Four-in-one sublingual · Provider review
MEDVi QUAD review: the per-dose price only holds if you finish the pack
QUAD is a compounded sublingual formula with four active ingredients, sold as 5 doses for $114 or 10 for $179. Those work out to $22.80 and $17.90 a dose — figures that assume something about your month that is probably not true.
Published · Rates as published by MEDVi on that date · Editorial score 9.2 out of 10
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The larger pack is marketed as a saving of roughly 22% per dose, and at face value that is correct: $17.90 against $22.80. The arithmetic only works at full utilisation, though — ten doses supplied and ten doses used. ED medication use is episodic rather than scheduled, so the more useful figure is cost per dose actually taken.
Recomputed that way, the 10-dose plan does not beat the 5-dose rate until you are using eight doses a month. At six or seven doses you have no choice but the larger pack — the smaller one cannot supply them — but you are paying $29.83 and $25.57 per dose used, well above the $22.80 the small pack charges, despite the discount on the label.
The short answer
- Best value for most
- The 5-dose plan at $114. $22.80 a dose with the consultation and shipping inside it, and no waste if your month is quieter than planned.
- When to size up
- At eight doses a month, not six. Eight of the ten doses used puts the larger pack at $22.38 — the point where the discount becomes real rather than nominal.
- What you are paying for
- The desire pathway and the 36-hour window. A generic sildenafil prescription is far cheaper and FDA-approved as sold. The premium here buys PT-141 and tadalafil coverage that sildenafil alone does not provide.
Cost per dose actually used
Each row assumes you buy the plan and use the stated number of doses that month. A dash means the pack cannot supply that many. The crossover is the row where the 10-dose column first drops below $22.80.
| Doses used | 5-pack ($114) | 10-pack ($179) | Cheapest plan that supplies it |
|---|---|---|---|
| 3 doses | $38.00 | $59.67 | 5-pack |
| 4 doses | $28.50 | $44.75 | 5-pack |
| 5 doses | $22.80 | $35.80 | 5-pack |
| 6 doses | — | $29.83 | 10-pack |
| 7 doses | — | $25.57 | 10-pack |
| 8 doses | — | $22.38 | 10-pack |
| 10 doses | — | $17.90 | 10-pack |
Annualised, the two plans are $1,368 and $2,148. The $780 difference is worth spending only if your genuine monthly usage is at the top of the table — and the honest way to find that out is to run the smaller plan for two months first and count. If the count comes back at two or three doses, a per-dose program is the structurally cheaper answer and no monthly plan will beat it.
What the four ingredients each do
“Four-in-one” is a marketing phrase that happens to describe something real here. Two of the four are PDE5 inhibitors doing related jobs at different durations; one is a peptide working on an entirely separate mechanism; one is a precursor supporting the vascular pathway.
| Ingredient | Pathway | What it contributes |
|---|---|---|
| PT-141 (bremelanotide) | Central nervous system | Acts on melanocortin receptors — the desire and arousal side, which no PDE5 inhibitor addresses |
| Sildenafil | Vascular | The PDE5 inhibitor in Viagra; drives the blood-flow response and peak firmness |
| L-citrulline | Vascular (support) | A nitric oxide precursor, included to support the same blood-flow pathway sildenafil works on |
| Tadalafil | Vascular (duration) | The PDE5 inhibitor in Cialis; the reason the response window is quoted at up to 36 hours |
The genuinely differentiated component is PT-141. Sildenafil and tadalafil address blood flow, which is the mechanism a standard prescription already covers; the National Institute of Diabetes and Digestive and Kidney Diseases describes erectile dysfunction as frequently having psychological as well as vascular contributors, and desire is the part a PDE5 inhibitor leaves untouched. If a standard tablet has produced a technically adequate but unsatisfying result, that is the gap this formula is aimed at.
Two PDE5 inhibitors in one dose is the clinical point to raise at intake, not a footnote. Sildenafil and tadalafil act on the same enzyme, both are contraindicated with nitrates, and the combined effect is what your prescriber is calibrating. Disclose your full medication list and cardiovascular history.
Compounded, and what that means here
QUAD is compounded, which is what allows four actives in one sublingual dose in the first place — no manufacturer sells this combination as a finished product. The trade-off is regulatory. The FDA does not review compounded drugs for safety, effectiveness or quality before they reach patients, and MEDVi does not publish a fixed milligram specification because each bottle is prepared to the concentrations your clinician specified.
Practically, that means the dosing sheet in your box is the only authoritative document about what you are taking, and it is worth reading rather than filing. It also means cross-provider comparisons of “the same” formula are looser than they look — the DirectMax triple-action tablet uses a different combination and a different delivery format, and neither publishes strengths.
What QUAD does well
- Four ingredients covering desire, firmness, blood flow and duration in one dose
- Sublingual delivery, with onset quoted at 10 to 15 minutes
- Response window of up to 36 hours from the tadalafil component
- Both plan prices published before intake, consultation and shipping included
- Clinician-calibrated dosing — concentrations can be adjusted on a partial response
- No in-person visit and no insurance required
Where it falls short
- The advertised per-dose saving assumes you finish the pack every month
- Compounded, so not FDA-approved as a finished product
- No published milligram strengths to compare against other providers
- Stacks two PDE5 inhibitors, which narrows who is eligible
- Substantially more expensive than a generic sildenafil prescription
- Unused doses in a light month are money already spent
How the program runs
- Complete the online intake covering health history, medications and cardiovascular risk
- A licensed US physician reviews your case and decides whether you are a candidate
- On approval, a licensed compounding pharmacy prepares your bottle to the prescribed concentrations
- The order ships discreetly with a dosing sheet specific to your prescription
- Report a partial response to the clinical team — concentrations can be adjusted rather than doubled up
Who it suits
Men who have tried a single-ingredient PDE5 inhibitor and found the result mechanically fine but incomplete — that is the specific gap PT-141 is in the formula to address. It also suits anyone who wants a fast-onset option without the 30-to-60-minute planning window a swallowed tablet imposes.
It suits two groups poorly. Anyone for whom generic sildenafil already works reliably is paying a large premium for pathways they do not need. And anyone using one or two doses a month is paying $57.00 or more per dose used — at that frequency, look across the ED provider rankings at per-dose pricing instead of a monthly plan.
The verdict
QUAD is one of the better-constructed compounded ED formulas available by telehealth. The ingredient logic holds together, the sublingual format delivers a real onset advantage, both prices are published before intake, and the consultation and shipping are inside the rate rather than bolted on.
The pricing presentation is where it is weakest. A 22% per-dose saving that requires perfect pack utilisation to materialise is a marketing figure, and the plan most buyers should start on is the smaller one regardless of what the discount badge says.
Strong recommendation for men whose problem is not purely vascular, on the 5-dose plan first. Move up only after two months of counting actual doses. Before enrolling, confirm your ingredient concentrations, nitrate and cardiovascular screening, and whether unused doses carry forward.
MEDVi QUAD: common questions
How much does MEDVi QUAD cost?
Two plans: five doses at $114 a month, or ten doses at $179 a month. That is $22.80 and $17.90 per dose respectively, and both include the clinician consultation and discreet shipping. Over a year the plans run $1,368 and $2,148.
Is the 10-dose plan actually better value?
Only if you use at least eight of the ten doses. At eight doses the larger pack works out at $22.38 per dose used, just under the five-pack rate of $22.80. At six doses it is $29.83 per dose used — about 31% worse than the small pack. The advertised 22% saving assumes you finish the pack every month.
What is in MEDVi QUAD and why four ingredients?
PT-141, sildenafil, L-citrulline and tadalafil. The logic is coverage: PT-141 works centrally on desire, sildenafil and tadalafil are PDE5 inhibitors working on blood flow and duration, and L-citrulline supports nitric oxide production. A single-ingredient prescription only addresses the vascular pathway, so the four-way formula is aimed at men for whom that alone has not worked.
Why does a sublingual dose work faster than a tablet?
A sublingual formula absorbs through the mucous membranes under the tongue and enters the bloodstream directly, bypassing the digestive tract and first-pass liver metabolism. MEDVi quotes onset in 10 to 15 minutes against the 30 to 60 minutes typical of a swallowed pill.
Is MEDVi QUAD FDA-approved?
No. QUAD is a compounded medication prepared by a licensed pharmacy for an individual patient, and compounded preparations are not FDA-approved as finished products. Sildenafil and tadalafil are FDA-approved molecules with extensive trial data, and PT-141 is approved as Vyleesi for low sexual desire in premenopausal women — but the QUAD combination itself has not been through FDA review.
What dose am I actually getting?
There is no published milligram list, because each bottle is compounded to the concentrations your reviewing clinician specifies. Two men on the same plan can be on different strengths. The dosing sheet shipped with your order is the authoritative document for your prescription — ingredient amounts quoted in forums describe somebody else's script.
Are two PDE5 inhibitors in one dose a problem?
It is the thing to raise at intake. Sildenafil and tadalafil work on the same enzyme, so the combined vasodilatory effect is what your clinician is calibrating around. Both are contraindicated with nitrates, and the combination warrants a full disclosure of your medication list and cardiovascular history before a prescription is issued.
What are the common side effects?
Typically mild and dose-related: headache, facial flushing, nasal congestion and some nausea — the nausea being more associated with the PT-141 component. Because the formula stacks two PDE5 inhibitors, report any dizziness or light-headedness to the clinical team rather than adjusting your own dose.
How does MEDVi QUAD compare with a generic sildenafil prescription?
Generic sildenafil is dramatically cheaper and is FDA-approved as sold. QUAD costs more and is compounded, and what the premium buys is the desire pathway PT-141 addresses plus the 36-hour window tadalafil provides. If plain sildenafil already works reliably for you, there is no clinical argument for switching.
Keep comparing
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Disclaimers and methodology
Medical content is informational only and does not replace professional diagnosis, treatment, or emergency care.
Some links are affiliate links and may generate commission at no extra cost to you.
Pricing reflects what MEDVi published on the date above and changes frequently. Per-dose figures are calculated from the published plan rates; the "cost per dose used" table assumes the plan is purchased in full regardless of how many doses are taken. Confirm current pricing and whether unused doses carry forward before enrolling.
eRxDoctor is an independent publisher. It is not a medical provider, is not affiliated with or endorsed by MEDVi QUAD, and does not sell treatment. Read our ranking methodology.