Is Sublingual Faster Than a Regular ED Tablet?

Key facts

• No published study has tested the compounded tablets on CHROMA23®, so no evidence shows they are faster than a swallowed tablet.
• A 2019 review found that several dissolving sildenafil tablets and films absorb like film-coated tablets. One film was the exception, and the authors called for more studies.
• A PubMed search for this page found no human study of tadalafil absorbed under the tongue. In a study of a tadalafil film, time to peak matched a film-coated tablet.
• Compounded tablets are not FDA-approved. No study shows they work as well as, or better than, an FDA-approved tablet.
• These tablets are not for use with nitrates or guanylate cyclase stimulators. An erection lasting longer than 4 hours is a medical emergency.

Is sublingual faster than oral?

For the compounded tablets on CHROMA23®, the answer is unknown, because a PubMed search found no published study of them. For sildenafil in other sublingual and dissolving forms, the evidence is small and mixed:

• A 2004 study gave 40 men sublingual sildenafil or a placebo and reported a quick onset. It had no swallowed-tablet group, so a later review noted that it could not compare the two.
• A 2018 study of 20 men compared a film and a dissolving tablet, both used under the tongue, with a swallowed tablet. Sildenafil levels rose faster with the film. The early rise with the dissolving tablet was not statistically significant.
• Another 2018 study, of 12 healthy men and a film from the same maker, found the film behaved the same under the tongue and on it. Its authors concluded that absorption through the mouth was negligible and that the sildenafil was likely swallowed.
• A 2021 trial of 120 men compared sildenafil strips with tablets. Strips averaged a few minutes earlier, and the difference was not statistically significant.
• A 2019 review concluded that several dissolving tablets and films absorb like film-coated tablets, that one film had a shorter onset, and that head-to-head studies are still needed.

Each of these results belongs to the product studied. None of them was a compounded tablet from CHROMA23®. For the wider picture, read this article on onset and absorption.

Is sublingual tadalafil faster?

Nothing shows that it is. A PubMed search for this page found no human study of tadalafil absorbed from under the tongue. The closest is a 2018 study of 36 healthy men that compared a tadalafil film with a film-coated tablet. Blood levels over time were nearly the same, and so was the median time to peak.

Tadalafil also takes time to peak when swallowed. The Cialis® label gives a median of 2 hours for that tablet. That figure is for an approved tablet, not for CHROMA X Max tablets, and no figure exists for them.

What is the bioavailability of sublingual sildenafil?

Bioavailability is the share of a dose that reaches the bloodstream. The Viagra® label puts it at about two fifths for that swallowed tablet, and published work links that to the liver breaking down part of the dose first. A few small studies report more with other forms. One study of 12 volunteers reported more sildenafil reaching the blood from a lab-made sublingual tablet than from a swallowed tablet. Another reported more in the first hour from a film used under the tongue.

No bioavailability figure exists for compounded tablets, and a higher figure would not by itself make a tablet better. The label for vardenafil orally disintegrating tablets reports higher exposure than film-coated vardenafil and says the two are not interchangeable. A dose cannot be assumed to carry from one form to another, so your provider sets it. The American Urological Association guideline says raising a PDE5 inhibitor dose adds little on average, while many side effects rise more clearly.

Why doesn't dissolving in the mouth always mean faster?

Sildenafil dissolves poorly in water, which limits how much can pass through the lining of the mouth. The 2019 review concluded that contact with that lining is not enough, and that specific added ingredients are needed. Medicine that dissolves in saliva can also be swallowed and absorbed in the gut like a tablet. The label for Vybrique™, an FDA-approved sildenafil film, says it can be swallowed with saliva once it breaks down.

The labels for FDA-approved dissolving forms do not describe faster absorption. Median time to peak is 60 minutes on the Viagra® label for that swallowed tablet, 80 minutes on the Vybrique™ label and 1.5 hours on the label for vardenafil orally disintegrating tablets. These come from separate studies, so they cannot be compared directly, but none of them shows a dissolving form peaking sooner.

How do compounded tablets compare with regular ED tablets?

Regular ED tablets such as Viagra® and Cialis® are FDA-approved. Each has a label, and the American Urological Association guideline says PDE5 inhibitors have been studied in nearly a quarter of a million men from the general ED population. It says sildenafil, tadalafil and vardenafil appear to have similar efficacy in those men.

Compounded tablets differ in form and in the mix of medicines. They are not FDA-approved, they have no label and no published study has tested them. Nothing shows that a compounded tablet works as well as an FDA-approved tablet, or better. Facts about those tablets do not carry over to compounded ones.

Do more medicines in one tablet work better?

That has not been shown for these tablets. The labels for Viagra® and Cialis® advise against combining those products with other PDE5 inhibitors. Supervised studies of tadalafil with sildenafil are covered in this article on taking them together, and they did not test a compounded tablet.

The American Urological Association guideline lists oral apomorphine among treatments that, in its panel's view, are ineffective, are not safe or lack enough evidence. The side effects page covers what each added medicine can do.

How do you choose between them?

You do not have to choose alone. The American Urological Association guideline treats ED care as a shared decision and says men should be told about all treatment options that are not medically contraindicated, along with the benefits and burdens of each.

A provider looks at your health history, your medicines and what you have tried, then decides what fits. These tablets are not for use with nitrates or guanylate cyclase stimulators. An erection lasting longer than 4 hours is a medical emergency.

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. Zucchi et al.: the first-generation PDE5 inhibitors and their pharmacokinetic issue (Andrology, 2019)
2. Deveci et al.: sublingual sildenafil in the treatment of erectile dysfunction (International Journal of Urology, 2004)
3. De Toni et al.: sublingual administration of sildenafil oro-dispersible film (Frontiers in Pharmacology, 2018)
4. Loprete et al.: a sildenafil orodispersible film used on and under the tongue (Clinical Drug Investigation, 2018)
5. Sangkum et al.: orally disintegrating strip sildenafil, a randomized trial (Sexual Medicine, 2021)
6. Park et al.: tadalafil orodispersible film versus film-coated tablet (Drug Design, Development and Therapy, 2018)
7. Hosny et al.: sildenafil citrate sublingual tablets (Drug Design, Development and Therapy, 2015)
8. Viagra® (sildenafil) full prescribing information
9. Cialis® (tadalafil) full prescribing information
10. Vybrique™ (sildenafil) oral film label (DailyMed)
11. Vardenafil orally disintegrating tablets label (DailyMed)
12. American Urological Association: erectile dysfunction guideline
13. FDA: compounding and the FDA, questions and answers

Keep reading