Sexual Health Medication Safety Information

PART 1. SEXUAL HEALTH MEDICATION SAFETY INFORMATION

Last updated: October 6, 2026 | Version 1.0

1. Emergency information

Do not wait for a reply by email, chat, text message or the patient portal.

Tell emergency staff which medicine you took and when you took your last dose. Heart medicines called nitrates, such as nitroglycerin, can cause a dangerous drop in blood pressure in a person who has taken sildenafil or tadalafil. Do not take a nitrate unless a medical professional who knows about your dose tells you to.

If you may have taken too much medicine, call Poison Control at 1-800-222-1222. Call 911 if the person collapses, has a seizure, has trouble breathing or cannot be woken up.

2. About this information

This page gives general safety information for adult men who are prescribed sildenafil or tadalafil through WellPeps, a Wyoming corporation (“WellPeps”). These medicines treat erectile dysfunction (ED), which means trouble getting or keeping an erection. They belong to a group called PDE5 inhibitors. This page does not replace your prescription label, your pharmacy’s paperwork, a Medication Guide or your clinician’s advice.

• WellPeps is not a medical practice or a pharmacy. WellPeps helps you reach telehealth services provided by independent licensed clinicians of OSI Medical Services, P.A. (the “Practice”). WellPeps does not prescribe, compound or dispense medication.
• A licensed clinician decides whether a prescription is medically appropriate for you. A prescription is not guaranteed.
• A state-licensed pharmacy prepares and ships your medication. Your label names it. Pharmacies that fill WellPeps prescriptions: OSI / Scriptful Rx, 433 Plaza Real, Suite 275, Boca Raton, FL 33432.
• Your label comes first. If this page and your label disagree, follow your label and contact your clinician or pharmacy.

3. About your medicine: compounded

WellPeps offers only compounded medications. It does not offer brand-name FDA-approved products. A compounded medicine is made by a state-licensed pharmacy for you, based on your prescriber’s order. Your label and pharmacy paperwork tell you what you have. If you have a question, ask the pharmacy before your first dose.

• Compounded medicines are not FDA-approved. FDA does not review them for safety, effectiveness or quality before they are sold.
• A compounded medicine is not the same as, equivalent to or interchangeable with an FDA-approved product, even when the active ingredient has the same name. The strength, form and how fast it is absorbed can be different.
• FDA-approved sildenafil and tadalafil products are not offered by WellPeps. They may be available through another provider and pharmacy. You can ask your clinician about your options at any time.
• Every warning on this page applies to your medicine. See also the Compounded Medication Disclosure and Consent.

4. Before you start, tell your clinician if you

Answer every health question fully and truthfully. A medicine can be unsafe for you if your answers are incomplete. Tell your clinician if you:

• take any nitrate medicine in any form, use “poppers,” or take riociguat (see section 5).
• have had a heart attack, a stroke or a dangerous heart rhythm, or have chest pain (angina) or heart failure.
• get chest pain or tightness, shortness of breath, dizziness or fainting with ordinary activity, such as climbing stairs or walking fast, or during sex.
• have low blood pressure, or high blood pressure that is not well controlled, or take blood-pressure medicine or an alpha-blocker.
• have ever had sudden vision loss in one eye, an inherited eye disease called retinitis pigmentosa, or sudden hearing loss.
• have had an erection that lasted too long, a curved or scarred penis (Peyronie’s disease), or sickle cell anemia, multiple myeloma or leukemia.
• have kidney or liver disease (including dialysis), a bleeding disorder or a stomach ulcer.
• have trouble urinating, blood in your urine or an enlarged prostate.
• take HIV medicine, an antifungal, an antibiotic, any other prescription or over-the-counter medicine, a supplement or a recreational drug.
• use any other ED product, or any product with sildenafil or tadalafil that is sold for a lung condition.
• have ever had an allergic reaction to sildenafil, tadalafil or any ingredient in your medicine.

5. Key warning: never mix with nitrates, riociguat or poppers

• Nitrates include nitroglycerin (tablets, sprays, patches and ointments), isosorbide mononitrate and isosorbide dinitrate. They are often used for chest pain. This applies whether you use them every day or only sometimes.
• Poppers are inhaled recreational drugs (amyl nitrite or butyl nitrite).
• Riociguat is a prescription medicine for certain lung blood-pressure problems.
• If you are not sure whether a medicine is a nitrate, ask your clinician or pharmacist before your first dose.

If you have chest pain after a dose, do not take a nitrate unless hospital or emergency staff, who know your dose and when you took it, tell you to. In a life-threatening situation where a nitrate is considered medically necessary, enough time must pass after your last dose first, and a nitrate should be given only with close medical supervision. Tell emergency staff which medicine you took and when you took it. They will decide what is safe.

6. Your heart and sexual activity

Sex is physical activity and puts extra strain on the heart. ED can also be an early sign of a heart or blood vessel problem. Before prescribing, your clinician checks your heart-related risk. They ask about your heart health, blood pressure, medicines and how you handle ordinary activity, to decide whether sexual activity is safe for you and whether these medicines are appropriate.

• Your clinician may ask for more information, a blood-pressure reading, test results, a visit with your own doctor or a heart specialist, or an in-person exam before deciding.
• Your clinician may decline to prescribe, or may stop your medicine, if sexual activity may not be safe for you or if you cannot complete this screening.
• A telehealth visit does not include a physical exam, so your honest answers matter.
• You must tell your clinician right away (message in the patient portal, or call 911 if severe) if you have chest pain, fainting or near-fainting, a very fast or irregular heartbeat, or new trouble with ordinary activity, such as shortness of breath or chest discomfort when you climb stairs. Report this before you start and at any time while you take the medicine.
• If you get chest pain, dizziness, nausea, or pain in your arm, neck or jaw during sex, stop and call 911.

7. Serious symptoms: stop and get help

Risk of sudden vision loss may be higher if you have had it before, have a crowded optic disc, are over 50, or have diabetes, high blood pressure, heart disease, high cholesterol or smoke. Tell your clinician if any of these apply.

8. Other medicines, alcohol and health conditions

Tell your clinician and pharmacist about every medicine you use before you start, and each time something changes. Do not start a new medicine, supplement or recreational drug without checking first.

• Alpha-blockers and other blood-pressure medicines. Alpha-blockers (such as doxazosin, terazosin, tamsulosin, alfuzosin and silodosin) and other blood-pressure medicines can lower your blood pressure too much when combined with a PDE5 inhibitor, especially when either is new. Your clinician may decide this combination is not right for you. Follow your clinician’s instructions and your pharmacy label.
• Medicines that raise the level of your medicine (CYP3A4 inhibitors). These include some HIV medicines (such as ritonavir), some antifungals (such as ketoconazole and itraconazole), some antibiotics (such as clarithromycin and erythromycin), and grapefruit or grapefruit juice. Other medicines (such as rifampin and some seizure medicines) can make your medicine work less well. Do not start or stop any of these without telling your clinician.
• Alcohol. Drinking a lot of alcohol while you take these medicines can cause dizziness, a fast heartbeat, headache and low blood pressure. Ask your clinician what is safe for you.
• Other ED products. Do not combine sildenafil and tadalafil, and do not use any other ED product, unless your clinician tells you to in writing. Some products with sildenafil or tadalafil are sold for lung conditions. They are also PDE5 inhibitors. Do not take them with your ED medicine.
• Kidney or liver disease. These conditions can raise the level of medicine in your body. Your clinician may choose a different plan or extra caution.

9. Sildenafil and tadalafil: what is different

• Sildenafil (as needed) is taken only when you plan sexual activity, as your label says. Do not take it more often than your label allows.
• Tadalafil (as needed) stays in your body longer than sildenafil. Its effects, including lower blood pressure and the danger with nitrates, can last much longer than those of sildenafil. Follow your clinician’s instructions and your pharmacy label. Do not take it more often than your label allows.
• Tadalafil (daily) is taken at about the same time every day, whether or not you plan sex. It keeps a steady level in your body, so every warning on this page applies every day, not only on days you have sex. Daily use may not be right if you have kidney or liver problems.
• Never take as-needed tadalafil on top of daily tadalafil. Do not switch between sildenafil and tadalafil, or between daily and as-needed use, on your own. Ask your clinician.

10. Other possible side effects

Common side effects include headache, flushing (a warm, red face, neck or chest), upset stomach or heartburn, a stuffy or runny nose and dizziness. Sildenafil can also cause vision changes, such as blurred vision, a blue tinge to what you see, or sensitivity to light. Tadalafil can also cause back pain, muscle aches and pain in the arms or legs, which often start hours after a dose and usually go away within a couple of days.

For a compounded product, side effects and how often they happen may be different or unknown. This is not a complete list. Contact your clinician about any side effect that is severe, lasts or worries you. Do not drive or use machinery until you know how the medicine affects you.

11. Dosing and use safety

• Use only the medicine, strength, form and directions on your current prescription label. This page gives no doses.
• Never take more than prescribed or more often than prescribed. If a dose does not seem to work, do not take another. Ask your clinician.
• Take the medicine the way your label says: swallowed, chewed or dissolved. Do not split or crush it unless your label tells you to.
• Do not combine sildenafil and tadalafil, or add any other ED product, unless your clinician tells you to in writing.
• Never share your medicine. Do not take anyone else’s. Do not give yours to anyone.
• Do not buy sildenafil, tadalafil or any “male enhancement” product from websites, social media, stores or other sources. Counterfeit pills, and some products sold as “natural” or “herbal,” have been found to contain hidden drugs in unknown amounts. A hidden PDE5 inhibitor can be deadly if you also take a nitrate.
• These medicines work only with sexual stimulation and do not increase desire. They do not protect against sexually transmitted infections, including HIV, and they are not birth control.
• These medicines are not for women or for anyone under 18.

12. Storage and product quality

• Follow the storage directions on your label or in your pharmacy paperwork.
• Keep your medicine out of reach of children and pets. Chewable, dissolvable or flavored forms can look like candy.
• Do not use your medicine if the package is damaged or opened, the label is missing or unclear, it looks, smells or tastes different from your last fill, or it is past the date on the label. Call the pharmacy first.
• If your package arrives late or was left in heat, contact the pharmacy before you use it. See also the Shipping and Delivery Policy.

13. Questions and reporting problems

• Non-emergency medical questions: message your clinician in the patient portal at portal.wellpeps.com.
• Orders, shipping or billing help: [email protected] or (307) 881-8700, during normal business hours. WellPeps support cannot answer medical questions.
• Ingredients, strength, preparation, storage or the date on the label: the pharmacy named on your label.
• To report a side effect or product problem to FDA: MedWatch at www.fda.gov/medwatch or 1-800-FDA-1088. Please also tell your clinician.

14. This is not everything

This page is a summary. It does not list every warning, side effect or interaction. If your prescription label, your pharmacy’s paperwork, a Medication Guide or your clinician’s instructions disagree with this page, follow them and ask your clinician or pharmacy. Read the paperwork that comes with each fill.

PART 2. SEXUAL HEALTH SAFETY ACKNOWLEDGMENT (required form)

Please read the Sexual Health Medication Safety Information (version 1.0, dated October 6, 2026) before checking each box. You can read it again at any time in the patient portal at portal.wellpeps.com. Signing this acknowledgment does not guarantee a prescription. A licensed clinician decides whether treatment is appropriate for you.

☐ 1. I have read the Sexual Health Medication Safety Information. I know I can ask my clinician or the pharmacy questions.

☐ 2. I understand that WellPeps is not a medical practice or a pharmacy, that an independent licensed clinician decides whether I receive a prescription, and that a prescription is not guaranteed.

☐ 3. I understand that my medicine is a compounded medicine, that compounded medicines are not FDA-approved, and that FDA does not review them for safety, effectiveness or quality. I understand that WellPeps does not offer FDA-approved products, which may be available through another provider and pharmacy.

☐ 4. I have answered all health questions truthfully and completely, including about my heart, chest pain, fainting, blood pressure, eyes, hearing, kidneys, liver and every medicine and drug I use. I will tell my clinician right away if anything changes.

☐ 5. I do not take any nitrate medicine (including nitroglycerin) in any form, I do not use poppers, and I do not take riociguat. I understand that taking sildenafil or tadalafil with any of these can be fatal. If this is not true for me, I will not check this box, and I will message my clinician instead.

☐ 6. I understand that my clinician screens my heart-related risk and may ask for more information or tests, or may decline to prescribe. I will tell my clinician right away if I have chest pain, fainting, a very fast or irregular heartbeat, or trouble with ordinary activity.

☐ 7. I know that an erection lasting more than 4 hours, chest pain, sudden vision loss, sudden hearing loss, fainting or a severe allergic reaction are emergencies. I will call 911 and tell emergency staff which medicine I took and when.

☐ 8. I understand that alpha-blockers and other blood-pressure medicines, some HIV medicines, antifungals and antibiotics, grapefruit and heavy alcohol use can affect this medicine. I will tell my clinician about any new medicine before I take it.

☐ 9. I understand that I must use only the medicine, strength and directions on my current label, never take more than prescribed, never combine sildenafil and tadalafil or any other ED product unless my clinician tells me to in writing, never share my medicine and never buy ED medicine from any other source.

☐ 10. I know how to report a side effect or product problem to my clinician, the pharmacy and FDA MedWatch (www.fda.gov/medwatch or 1-800-FDA-1088).

Electronic signature

By typing my name, I agree that my electronic signature is the legal equivalent of my handwritten signature, and that I have already agreed to receive and sign documents electronically. This acknowledgment does not replace the Informed Consent to Telehealth Services and Treatment and does not by itself create a clinician-patient relationship.