Sildenafil / Aminophylline / Arginine / Testosterone

Cream

2% / 3% / 6% / 0.1%

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Product Overview

Sildenafil / Aminophylline / Arginine / Testosterone Description1-13

This compounded cream combines sildenafil, aminophylline, arginine, and testosterone into a topical formulation designed to support sexual function. The cream may enhance libido, sexual arousal, and genital sensitivity, improve blood flow to genital tissues, and provide testosterone for hormonal balance. It is typically applied to the vulvar or clitoral area in women or genital area in men before sexual activity to promote arousal, increase lubrication, and enhance orgasmic response in women with Female Sexual Arousal Disorder (FSAD) or to support erectile function in men.

Sildenafil1-5

Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor with a half-life of approximately 4 hours. It is clinically used to treat erectile dysfunction and pulmonary hypertension. Research indicates it may also support female sexual arousal. Due to its half-life, oral sildenafil is typically used “on-demand” before sexual activity.

Aminophylline6,7

Aminophylline is a complex of theophylline and ethylenediamine, which improves its solubility. Historically, aminophylline has been used for asthma, chronic obstructive pulmonary disease, and apnea of prematurity. It is thought to have vasodilatory activity and may also exert cardiac and diuretic effects. Its actions in the body may include inhibition of type III or IV phosphodiesterase (PDE), increasing calcium ion concentration in smooth muscle, inhibiting histamine release, and antagonizing adenosine.

Arginine8,9

L-Arginine is an essential amino acid converted in the body to nitric oxide, a potent vasodilator and neurotransmitter. It is naturally present in red meat, poultry, fish, and dairy, and also supports protein synthesis, immune function, and wound healing.

Testosterone10-13 

Micronized testosterone, derived from plants (commonly yams), undergoes a synthetic process to produce bioidentical testosterone. Unlike injectable forms, free testosterone is metabolized rapidly after absorption, requiring more frequent administration compared to weekly or monthly injections (e.g., cypionate, enanthate). It has been studied for its potential role in managing male hypogonadism and supporting libido in both men and women. Micronized testosterone is commonly used in compounded dosage forms, including transdermal creams.

Sildenafil1-4

Phosphodiesterase (PDE) has many isoforms and is an enzyme that has many functions in the body including degrading the effect of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). PDE5 is an enzyme that is found in many parts of the body including in the smooth muscle of the corpus cavernosum, prostate, bladder, the vascular and visceral smooth muscle, skeletal muscle, urethra, platelets, kidney, lung, cerebellum, heart, liver, testis, seminal vesicle, and pancreas. Sildenafil is structurally similar to cGMP and prevents degradation of cGMP by competitively binding and inhibiting activity of PDE5. When PDE5 is inhibited, cGMP accumulates and leads to smooth muscle relaxation. Studies have shown that sildenafil facilitates the relaxation of the clitoral corpus cavernosum through the nitric oxide-cGMP pathway. This may improve genital blood flow and vaginal engorgement.

Aminophylline6,7

Phosphodiesterase activity-Inhibits phosphodiesterase (PDE), leading to increased intracellular cyclic AMP (cAMP) levels. Elevated cAMP may promote smooth muscle relaxation and vasodilation, improving blood flow to applied areas.

Nonselective adenosine receptor antagonist-It acts on A1, A2, and A3 receptors with similar affinity which may explain the drug’s cardiac effects. Adenosine-mediated channels also increase the contraction force of diaphragmatic muscles by enhancing their calcium uptake.

Arginine8,9

L-Arginine is necessary for making proteins and is commonly used to promote circulation. The body converts arginine to nitric oxide (NO) through the action of nitric oxide synthase which may relax blood vessels, allowing blood to flow.

Testosterone10-13 

Testosterone binds to androgen receptors in various tissues, exerting anabolic and androgenic effects. Testosterone may have a role in the development and maintenance of male secondary sexual characteristics, stimulation of muscle and bone growth, and regulation of libido and mood in both men and women.

Adverse Reactions5,7,8,9,10

Common (topically)

  • Application site erythema
  • Application site discomfort
  • Itching, burning
  • Rash, pruritic
  • Headache

Rare

  • Anaphylactoid reactions, exfoliative dermatitis (ethylenediamine)

Oral (sildenafil) 

  • Flushing
  • Dyspepsia
  • Nasal congestion
  • Dizziness

Contraindications5,7,8,9,10

  • Known hypersensitivity or intolerance to sildenafil, aminophylline, arginine or testosterone
  • Use of nitrates and alpha-blockers due to risk of life-threatening hypotension

Precautions5,7,8,9,10

  • Use with caution in patients with:
  • Severe hepatic impairment (Child-Pugh Class C)
  • Severe renal impairment (creatinine clearance <30 mL/min)
  • History of NAION (non-arteritic anterior ischemic optic neuropathy)
  • Recent history of myocardial infarction, stroke, or unstable angina

Store at 20–25°C (68–77°F). Protect from excessive heat, light, and moisture.

  1. Sildenafil Prescribing Information – Pfizer. www.accessdata.fda.gov/drugsatfda_docs/label/2011/021368s20s21lbl.pdf Revised March 2014. Accessed May 31, 2025
  2. Clinical Pharmacology Sildenafil clinical monograph 2025 https://www.clinicalkey.com/pharmacology/
  3. Smith BP, Babos M. Sildenafil. [Updated 2023 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558978/  
  4. Alatas E, Yagci AB. The effect of sildenafil citrate on uterine and clitoral arterial blood flow in postmenopausal women. MedGenMed. 2004 Oct 13;6(4):51. PMID: 15775878; PMCID: PMC1480594.
  5. Thurman AR, Johnson I, Cornell KA, Hatheway J, Kim NN, Parish SJ, Dart C, Friend DR, Goldstein A. Safety of topical sildenafil cream, 3.6% in a randomized, placebo-controlled trial for the treatment of female sexual arousal disorder. J Sex Med. 2024 Sep 3;21(9):793-799.
  6. Jilani TN, Preuss CV, Sharma S. Theophylline. StatPearls. May 1, 2023. Accessed August 7, 2025
  7. Clinical Pharmacology Aminophylline clinical monograph 2025 https://www.clinicalkey.com/pharmacology/
  8. L-Arginine – Patient Handout; NatMed Pro; 2025; https://naturalmedicines-therapeuticresearch-com.lp.hscl.ufl.edu/databases/food,-herbs-supplements/patienthandout.aspx?productid=875&lang=en
  9. Oyovwi MO, Atere AD. Exploring the medicinal significance of l-Arginine mediated nitric oxide in preventing health disorders. European Journal of Medicinal Chemistry Reports.Volume 12,2024:100175.
  10. Clinical Pharmacology Testosterone clinical monograph accessed June 17 2025; https://www.clinicalkey.com/pharmacology/monograph/595?n=Testosterone
  11. Tauchen J, Jurášek M, Huml L, Rimpelová S. Medicinal Use of Testosterone and Related Steroids Revisited. Molecules. 2021 Feb 15;26(4):1032. doi: 10.3390/molecules26041032. PMID: 33672087; PMCID: PMC7919692.
  12. AndroGel (testosterone gel 1.62% for topical use) [package insert] AbbVie US LLC , revised May 2013, accessed June 2025 through: https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021015s036lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/085635s040lbl.pdf
  13. Clayton AH, Goldstein I, Kim NN, Althof SE, Faubion SS, Faught BM, Parish SJ, Simon JA, Vignozzi L, Christiansen K, Davis SR, Freedman MA, Kingsberg SA, Kirana PS, Larkin L, McCabe M, Sadovsky R. The International Society for the Study of Women’s Sexual Health Process of Care for Management of Hypoactive Sexual Desire Disorder in Women. Mayo Clin Proc. 2018 Apr;93(4):467-487. doi: 10.1016/j.mayocp.2017.11.002. Epub 2018 Mar 12. PMID: 29545008.

WPPL operates as a 503A compounding pharmacy and prepares individualized prescription medications pursuant to provider direction. Compounded preparations are not reviewed, tested, or approved by the FDA.

This listing also includes commercially manufactured products for convenience; these items are not compounded by our pharmacy and are sold as provided by their manufacturers. Actual products in stock at time of dispensing may vary due to supply chain variability. Any statements regarding non-compounded products are manufacturer-supplied, have not been evaluated by the FDA, and are not intended to diagnose, treat, cure, or prevent any disease. WPPL does not verify or endorse any therapeutic claims made by manufacturers. Please refer to original labeling for complete product information.

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