Safety information

Who must not take The Quattro

Do not take The Quattro, and tell your clinician, if any of these apply to you:

• You take nitrates in any form. This includes nitroglycerin tablets, sprays, patches and ointments, isosorbide mononitrate or dinitrate, and recreational nitrites such as amyl nitrite ("poppers"). PDE5 inhibitors combined with nitrates can cause a sudden, serious drop in blood pressure.
• You take riociguat (a guanylate cyclase stimulator used for pulmonary hypertension). The combination with PDE5 inhibitors can lower blood pressure dangerously.
• You have unstable cardiovascular disease, such as unstable angina, uncontrolled high or low blood pressure, uncontrolled arrhythmia, or heart failure that limits your daily activity. Sexual activity itself is a strain on the heart; if your clinician would tell you to avoid it, The Quattro is not appropriate.
• You had a stroke or heart attack in the last six months.
• You have severe liver or kidney disease. Several of the actives are cleared by the liver and kidneys, and levels can build up.
• You are allergic to sildenafil, vardenafil, tadalafil or apomorphine, or to any ingredient the pharmacy lists on the label.

Your clinician may also decline to prescribe for reasons not listed here, including retinal disease such as retinitis pigmentosa, a history of priapism, anatomical deformation of the penis, bleeding disorders, active stomach ulcers, a history of fainting, or a recent loss of vision or hearing while taking a PDE5 inhibitor.

Medications that interact

• Alpha-blockers (for example tamsulosin, doxazosin, terazosin, alfuzosin) and other blood-pressure medications can add to the blood-pressure-lowering effect. Your clinician may adjust the dose or decline.
• Strong CYP3A4 inhibitors such as ketoconazole, itraconazole, clarithromycin, ritonavir and other HIV protease inhibitors slow the breakdown of PDE5 inhibitors and can raise their levels considerably.
• Other PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) or other erectile dysfunction treatments, including injections, must not be combined with The Quattro.
• Dopamine antagonists, including many antipsychotics and the anti-nausea drugs metoclopramide and prochlorperazine, work against apomorphine. Ondansetron combined with apomorphine has caused severe drops in blood pressure and must be avoided.
• Medications that prolong the QT interval and certain antidepressants can matter for apomorphine and vardenafil. List everything you take.

Alcohol

Alcohol lowers blood pressure and can make dizziness and fainting more likely when combined with PDE5 inhibitors or apomorphine. It also makes erectile dysfunction worse on its own. Keep intake low around a dose, and do not take The Quattro if you are intoxicated.

Common side effects

These are the side effects known from the individual actives. Most are mild and pass within a few hours.

• Headache
• Flushing of the face or neck
• Stuffy or runny nose
• Nausea, which is the most common effect of apomorphine
• Dizziness or light-headedness, especially when standing up
• Indigestion or heartburn
• Back pain or muscle aches, more often with tadalafil
• Temporary changes in colour vision or increased light sensitivity
• Yawning, sweating or drowsiness with apomorphine

Tell your clinician if a side effect is persistent or bothers you. The dose can often be adjusted.

When to seek emergency care

An erection that lasts longer than 4 hours (priapism) is a medical emergency. Go to an emergency department immediately, even if it is not painful. Untreated, it can cause lasting damage to the tissue of the penis.

Also seek emergency care if you experience chest pain, pain spreading to the arm or jaw, severe dizziness or fainting, a sudden loss of vision in one or both eyes, a sudden loss or decrease of hearing, or an allergic reaction with swelling of the face, lips or throat or difficulty breathing. Tell the emergency team that you have taken sildenafil, vardenafil, tadalafil and apomorphine, and when.

Taking a sublingual dose

Your clinician and the pharmacy label tell you the exact dose and how often you may take it. Each vial is one dose: twist the cap off, empty it under the tongue and hold it there for a moment. Never take more than one vial in the interval your clinician set, and never combine it with another erectile dysfunction medication. Because the tadalafil component stays active for approximately 36 hours, the nitrate warning above applies for at least that long after a dose.¹ If you are admitted to hospital or prescribed a new medication in that window, say that you have taken The Quattro.

What "compounded" means for safety

The Quattro is prepared for you by a US-licensed compounding pharmacy to your clinician's prescription. Compounded medications are not approved or evaluated for safety, effectiveness, or quality by the FDA. The individual actives have each been studied and used as single-ingredient medications; the combination itself has not been evaluated by the FDA. That is why every intake is reviewed by a licensed clinician and why this page exists.

This page does not replace the consultation with your clinician. If you have a question about your own situation, message the care team or ask your own doctor.

1. 1 Based on the pharmacology of the individual actives; individual response varies. Compounded medications have not been evaluated by the FDA. The Quattro is not a generic version of Viagra or Cialis and has not been shown to be equivalent to them. Viagra and Cialis are trademarks of their owners; Vyro Health is not affiliated with them.