MEDVi QUAD Review: 4-in-1 with Apomorphine - What to Know Before Buying

Published 06/04/2026

MEDVi is a telehealth platform offering a compounded prescription ED medication called QUAD, a 4-in-1 sublingual liquid combining sildenafil, tadalafil, apomorphine, and L-citrulline. MEDVi has grown quickly in the ED telehealth market.

Sildenafil and tadalafil are individually FDA-approved for the treatment of erectile dysfunction. Apomorphine is FDA-approved for other indications and is used off-label in this context. L-citrulline is an amino acid that is typically sold as a dietary supplement and is not an FDA-approved drug. MEDVi QUAD is a compounded medication and is not FDA-approved as a finished drug product.

A note on the formula change: Earlier versions of QUAD contained vardenafil (the active ingredient in Levitra) as one of three PDE5 inhibitors. MEDVi changed the formula during 2026, and the current version lists two PDE5 inhibitors (sildenafil and tadalafil) plus apomorphine and L-citrulline. Some third-party reviews still describe the older formula. If you are considering QUAD, confirm the ingredients on your prescription label and with your prescribing clinician.

This article reviews MEDVi's ED offering, how it works, what it contains, its cost, and its pros and cons.

This article is for informational purposes only and should not be taken as medical advice. If you have questions or concerns about your condition or treatment, please consult a healthcare provider.

What Is MEDVi?

What it is: MEDVi is a direct-to-consumer telehealth platform offering prescription compounded ED medication through an online consultation process. After completing an intake form, a licensed clinician reviews your information and, if appropriate, issues a prescription that is filled by a compounding pharmacy and shipped to your door.

What it offers for ED: MEDVi currently offers one ED product, QUAD, a 4-in-1 sublingual liquid combining sildenafil, tadalafil, apomorphine, and L-citrulline.

How much it costs: MEDVi's product page shows monthly pricing starting at approximately $114 to $179 per month, depending on the plan selected. Per-dose pricing is not listed. Full pricing details are presented during the MEDVi intake process.

Pros: Four ingredients in one dose; sublingual liquid delivery; combines blood-flow support with a centrally acting ingredient aimed at arousal; includes ongoing clinician oversight.

Cons: Compounded medication not FDA-approved as a finished product; two PDE5 inhibitors combined in one dose require careful prescriber oversight; L-citrulline has limited clinical evidence for ED; the formula has changed more than once, so older reviews may not reflect the current product; not suitable for all patients.

Good for: Men who have not achieved adequate results from single-ingredient ED medications and are looking for a multi-mechanism approach under clinician supervision.

Not ideal for: Men new to ED treatment who have not yet tried standard single-ingredient sildenafil or tadalafil; men with cardiovascular conditions or those on certain medications that interact with PDE5 inhibitors.

MEDVi's ED Product: QUAD

QUAD is MEDVi's flagship ED product, a compounded sublingual liquid designed to address erectile dysfunction through four ingredients working across different mechanisms.

Ingredients:

Sildenafil (the active ingredient in Viagra): A PDE5 inhibitor that increases blood flow to the penis by blocking the enzyme that breaks down cGMP. Known for faster onset among PDE5 inhibitors.
Tadalafil (the active ingredient in Cialis): A PDE5 inhibitor with a significantly longer half-life than sildenafil, supporting effects for up to 36 hours.
Apomorphine: A dopamine agonist that works on the central nervous system rather than through vascular pathways. It is thought to enhance the brain's arousal response, addressing the neurological component of sexual function that PDE5 inhibitors alone do not target.
L-citrulline: An amino acid the body converts into L-arginine, which is used to produce nitric oxide, a signaling molecule involved in relaxing blood vessels. Clinical evidence for L-citrulline in ED is limited to small studies, mostly in men with mild ED, and it is not an FDA-approved ED treatment.

Formulation: Sublingual liquid (placed under the tongue for absorption through the mucous membranes)

How to take it: Administered under the tongue before sexual activity, as directed by your prescribing clinician

How fast it works and how long it lasts: Sublingual delivery bypasses first-pass metabolism in the liver, theoretically allowing faster absorption than swallowed tablets. Sildenafil provides faster-onset effects; tadalafil extends duration up to 36 hours.

A note on combining PDE5 inhibitors: QUAD combines two PDE5 inhibitors in a single formulation. While sildenafil and tadalafil are each FDA-approved, the combination as a finished product has not been FDA-evaluated. Combining PDE5 inhibitors increases potency and the potential for dose-related side effects. This makes proper clinician evaluation and dosage calibration particularly important before starting QUAD.

How Does MEDVi QUAD Work?

QUAD addresses erectile dysfunction through two main pathways, with L-citrulline as a supporting ingredient.

The two PDE5 inhibitors, sildenafil and tadalafil, work by blocking the phosphodiesterase type 5 enzyme, which normally breaks down cyclic GMP (cGMP) in penile blood vessels. By inhibiting PDE5, these medications allow cGMP to accumulate, relaxing smooth muscle and increasing blood flow to the penis during sexual stimulation. Sildenafil provides faster onset; tadalafil provides extended duration.

L-citrulline acts further upstream in the same pathway. The body converts it to L-arginine, the building block for nitric oxide. Nitric oxide triggers cGMP production, which PDE5 inhibitors then help preserve. In principle, this may modestly support the blood-flow response, but the clinical evidence for this effect is limited.

Apomorphine works through a separate mechanism entirely. As a dopamine agonist, it acts on the brain's dopaminergic pathways, which play a role in sexual arousal and desire. In clinical research, apomorphine has been studied for its ability to support the neurological component of arousal rather than addressing blood flow. The combination of blood-flow support and central arousal support is the defining characteristic of the QUAD formulation.

Side Effects of MEDVi QUAD

Because QUAD combines two PDE5 inhibitors, its potential side effect profile is similar to that of individual PDE5 inhibitors but may be more pronounced due to the combined potency. All side effects should be discussed with your prescribing clinician before starting.

Common side effects of PDE5 inhibitors:

Headache
Flushing
Nasal congestion
Dizziness
Upset stomach or indigestion
Muscle or back pain
Temporary vision changes

Apomorphine-related side effects:

Nausea (most common with apomorphine)
Dizziness
Yawning
Low blood pressure

L-citrulline-related side effects:

Generally well tolerated at supplement doses
Mild stomach upset in some people
May modestly lower blood pressure, which could add to the blood-pressure-lowering effect of PDE5 inhibitors

Rare but serious side effects:

Sudden hearing or vision loss
Severely low blood pressure
Priapism (a prolonged erection lasting more than four hours) requires immediate medical attention

PDE5 inhibitors should not be combined with nitrate medications, other ED drugs not prescribed as part of the same protocol, or certain blood pressure medications. Men with cardiovascular conditions should discuss their full medical history with a provider before starting QUAD.

How to Get a MEDVi Prescription

The process is fully online:

Complete an online medical intake form on the MEDVi website
A licensed clinician reviews your intake information
If appropriate, a prescription is issued and filled by a licensed compounding pharmacy
Your medication is shipped discreetly to your door

How Much Does MEDVi Cost?

MEDVi's QUAD product page shows monthly pricing starting at approximately $114 to $179 per month. The page does not list a per-dose price or the number of doses included at each price point. Full pricing is presented during the consultation process on the MEDVi website.

For reference, single-ingredient generic ED medications (sildenafil or tadalafil) from telehealth providers typically range from $2 to $10 per dose. QUAD's price reflects its multi-ingredient compounded format and bundled consultation management.

Health insurance is not accepted.

MEDVi Reviews and Reputation

MEDVi is a relatively new platform in ED telehealth. The company has grown quickly, with its QUAD product gaining attention as one of the few 4-in-1 compounded ED formulations available. Customer reviews of the product are generally positive among men who report trying it after finding single-ingredient options insufficient.

Note that QUAD's formula has changed during 2026, so reviews written before the change may describe a different product. Prospective customers should review MEDVi's current ingredient list, terms, policies, and any regulatory updates on the MEDVi website before enrolling.

Who Is MEDVi For?

MEDVi QUAD may be worth considering for men who:

Have tried standard single-ingredient sildenafil or tadalafil and found results inconsistent or insufficient
Want a multi-mechanism approach that addresses both the physical blood flow component and the neurological arousal component of ED
Are comfortable with compounded medications and the telehealth prescription model
Are under clinician supervision with appropriate cardiovascular health for PDE5 inhibitor use

Who May Not Want to Choose MEDVi?

Men who are new to ED treatment and have not yet tried single-ingredient monotherapy
Men with cardiovascular conditions, those on nitrates, or those on blood pressure medications that interact with PDE5 inhibitors
Men who prefer FDA-approved finished drug products only

Is MEDVi QUAD FDA-Approved?

No. MEDVi QUAD is a compounded medication. Sildenafil and tadalafil are FDA-approved for ED treatment when prescribed individually. Apomorphine is FDA-approved for other indications. L-citrulline is an amino acid sold as a dietary supplement and is not an FDA-approved drug. The 4-in-1 compounded combination as a finished product has not been FDA-evaluated for safety, efficacy, or quality.

MEDVi Pros and Cons

Pros

Four-ingredient formulation: Combines two PDE5 inhibitors, apomorphine, and L-citrulline to address both vascular and neurological components of ED
Sublingual liquid delivery: Designed for faster absorption than swallowed tablets
Clinician oversight included: Prescription requires licensed clinician review
Multi-mechanism approach: Addresses ED through multiple pathways simultaneously

Cons

Compounded medication: Not FDA-approved as a finished product
Two PDE5 inhibitors combined: Higher combined potency requires careful prescriber calibration; not appropriate for all patients
Limited evidence for L-citrulline: Its contribution to the formula is supported by small studies only
Formula changes: QUAD has been reformulated during 2026, so older reviews and information may not match the current product
Higher monthly cost: Pricing starting around $114 to $179 per month is higher than standard single-ingredient generics

Alternatives to MEDVi for ED

For men interested in a sublingual combination ED treatment with clinician oversight, Rugiet Ready is a sublingual lozenge combining sildenafil, tadalafil, and apomorphine in four dose tiers. Rugiet Ready offers the option to start at a lower strength and adjust as needed, which may be relevant for men who want to titrate carefully. Visit rugiet.com to learn more.

Bottom Line

MEDVi's QUAD product represents a multi-ingredient approach to ED treatment, combining two PDE5 inhibitors, apomorphine, and L-citrulline in a single sublingual dose. A few things worth knowing before you start:

The formula has changed. QUAD no longer contains vardenafil. Confirm the current ingredients on your prescription label before starting.
QUAD is not for men new to ED treatment. It is a compounded combination formulation best suited to men who have already tried and found single-ingredient options insufficient.
Clinician evaluation matters more here than with standard generics. Combining two PDE5 inhibitors requires careful assessment of cardiovascular health and current medications.

If you are considering a sublingual combination ED treatment and want to start with dosage flexibility, Rugiet Ready offers four strength tiers as an alternative worth exploring.