Powerhouse Rx 3-in-1
Two PDE5 inhibitors is still a pairing without evidence — but every dose here sits inside its own envelope.
An unapproved combination, but each component sits inside its own approved dosing envelope. The pairing lacks evidence; the individual doses are not the problem.
- Price
- Price not published
- Verdict
- Proceed carefully
- Sourcing
- Read at source
- Last checked
- 2 August 2026
Read this first
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Two different PDE5 inhibitors stacked in a single tablet, plus a third drug that has never been approved for erectile dysfunction in the United States. No approved product combines two PDE5 inhibitors, and there is a reason for that.
What the company states
- Active ingredients
- Tadalafil 5mg, vardenafil 10mg, apomorphine 2mg
- Format
- Sublingual tablet, dissolved under the tongue
- Dosing
- “Take 15–30 minutes before sexual activity.” As-needed. “Do not take more than one dose in 24 hours.”
- FDA status
- Keeps states: “Powerhouse Rx 3-in-1 is a compounded medication and has not been approved by the FDA as a finished drug product.”
- Stated side effects
- Headache, flushing, nasal congestion, nausea, indigestion and dizziness
Our assessment
The first two ingredients are the story. Tadalafil and vardenafil are both PDE5 inhibitors — the same class, the same enzyme, the same mechanism. Every approved product in this category contains exactly one of them. There is no approved combination of two, no published trial establishing that pairing them helps, and no dosing guidance to fall back on if it goes wrong.
Combining two drugs of one class does not usually produce a new capability. It produces the same effect with additive risk, and PDE5 inhibitors carry a specific risk that is dose-related: a drop in blood pressure. That is why the class has a hard contraindication with nitrates and warnings about alpha-blockers.
Potency makes the stack harder to reason about, not easier. Vardenafil is substantially more potent per milligram than sildenafil — Boston University's sexual medicine group puts it at nearly ten times more biochemically potent — so 10mg of vardenafil is not a token addition alongside the tadalafil. Two active PDE5 inhibitors are present in meaningful quantity.
Then the durations diverge. Vardenafil is a short-acting drug taken before sex; tadalafil has a half-life of about 17.5 hours and is what daily dosing regimens are built on. Combining them means the vardenafil effect fades while tadalafil is still circulating well into the next day. If you develop a problem, you cannot tell which drug caused it, and you cannot stop one without stopping both.
The third ingredient is apomorphine, at 2mg, and it is the most defensible thing in the tablet. It acts centrally on dopamine pathways involved in arousal rather than on penile blood flow, so unlike the other two it is not a fourth go at the same enzyme. Sublingual apomorphine was licensed in Europe for erectile dysfunction as Uprima and Ixense at 2 to 3mg — this route, this dose — with pooled trial data showing erections firm enough for penetration in about 54 per cent of attempts against 34 per cent on placebo. It withdrew from the market for commercial reasons rather than safety ones. It is not approved for this use in the United States, so its use here is off-label, and nausea is its characteristic dose-limiting effect.
One thing Keeps does properly: it states plainly that the product is compounded and not FDA-approved, lists the expected side effects, and points to MedWatch for adverse-event reporting. That is more candour than [several competitors](/malemd-knockout-reviews) manage, and it deserves saying. It does not resolve the pharmacology.
If the goal is a fast on-demand drug, vardenafil alone is approved and available. If the goal is coverage into the following day, [tadalafil alone](/generic-sildenafil-tadalafil-reviews) is approved, available, and costs about a dollar a tablet. The stack buys nothing that a single approved molecule does not already provide.
Reasonable for
- Men whose prescriber has weighed a central agent alongside a peripheral one and wants both
- Men who have already established that a single approved PDE5 inhibitor at a proper dose does not suit them
Not for
- Anyone taking nitrates in any form — absolutely contraindicated, and doubly so with two PDE5 inhibitors present
- Men on alpha-blockers or other blood-pressure medication
- Anyone who has not discussed this specific combination with a physician who knows their cardiovascular history
- Men who have not first tried a single approved PDE5 inhibitor at a proper dose
Important
The information on this website is provided for general education and does not constitute medical advice, diagnosis, or treatment. Erectile dysfunction can be the first sign of cardiovascular disease, diabetes, or hormonal disorders. Always consult a licensed physician about your individual circumstances, and never start, stop, or change a prescription based on what you read here.
If you want the other thing
A diagnosis, rather than a subscription.
If you have already been assessed and just need a refill, this may serve you well. If nobody has taken your blood pressure in years, that is the appointment to make.