Sublingual ED Medication: What It Is and How It Differs

Key facts

• A sublingual tablet is made to dissolve under the tongue. A dissolving tablet is made to break down in the mouth.
• CHROMA X Max and CHROMA X Max Peak are sublingual. CHROMA 3X and CHROMA 4X dissolve in the mouth.
• All four are compounded prescriptions and are not FDA-approved.
• No published study has tested these tablets, so no evidence shows they work faster than a swallowed tablet.
• They are not for use with nitrates or guanylate cyclase stimulators. An erection lasting longer than 4 hours is a medical emergency.

What is sublingual ED medication?

Sublingual means under the tongue. A sublingual ED tablet is made to dissolve there. A dissolving tablet, also called an orally disintegrating tablet, is made to break down in the mouth. The two overlap, and neither name tells you how much medicine is absorbed in the mouth and how much is swallowed with saliva.

The sublingual and dissolving tablets listed on CHROMA23® are compounded. A pharmacy prepares them from a prescription, so they have no FDA label and they are not FDA-approved. FDA-approved ED products are different products. They include swallowed tablets, a sildenafil oral film and vardenafil orally disintegrating tablets. The FDA status page explains the difference.

How is ED medication under the tongue different from a swallowed tablet?

A swallowed tablet travels to the gut, and the liver breaks down part of the dose before it reaches the bloodstream. The tissue under the tongue is thin, so in theory some medicines can pass from there straight into the blood.

In practice that depends on the medicine and on what the tablet is made of. A 2019 review found that several dissolving sildenafil tablets and films absorb much like film-coated tablets, and that sildenafil needs specific added ingredients to pass through the lining of the mouth. The comparison page sets out what the studies show. This article on onset and absorption explains the pathway in more depth.

Which ED medications dissolve under the tongue?

CHROMA23® lists four tablets, two that dissolve under the tongue and two that dissolve in the mouth. Each one combines more than one medicine:

• CHROMA X Max: a 3-in-1 sublingual tablet with tadalafil, oxytocin and PT-141, also called bremelanotide, at the entry strength
• CHROMA X Max Peak: the same three medicines at full strength
• CHROMA 3X: a 3-in-1 tablet that dissolves in the mouth, with sildenafil, tadalafil and citrulline
• CHROMA 4X: a 4-in-1 tablet that dissolves in the mouth, with sildenafil, vardenafil, tadalafil and apomorphine

Sildenafil, tadalafil and vardenafil are PDE5 inhibitors. Citrulline is an amino acid. Apomorphine acts on dopamine receptors, PT-141 acts on melanocortin receptors and oxytocin is a hormone. A PubMed search for this page found no published study of any of these four combinations, and none of them is FDA-approved.

Your provider sets the product, the strength and how you use it. The pharmacy's written instructions ship with your order.

How does sublingual ED medication work?

PDE5 inhibitors help the muscle in the penis relax so blood can flow in. They depend on sexual stimulation. The Viagra® label says sildenafil at recommended doses has no effect without it, and the American Urological Association guideline says men should be told stimulation is necessary.

The other medicines in these tablets act elsewhere in the body, and none of their FDA labels covers ED. The FDA status page sets out what each label does cover. This article on apomorphine goes further on that medicine.

How fast does it work, and how long does it last?

These tablets have no FDA label and no published study, so there is no established figure for how fast they work or how long they last.

The comparison page covers whether sublingual is faster.

Who might sublingual ED tablets fit?

A provider decides what fits. A published review names practical reasons for a dissolving form, such as trouble swallowing tablets or wanting something more discreet. If one medicine has not worked for you, tell your provider.

The FDA says compounded drugs should only be used in patients whose medical needs cannot be met by an FDA-approved drug. The American Urological Association guideline says men should be told about all treatment options that are not medically contraindicated. If an FDA-approved tablet or film could meet your needs, raise that with your provider.

These tablets do not fit everyone. They are not for use with nitrates, including nitroglycerin, or with guanylate cyclase stimulators such as riociguat, because together these can drop blood pressure to an unsafe level. Tell your provider about every medicine you take and any heart, blood pressure, liver, kidney or eye condition. The side effects page has the full list.

Are sublingual ED tablets safe?

They carry real risks, and a provider weighs them against your health history. Compounded medicines have no FDA review of their safety, effectiveness or quality before they reach patients. CHROMA 3X and CHROMA 4X each hold more than one PDE5 inhibitor, and the Viagra® and Cialis® labels advise against combining those products with other PDE5 inhibitors.

An erection lasting longer than 4 hours is a medical emergency. Go to an emergency department and do not wait for it to pass.

How do you get sublingual ED tablets online?

These tablets are prescriptions. CHROMA 3X is from $3.77 a dose, visit and shipping included, plus tax where required, and the cost page lists all four. You choose a plan and pay, then complete the intake. An independent licensed provider in your state, where available, reads your case and decides what fits. If a prescription is written, a licensed U.S. pharmacy fills it and ships it. You're notified at every step.

If a provider decides a tablet does not fit, your order is fully or partially refunded under the Refund Policy.

Frequently asked questions

About CHROMA23®

CHROMA23® brings weight loss, longevity, sexual health, hair, and skincare into one place. Every prescription decision is made by an independent provider licensed in the patient's state, where available, and every medication is dispensed by a state-licensed pharmacy. The assessment is free. One clear price per plan, shown in full before you pay. The medicine is real. The provider is real.

Sources

1. Viagra® (sildenafil) full prescribing information
2. Cialis® (tadalafil) full prescribing information
3. American Urological Association: erectile dysfunction guideline
4. Zucchi et al.: the first-generation PDE5 inhibitors and their pharmacokinetic issue (Andrology, 2019)
5. FDA: compounding and the FDA, questions and answers
6. Vybrique™ (sildenafil) oral film label (DailyMed)
7. Vardenafil orally disintegrating tablets label (DailyMed)

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