What Is Quattro? The Four-Ingredient Sublingual ED Combination, Explained
Quattro puts four prescription medications into a single dose that dissolves under the tongue. Here is what each one is, what the research on each says, and what is still unknown about combining them.
The short version
- Quattro is a compounded, prescription-only sublingual dose made by Vea Health's partner 503A pharmacy.1
- It combines three PDE5 inhibitors (sildenafil, tadalafil, vardenafil) with apomorphine, a dopamine agonist.1
- Each ingredient has been studied on its own. The four-way combination has not been studied in a clinical trial.2
- A licensed clinician reviews your health history and sets the dose. Compounded drugs are not FDA-approved.3
Most erectile dysfunction prescriptions are a single medication: one sildenafil tablet, or one tadalafil tablet. Quattro, from the telehealth company Vea Health, takes a different approach. It combines four medications in one sublingual dose, prescribed by a licensed clinician and compounded for the individual patient.1 That design raises fair questions, so this guide covers what is in it, where each ingredient's evidence comes from, and where the evidence stops.
The four ingredients
| Ingredient | Drug class | What the FDA label or trial data says |
|---|---|---|
| Sildenafil | PDE5 inhibitor | Approved tablet is taken about an hour before sexual activity; half-life about 4 hours2 |
| Tadalafil | PDE5 inhibitor | Approved tablet improved erectile function for up to 36 hours after a dose4 |
| Vardenafil | PDE5 inhibitor | Approved in tablet and orally disintegrating forms5 |
| Apomorphine | Dopamine agonist | Acts in the brain rather than on blood flow; studied as a sublingual tablet for ED6 |
Why three PDE5 inhibitors?
Sildenafil, tadalafil and vardenafil all work by blocking the same enzyme, PDE5, which lets blood vessels in the penis relax in response to sexual stimulation. None of them causes an erection without arousal.2,4 Where they differ is timing. Sildenafil is a shorter-acting drug,2 while tadalafil's effect lasts much longer.4 Combining drugs with different timing profiles is the reasoning behind formulas like Quattro.
Why apomorphine?
Apomorphine is different from the other three. It is a dopamine agonist that acts on arousal pathways in the brain. In a double-blind European trial of a sublingual apomorphine tablet, the drug was compared against placebo in men with ED, and nausea was the most common side effect.6 Sublingual apomorphine is not sold as an FDA-approved ED drug in the United States, so in the U.S. it is available for this purpose only through compounding.
What "compounded" means
Quattro is made by a state-licensed 503A compounding pharmacy for a specific patient, based on a prescription.1 Compounding lets a pharmacy combine drugs or use a dosage form that is not commercially available. The tradeoff is that compounded drugs are not FDA-approved: the FDA has not reviewed the specific formula for safety, effectiveness or quality.3 That is true of every compounded combination in this category, not just Quattro.
What the research does not cover
Each of Quattro's four ingredients has its own published evidence. The combination does not. The FDA-approved label for sildenafil states that the safety and efficacy of combining it with other ED treatments have not been studied and that such combinations are not recommended.2 A compounded combination is therefore a prescribing decision made by a clinician for an individual patient, not a standard treatment backed by a combination trial. That is the most important thing to understand before choosing any multi-drug ED formula, and it is a good question to put directly to the prescribing clinician.
Why the dose is under the tongue
Quattro is dispensed as single-use sublingual doses.1 A sublingual dose dissolves in the mouth instead of being swallowed. Apomorphine is the clearest case for this format, since it was developed and studied as a sublingual tablet.6 For the PDE5 inhibitors, vardenafil is already sold in an orally disintegrating form.5
Who should not take it
Anyone who uses nitrates, such as nitroglycerin for chest pain, cannot take any PDE5 inhibitor.2 Men taking alpha-blockers, men with significant heart disease, and men who have been told sexual activity is unsafe for them need a careful review first.2,4 ED can also be an early sign of cardiovascular disease, which is why the American Urological Association recommends a medical evaluation as part of ED care.7 The intake questionnaire exists to catch these issues, and the clinician can decline to prescribe.
Considering Quattro?
Quattro is prescribed only after a licensed clinician reviews your health history, and you are not charged unless a clinician approves the prescription.
See if Quattro is right for you →Sponsored. Quattro is compounded by a state-licensed 503A pharmacy for an individual patient. Compounded drugs are not FDA-approved and have not been reviewed by the FDA for safety or effectiveness. Prescription required; subject to clinician approval.
Frequently asked questions
What is in Quattro?
Quattro combines four prescription medications in one sublingual dose: sildenafil, tadalafil and vardenafil, which are PDE5 inhibitors, plus apomorphine, a dopamine agonist.
Is Quattro FDA-approved?
No. Quattro is compounded by a state-licensed 503A pharmacy for an individual patient. Compounded drugs are not FDA-approved and have not been reviewed by the FDA for safety or effectiveness.
Has the Quattro combination been studied?
Each ingredient has been studied on its own, but the four-drug combination has not been tested in a clinical trial. A clinician decides whether it is appropriate for an individual patient.
Do I need a prescription for Quattro?
Yes. A licensed clinician reviews an online health questionnaire and must approve the prescription before anything is dispensed.
Keep reading
Sources
- Vea Health. Quattro. Accessed October 9, 2026.
- Pfizer. VIAGRA (sildenafil citrate) prescribing information. DailyMed, U.S. National Library of Medicine.
- U.S. Food and Drug Administration. Compounding and the FDA: Questions and Answers.
- Eli Lilly. CIALIS (tadalafil) prescribing information. DailyMed, U.S. National Library of Medicine.
- Vardenafil hydrochloride prescribing information. DailyMed, U.S. National Library of Medicine.
- Dula E, et al. Double-blind, crossover comparison of 3 mg apomorphine SL with placebo and with 4 mg apomorphine SL in male erectile dysfunction. Eur Urol. 2001. PubMed 11464037.
- American Urological Association. Erectile Dysfunction (ED) Guideline.
Advertising disclosure. Men's Health Insider is published in partnership with Vea Health, which makes Quattro, the product covered on this page. We may earn compensation when readers buy through links here. Nothing on this site is medical advice; a licensed clinician should decide what is right for you.