips, tongue, or throat, or difficulty breathing.

Common side effects

Many people experience no side effects. The most commonly reported are:

• Headache
• Flushing (warmth or redness in the face, neck, or chest)
• Indigestion or upset stomach
• Nasal congestion or a runny nose
• Back pain or muscle aches, more often with tadalafil and usually appearing 12–24 hours after a dose
• Dizziness or lightheadedness, especially when standing up quickly
• Changes in vision such as a blue tinge to your sight, blurred vision, or increased light sensitivity, more often with sildenafil

Drug interactions

Tell your provider about every medication and supplement you take. Alpha-blockers (such as tamsulosin or doxazosin) and other blood pressure medications can combine with this medication to lower blood pressure too far; your provider may need to separate the doses or adjust them. Medications that inhibit the CYP3A4 enzyme — including ketoconazole, itraconazole, clarithromycin, erythromycin, and HIV protease inhibitors such as ritonavir — raise the level of this medication in your blood and usually require a lower dose. Grapefruit and grapefruit juice have the same effect and are best avoided.

Do not combine this medication with other ED treatments, including other PDE5 inhibitors, without your provider's direction. Alcohol can add to the blood-pressure-lowering effect and increase dizziness; large amounts also make it harder to get an erection.

Important reminders

• This medication does not protect against HIV or any other sexually transmitted infection.
• It does not work on its own — sexual stimulation is required for it to have any effect.
• Prescribed for you only. Never share it with anyone else, and never take a dose prescribed for another person.
• Take no more than one dose in a 24-hour period unless your provider tells you otherwise.
• Tell your provider your full medical history before starting, including any heart disease, recent heart attack or stroke, irregular heartbeat, uncontrolled high or low blood pressure, liver or kidney problems, stomach ulcers, bleeding disorders, retinitis pigmentosa or other eye conditions, sickle cell anemia, leukemia, myeloma, or a deformity of the penis such as Peyronie's disease.
• Erectile dysfunction can be an early sign of heart disease, diabetes, or another underlying condition. Treating the symptom does not treat the cause — talk to your provider about the rest of your health.
• Not for use by anyone under 18, by women, or by anyone who is pregnant or breastfeeding.

Two medications in one tablet

This tablet contains two PDE5 inhibitors, so their effects overlap and the combined blood-pressure-lowering effect is greater than either alone. Do not take any additional ED medication alongside it. Because tadalafil is long-acting, do not take a second dose the next day assuming the first has worn off.

Please consult the medication packaging for a full list of side effects, warnings, interactions, and additional information. To report suspected adverse reactions, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergency, call 911 or go to the nearest emergency room.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Daily Pill (Daily Boost Pill)

Compounded medications may be prescribed by a licensed provider but are not FDA-approved for safety, effectiveness, or quality. FDA-approved medicines containing tadalafil are available.

Daily Boost Pill is a compounded low-dose tadalafil tablet taken every day rather than only before sexual activity. Because you take it continuously, tadalafil is present in your body at all times — which means the contraindication with nitrates applies every single day, not just on days you expect to be sexually active. Carry a note of this medication and tell any provider treating you for chest pain that you take it.

Do not take with nitrates

Never take this medication if you use any form of nitrate. Taking a PDE5 inhibitor with a nitrate can cause a sudden, severe, and potentially fatal drop in blood pressure. This includes nitroglycerin (tablets, sprays, patches, or ointments), isosorbide mononitrate and dinitrate, and recreational inhalants known as "poppers" (amyl, butyl, or isobutyl nitrite). If you take a nitrate only occasionally, you still cannot take this medication. If you develop chest pain after taking it, tell emergency responders when you last took it — you must not be given nitrates.

Do not take this medication if you use riociguat (Adempas) or another guanylate cyclase stimulator for pulmonary hypertension, as the combination can cause dangerously low blood pressure. Do not take it if you have been advised by a provider that sexual activity is inadvisable because of a heart condition, or if you are allergic to sildenafil or tadalafil.

When to seek emergency care

Stop taking this medication and get medical help right away if you experience:

• An erection lasting more than 4 hours (priapism) — this is a medical emergency and can permanently damage the penis if untreated. Do not wait to see whether it resolves on its own.
• Sudden loss of vision in one or both eyes, which may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION).
• Sudden decrease or loss of hearing, sometimes with ringing in the ears or dizziness.
• Chest pain, severe dizziness, or fainting — particularly during or after sexual activity.
• Signs of a serious allergic reaction: rash, hives, swelling of the face, lips, tongue, or throat, or difficulty breathing.

Common side effects

Many people experience no side effects. The most commonly reported are:

• Headache
• Flushing (warmth or redness in the face, neck, or chest)
• Indigestion or upset stomach
• Nasal congestion or a runny nose
• Back pain or muscle aches, more often with tadalafil and usually appearing 12–24 hours after a dose
• Dizziness or lightheadedness, especially when standing up quickly
• Changes in vision such as a blue tinge to your sight, blurred vision, or increased light sensitivity, more often with sildenafil

Drug interactions

Tell your provider about every medication and supplement you take. Alpha-blockers (such as tamsulosin or doxazosin) and other blood pressure medications can combine with this medication to lower blood pressure too far; your provider may need to separate the doses or adjust them. Medications that inhibit the CYP3A4 enzyme — including ketoconazole, itraconazole, clarithromycin, erythromycin, and HIV protease inhibitors such as ritonavir — raise the level of this medication in your blood and usually require a lower dose. Grapefruit and grapefruit juice have the same effect and are best avoided.

Do not combine this medication with other ED treatments, including other PDE5 inhibitors, without your provider's direction. Alcohol can add to the blood-pressure-lowering effect and increase dizziness; large amounts also make it harder to get an erection.

Important reminders

• This medication does not protect against HIV or any other sexually transmitted infection.
• It does not work on its own — sexual stimulation is required for it to have any effect.
• Prescribed for you only. Never share it with anyone else, and never take a dose prescribed for another person.
• Take no more than one dose in a 24-hour period unless your provider tells you otherwise.
• Tell your provider your full medical history before starting, including any heart disease, recent heart attack or stroke, irregular heartbeat, uncontrolled high or low blood pressure, liver or kidney problems, stomach ulcers, bleeding disorders, retinitis pigmentosa or other eye conditions, sickle cell anemia, leukemia, myeloma, or a deformity of the penis such as Peyronie's disease.
• Erectile dysfunction can be an early sign of heart disease, diabetes, or another underlying condition. Treating the symptom does not treat the cause — talk to your provider about the rest of your health.
• Not for use by anyone under 18, by women, or by anyone who is pregnant or breastfeeding.

Daily dosing

Take one tablet at about the same time each day, with or without food. Do not take a double dose to make up for a missed one. It may take several days of consistent dosing before you notice the full effect. Do not combine it with an on-demand ED medication unless your provider specifically directs you to.

Please consult the medication packaging for a full list of side effects, warnings, interactions, and additional information. To report suspected adverse reactions, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. In case of emergency, call 911 or go to the nearest emergency room.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.