Licensed US clinicians · 503A compounding pharmacy · Ships to all 50 states
RIVO
Health
VAST 4-in-1 · Sublingual · Prescription only
$114/month
$228
Save 50% on your first month
No in-person doctor visit required. Complete a short online health form, a licensed US clinician reviews it the same day, and approved treatment ships to your door in discreet, unbranded packaging.
Onset in under 10 minutes for most men
Active window up to 36 hours from one dose
No needles, no water, nothing to swallow
If you don't qualify, you don't pay
Sublingual tablet · 1 per dose
VAST 4-in-1
Rx
ONLY
Apomorphine
Works on desire — the signal that starts everything
Vardenafil
Rapid onset — the reason it moves in minutes
Sildenafil
Peak strength through the window that matters
Tadalafil
Duration — carries the dose up to 36 hours
Compounded to prescription by a US 503A licensed pharmacy. Dosing is set by your clinician based on your health form. Compounded medications are not FDA-approved.
Why one compound isn't enough
Failure 1
It takes too long
A swallowed tablet has to clear your stomach first. Eat a real dinner beforehand and you can be waiting an hour or more — long past the moment.
Failure 2
The head isn't in it
Blood flow is only half the equation. If desire isn't there, a PDE5 tablet has nothing to work with — which is why so many men say "it just didn't do anything."
Failure 3
The window closes early
Four hours of coverage means watching the clock instead of the person next to you. Miss it, and you're dosing again tomorrow.
The formula
01 · Desire
Apomorphine
Acts centrally rather than on blood flow. It addresses the part standard ED tablets ignore completely: wanting it in the first place.
02 · Speed
Vardenafil
The fastest-moving compound in the formula. Absorbed sublingually, it's the reason most men feel VAST working in under 10 minutes.
03 · Strength
Sildenafil
The most studied ED compound in the world, carrying peak firmness through the hours you actually care about.
04 · Duration
Tadalafil
The long tail. One dose stays active for up to 36 hours, so a Friday night doesn't need a second dose on Saturday morning.
One dose, mapped
What the next 36 hours look like
Desire
Rapid onset
Peak strength
Duration — up to 36 hours
Dose
1 hr
4 hr
12 hr
24 hr
36 hr
36 hr
Onset and duration ranges are typical and depend on your dose, your health history and what else is in your system. Your clinician sets your dose. Never take VAST with nitrates or another ED medication.
Fast online prescription process. No in-person visit, no waiting room. Discreet home delivery in 2–3 days once approved.
Where it sits
When tablets stop working, the next thing most men get offered is Trimix — a medication you inject into the penis before sex. Here's the honest comparison.
Text
VAST 4-in-1
Generic tablets
Trimix injection
How you take it
Dissolves under the tongue
Swallowed with water
Injected into the penis before sex
Active compounds
Four, each with a different job
One
Three, vasodilators only
Typical onset
Under 10 minutes
30–60 minutes, longer after food
5–20 minutes
Active window
Up to 36 hours
4–6 hours (sildenafil)
30–60 minutes per injection
Affected by a heavy meal
No — bypasses the stomach
Yes, significantly
No
Addresses desire
Yes — apomorphine
No
No
Refrigeration & supplies
None — pocket-sized
None
Cold storage, syringes, sharps disposal
Discretion
Take it in the bathroom in 60 seconds
Needs water and a head start
Requires privacy and preparation
Comparison reflects typical use of each treatment type. Trimix and generic tablets remain appropriate options for many men — your clinician will advise on what fits your history.
Start to doorstep
Answer the health form
Around two minutes online, covering your symptoms, medications and medical history. No video call to schedule and no in-person doctor visit required.
A licensed clinician reviews it
Same-day review by a US-licensed clinician through our prescriber network. If VAST is right for you, they write the prescription and set your dose.
It ships to your door
Compounded by a US 503A pharmacy and delivered in 2–3 days in plain, unbranded packaging. Nothing on the box says what's inside.
Pricing
Starter
5 doses
$79
$15.80 per dose
Try it once
Most chosen
Monthly
10 doses
$114
$11.40 per dose · billed monthly
Save 50% today
Best value
20 doses
$60
From $3 per dose
Lowest cost per dose
You're charged after a clinician approves you — not before.
If you don't qualify, you don't pay.
Complete the health form at no cost. If a clinician decides VAST isn't appropriate for you, there's no charge and they'll tell you what may be.
From men on the program
★★★★★
Tablets always meant planning an hour ahead and skipping dinner. This one goes under my tongue and I stop thinking about it. That's the part I didn't expect.
Marcus D.
Verified customer
★★★★★
My doctor had already brought up injections and I wasn't going near that. Filled in the form on a Tuesday, had it Friday, and it worked the first time.
Ray T.
Verified customer
★★★★★
The whole thing took about two minutes and nobody had to look me in the eye. Box arrived with nothing on it. Wish I'd done it two years ago.
Jonathan P.
Verified customer
Individual experiences. Results vary and are not guaranteed.
Before you start
No. The entire process is online. You complete a health form, a US-licensed clinician reviews it the same day, and if appropriate they write your prescription. There's no in-person visit and no video appointment to schedule.
VAST is a compounded medication, prepared for you by a US-licensed 503A pharmacy against your prescription. Compounded medications are not FDA-approved, though the individual active compounds are well established and widely prescribed. Your clinician will explain what that means for you.
Packaging is plain and unbranded, with nothing on the outside indicating what's inside or that it came from a telehealth provider. Billing appears under a neutral descriptor.
Because it dissolves under the tongue, VAST bypasses digestion. Most men feel it within about 10 minutes rather than the 30–60 minutes a swallowed tablet typically needs. Food doesn't slow it down the way it slows a standard tablet.
Message your care team. Dosing is adjustable, and your clinician can change your strength or recommend a different treatment from RIVO's men's health range. You aren't stuck with the first thing you're prescribed.
Anyone taking nitrates or nitric oxide donors, anyone on a guanylate cyclase stimulator such as riociguat, and anyone with certain heart, blood pressure, liver, kidney or eye conditions. Never combine VAST with another ED medication. The health form is designed to catch these — answer it honestly.
Yes. Message your care team and they'll adjust your plan, change your pack size, delay a shipment or stop treatment. Because this is a prescription, a clinician may want a short conversation first to make sure nothing is being missed.
All 50 states, through our US-licensed prescriber network and compounding pharmacy partner.
Important safety information
VAST is available by prescription only, following review by a licensed clinician. It is a compounded medication and is not FDA-approved. It does not protect against sexually transmitted infections.
Do not take VAST if you take nitrates in any form (including nitroglycerin, isosorbide, or amyl nitrite "poppers"), or a guanylate cyclase stimulator such as riociguat. Combining them can cause a sudden, unsafe drop in blood pressure.
Do not combine VAST with any other ED medication, prescription or otherwise. Tell your clinician about every medication and supplement you take, including alpha blockers and blood pressure medication.
Common side effects can include headache, flushing, nasal congestion, indigestion, dizziness, nausea and back or muscle pain. Alcohol can make dizziness and low blood pressure worse.
Seek immediate medical attention for an erection lasting more than four hours, sudden vision or hearing loss, chest pain, or fainting. Call 911 in an emergency.
This page is for information only and is not medical advice. Only a licensed clinician who has reviewed your health history can decide whether VAST is appropriate for you.
Last step
No in-person doctor visit. Fast online prescription process. Discreet home delivery.
If you don't qualify, you don't pay.
RIVO
Health
Licensed US telehealth for men's sexual health, weight management and hormone care. Prescriptions written by US-licensed clinicians and compounded by US-licensed pharmacies.
Support
RIVO Health LLC. Prescriptions are issued by independently licensed clinicians through the DrTelx prescriber network and dispensed by Foothills Professional Pharmacy, a 503A compounding pharmacy in Tempe, AZ. RIVO Health does not practice medicine and does not dispense medication.
Compounded medications are not FDA-approved and are not reviewed by the FDA for safety, efficacy or quality. Statements on this page have not been evaluated by the FDA. Individual results vary and are not guaranteed. Customer statements reflect individual experiences.
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