The doses are the story
Sildenafil 28 mg and tadalafil 11 mg. Both numbers are unusual, and both are low.
For context, sildenafil is normally prescribed at 25, 50 or 100 mg, and tadalafil at 10 or 20 mg as needed. So this is roughly a half dose of each, combined. Every other stacked product we have audited either pushes past those ceilings — one tier reaches sildenafil 110 mg with tadalafil 22 mg, above the maximum of both — or refuses to publish its doses at all.
That makes this the most cautious combination product in our set, and it is a genuine point in its favour. Our objection to stacking two PDE5 inhibitors does not disappear — no guideline supports it and no approved product does it — but a conservative dose is a materially different proposition from a maximal one. Why stacking is the wrong place to start.
The best terms in the category
Billing is where this whole market behaves worst, and Keeps is the clear exception. You can adjust, pause or cancel from the portal, there are no cancellation fees, and there is a 60-night money-back guarantee with no returns required.
Compare that with the rest of the field: several services state no cancellation terms at all on the page, one requires an annual commitment that is not pro-rated, and one buries the exit behind separate cancellations for each bundled condition. This is the one service where getting out looks as easy as getting in.
What it does not tell you
Nitrates. Not mentioned. This is the omission that matters most, because the combination of a PDE5 inhibitor and a nitrate can drop blood pressure to a fatal level, and the men most likely to be carrying a nitroglycerin spray are exactly the men buying this.
The four-hour rule. Not mentioned either. An erection that will not subside is an emergency room visit, and the window before tissue damage begins is measured in hours.
That the product is compounded. No FDA-approved medicine combines sildenafil and tadalafil, so this one is necessarily compounded — mixed to order rather than manufactured and approved. The page never says so.
Worse, the phrase it does use is “Rx only”. That is true, and to a reader it reads like reassurance, because prescription medicines are normally the approved ones. Four of the other services we audited state plainly that compounded drugs are not evaluated by the FDA for safety, effectiveness or quality. This one lets “Rx only” do work it cannot honestly do.
The price you cannot see
There is no price on the page we audited, and a footnote states that the figure shown “represents cost of first order with initial discount”.
Read that carefully: it is an admission that the number you are shown is not the number you will keep paying. Budget on the renewal price, whatever it turns out to be, and check it before the second charge.
The bottom line
If you have decided on a combination product, this is the one we would pick on formulation and terms — the lowest doses in the category and an exit you can actually use. Go in knowing the two things the page will not tell you: do not touch it if you take nitrates, and treat a four-hour erection as an emergency.