Sildenafil / Arginine / Menthol

Gel

2% / 3% / 1%

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Disclaimer: Images are for reference only; actual products may vary.

Product Overview

This topical gel combines sildenafil, arginine, and menthol. It is formulated to potentially enhance genital blood flow in individuals experiencing erectile dysfunction or female sexual arousal disorder.

Sildenafil1-5

Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor with a half-life of approximately 4 hours. Clinically, it is used for the treatment of erectile dysfunction and pulmonary hypertension. Research suggests it may also be beneficial for female sexual arousal disorder. Due to its half-life, oral sildenafil is typically used “on-demand” prior to sexual activity.

Arginine6,7

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

Menthol8,9

Menthol, a naturally occurring cyclic terpene alcohol derived from plants, has been used medicinally for thousands of years. Topically, at specific concentrations, menthol has been applied as an antipruritic, antiseptic, and analgesic. Studies indicate it may enhance drug penetration through the skin. Additionally, menthol activates transient receptor potential melastatin 8 (TRPM8) receptors on sensory nerves and vasculature, producing a cooling sensation when applied topically.

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.

Arginine6,7

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 relaxes blood vessels, allowing more blood to flow.

Menthol8,9

Antipruritic effects

Different opioid receptors have different effects on pruritus. Both mu-opioid receptor agonists and k-opioid receptor antagonists can induce itch, while mu-receptor antagonists and k-receptor agonists can reduce it. Menthol may affect pruritis by selectively activating k-opioid receptors.

Analgesic effects

Menthol may have analgesic properties through its activation of TRPM8 and/or inhibition of TRPA1.

Drug penetration into the skin

Menthol is also believed to increase penetration into the skin by the following mechanisms 1) disruption of the highly ordered lipid structure of the stratum corneum 2) by increasing drug partitioning into the stratum and 3) increasing electrical conductivity of tissues thereby opening polar pathways within the stratum.

Common  (topically)1-9

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

Oral (sildenafil)1-3

  • Flushing
  • Dyspepsia
  • Nasal congestion
  • Dizziness

Contraindications1-9

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

 

Precautions1-9

  • 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. 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
  7. 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.
  8. Kamatou GP, Vermaak I, Viljoen AM, Lawrence BM. Menthol: a simple monoterpene with remarkable biological properties. Phytochemistry. 2013 Dec;96:15-25.
  9. Patel T, Ishiuji Y, Yosipovitch G. Menthol: a refreshing look at this ancient compound. J Am Acad Dermatol. 2007 Nov;57(5):873-8.

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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