Tadalafil (generic Cialis®)
Oral PDE5 inhibitor
An oral PDE5 inhibitor with a longer duration of action. Depending on the clinical plan, it may be prescribed as needed or on a regular schedule.
Care Path
Sexual Health
Physician-guided care for erectile dysfunction, including generic sildenafil (the active ingredient in Viagra®) and tadalafil (the active ingredient in Cialis®) when they are medically appropriate. Erectile changes can involve circulation, medications, hormones, stress, sleep or other health conditions, so the private visit starts with understanding what is going on.
Independent, physician-owned St. Louis men’s health practicePersonal care from a consistent physician-led teamServing St. Louis and the Metro East1062 Old Des Peres Road, St. Louis, MO 63131314-394-1660
Sexual health at MMi
Private, physician-guided ED care.
Generic sildenafil and tadalafil are prescription medicines that help support erections when they are medically appropriate. Dr. Ted reviews your health history, medications and goals first, then explains which option, if any, fits you.
Desire is different from erectile function. When a diagnosed low testosterone level is affecting desire, it may be addressed alongside ED care—see testosterone therapy. NAD+ therapy is a separate wellness conversation, not an established ED treatment or a required add-on.
Overview
Is this worth evaluating?
Erectile changes are common and they are worth raising. Men most often describe:
- Difficulty getting or keeping an erection, consistently or in certain situations
- A change in sexual desire alongside the erectile change
- Fewer morning or spontaneous erections than before
- Concern that something else — blood pressure, blood sugar, a medication — may be behind it
Erectile dysfunction can be a marker of cardiovascular or other health concerns. That is one of the clearest reasons to have it evaluated rather than treated blindly.
Evaluation
A careful evaluation comes first.
The evaluation is a conversation first. Depending on what you describe, it may cover:
- When the changes began, and whether they are consistent or situational
- Sexual desire, and whether morning or spontaneous erections still occur
- A review of your medications and substance use, including alcohol
- Diabetes, cardiovascular, blood pressure and neurologic history
- Testosterone or other laboratory testing, when clinically relevant
- Your goals, and how comfortable you are with each treatment route
Options
How the options differ
Treatment routes differ in how they are taken, how they are timed and what instruction they require.
Sildenafil (generic Viagra®)
Oral PDE5 inhibitor
An oral PDE5 inhibitor generally taken ahead of anticipated sexual activity. Timing, food and individual health factors can affect how it is used.
TriMix
Compounded intracavernosal injection
A compounded injection containing more than one medicine. It requires a prescription, hands-on instruction in the office, storage guidance and a clear plan for what to do in an emergency.
Compounded and not FDA approved as a combination product.
Safety
Safety, limits and monitoring
A few points here are not negotiable. Read them before any treatment conversation.
- Sildenafil and tadalafil must not be combined with nitrate medications. The combination can drop blood pressure dangerously.
- Other cardiovascular medicines, and alpha blockers in particular, require review before a PDE5 inhibitor is prescribed.
- Common side effects of sildenafil and tadalafil can include headache, flushing, nasal congestion, indigestion and back or muscle aches. Dr. Mimlitz reviews them with you before you start.
- These medicines treat erectile dysfunction. They are not prescribed to enhance performance in men who do not have ED.
- TriMix is a compounded preparation and is not FDA approved as a combination product. Compounded medications are not FDA approved. The FDA does not review compounded drugs for safety, effectiveness or quality before they are marketed, and a compounded preparation is not a generic version of, or equivalent to, an FDA-approved product.
- Erectile dysfunction can be a marker of cardiovascular or other health concerns, which is why evaluation comes before treatment.
Seek care immediately
- Sudden changes in vision or hearing require urgent medical attention.
- An erection lasting four hours or longer is a medical emergency. Seek emergency care.
What to expect
What to expect at MMI
Dr. Mimlitz personally conducts every initial evaluation and follow-up visit.
MMI is independent and physician-owned, so the MMI care team coordinating your care knows your plan, communicates clearly and supports consistent follow-through without corporate layers in between. Decisions are made individually by the physician who knows your history.
- 01
Schedule an evaluation
Tell us what you are noticing. We schedule a focused visit rather than a rushed one.
- 02
Review symptoms and labs
Dr. Mimlitz reviews your history, symptoms and lab work with you and explains what they mean.
- 03
Agree on a plan
If treatment is appropriate, you leave understanding the options, the tradeoffs and the next step.
- 04
Follow through
Care is adjusted over time based on how you feel and what your follow-up labs show.
Questions to bring to your visit
- Could one of my current medications be contributing to this?
- Does anything in my evaluation suggest a broader health issue worth pursuing?
- How do the oral options differ for someone with my history?
- What would need to be true before an injectable option is considered?
Related care
- Testosterone therapy
Diagnosed low testosterone can affect desire, and may be addressed alongside ED care.
- NAD+ therapy
A separate wellness conversation. Not an established ED treatment or a required add-on.
- How care works
What a first visit at MMI involves, and what happens after it.
- Answers Center
A developing, physician-reviewed library. Articles are published as Dr. Mimlitz reviews them.
A straightforward conversation. Man to man.
Questions about desire or sexual performance can be personal. Bring them to a straightforward conversation with Dr. Ted.
Easy refills
Already an MMi patient? Call or text our staff to request your refill.
Clinical references
This page is general education, not medical advice, and it is not a substitute for an evaluation. The information here draws on the primary sources below.
- Tadalafil prescribing information — DailyMed (opens in a new tab)
- Sildenafil prescribing information — DailyMed (opens in a new tab)
- American Urological Association: Erectile dysfunction guideline (PDF) (opens in a new tab)
- FDA: Compounding and the FDA — questions and answers (opens in a new tab)