Ro Sparks Review

Erectile dysfunction (ED) is incredibly prevalent, affecting around a third of all men in the U.S. For many men, small doses of Viagra, Cialis, or either of their generic active ingredients aren’t quite enough to tackle their ED.1 Increasing the dose is one option to improve outcomes, but there’s also evidence that combination therapy (e.g., Viagra and Cialis taken together) might be a superior choice to monotherapies — not as a first-line treatment for men with ED, but perhaps for those whose ED is treatment-resistant.2

Ro Sparks is a combination ED medication that puts together both generic equivalents of Viagra and Cialis. Sparks’ doses of each medication — sildenafil and tadalafil, respectively — are high enough that either would work well on its own for many men.3 For those who need a little extra medication to achieve an erection, the two doses in combination should get the job done.

But are there increased risks associated with combining these higher doses? And is the combination approach a good place for men who haven’t yet tried ED medications to start? Our research team investigates the science to find out.

For men who need more than a single ED medication can offer, the combination of 50mg sildenafil and 22mg tadalafil in Ro Sparks presents a strong option that may provide better results for some patients who did not see enough benefit with monotherapy. The fact that it comes as a dissolving sublingual tablet adds a layer of convenience, at least in theory, removing the need to chase it with a glass of water. However, the tablet takes a little too long to dissolve to be a truly convenient option, even if the sublingual delivery lets the medication take effect more quickly. In the end, Ro Sparks is a niche product for a subset of men with ED who may certainly benefit from it, but it’s not the best place to start for men who are new to ED meds. If you've never tried ED medications before, learn about better starting points using our comprehensive guide to the best ED treatments.

At Innerbody Research, we thoroughly research and test every product and service we review, including Ro Sparks. Our team has been evaluating products in the ED space for the better part of a decade, reading more than 100 scholarly articles on ED and its potential treatments and ordering and trying products from over a dozen companies.

For this review of Ro Sparks, we leveraged our previous research and testing of competing products in the ED space and took a close look at the specifics of sublingual medication delivery, as well as the potential efficacy of Sparks’ specific doses and medication combination. We also ordered Sparks for ourselves so we could report back on things like customer experience and taste.

Additionally, we worked with Dr. Ilija Kelepurovski, urologist and member of our Medical Review Board, to verify the medical accuracy of this piece and gain unique insights from a practicing physician treating ED on a daily basis.

Over the past two decades, Innerbody Research has helped tens of millions of readers make more informed decisions about staying healthy and living healthier lifestyles.

In evaluating Ro Sparks, we had an enormous amount of ED medication research to reference, as well as years spent scrutinizing medical offerings from many of Ro’s competitors. We also have numerous pieces involving Ro’s other ED offerings, like its traditional tablets and daily tadalafil gummies.

For Sparks, we applied the same criteria we’ve used in most of those other articles, looking closely at efficacy and safety but also comparing costs to other products. Additionally, since Sparks is billed as more convenient than other ED medications, our convenience consideration was crucial.

Let’s take a closer look at each criterion to see how Sparks measures up.

Effectiveness

If efficacy were your only consideration, Ro Sparks would probably be a good fit. Clinical guidelines typically regard 50mg of sildenafil as the standard starting dose for most patients, with 25mg being used in older patients or patients with certain cardiovascular risk factors.2 For as-needed tadalafil, 10mg is considered an average dose, with 20mg considered a high dose.4

Ro Sparks combines a 50mg sildenafil dose with a 22mg tadalafil dose. The sildenafil dose is certainly right in line with the average, but 22mg of tadalafil is especially high. Research has indicated linear pharmacokinetics for tadalafil doses between 2.5mg and 20mg (higher doses resulting in improved outcomes).5 Studies on doses above 20mg are scarce, but there’s no reason to believe the linear pattern wouldn’t continue here, making 22mg a hair more effective than 20mg.

Increases in efficacy are a result of more than just individual ingredient doses, as well. The act of combining PDE5 inhibitors like sildenafil and tadalafil appears to work better than taking one of these medications in isolation. A systematic review of combination therapies versus monotherapies concluded that combination therapies were superior, with a caveat detailed here by Dr. Ilija Kelepurovski, urologist and member of our Medical Review Board:6

“It is important to note that although the study addressed the use of combination therapies, there were no randomized trials specifically assessing the combination of sildenafil with tadalafil, and more clinical research is necessary to confirm the safety and efficacy of this specific combination.”

Here’s a quick look at the drugs and doses available in similar combination treatments from Ro and its closest competitor, Hims:

Hims offers vardenafil as an alternative to sildenafil in its Hard Mints, which is nice for men concerned with one of sildenafil’s rarer side effects. But Ro offers more sildenafil and double the dose of tadalafil per tablet. However, those higher doses may increase side effect risks, which we’ll discuss in our next section.

Safety

A well-known trade-off with escalating PDE5 inhibitor dosage or combining agents is an increased risk of dose-dependent adverse effects.

To be fair, there hasn’t been any side effect research into the specific doses Ro uses in combination to determine their safety compared to a lower-dose combination or monotherapy. But studies into sildenafil and tadalafil on their own reveal dose-dependent relationships with many adverse effects. For example, a 2006 study from the journal Urology showed a marked increase in headache, malaise, dyspepsia, and nasal congestion as tadalafil doses increased from 5mg to 20mg.7 Studies in sildenafil have shown a similar linear pattern, with 100mg doses causing more adverse effects than 50mg or 25mg doses.8

One study looking into 5mg of daily tadalafil combined with a 50mg as-needed sildenafil dose found that the addition of as-needed sildenafil to a daily tadalafil regimen didn’t remarkably increase adverse effects.9 However, there were slight increases in flushing, dyspepsia, and muscle pain.

“It is logical to assume that the combination of 50mg sildenafil with 22mg tadalafil would increase the likelihood of side effects based on known dose-dependent adverse event profiles,” Dr. Kelepurovski says. “However, this is hypothetical given that there are no controlled safety data about this recommended dose.”

For many men, especially those who’ve already tried higher doses of either medication, Ro Sparks may be perfectly safe. But if you haven’t tried either medication at as high a dose, it would likely be smart to start elsewhere and work your way up toward Sparks should monotherapies or less potent combination therapies prove fruitless.

Cost

For what it contains, Ro Sparks’ pricing isn't all that bad. The problem is that it’s too expensive an option compared to alternative monotherapies or certain similar custom combinations offered by rivals.

Here’s another head-to-head comparison between Ro and Hims for their respective combination treatments:

Obviously, the Hims option is less expensive, but it’s worth remembering that it’s also less potent.

A stronger option exists from Rugiet, a company that makes sublingual lozenges at various strengths but only sells them in six-dose packets with no other savings options for buying more or billing quarterly. Its medium-strength combination includes 65mg sildenafil, 22mg tadalafil, and 2mg apomorphine for $100. That’s $16.67/dose, more expensive than Ro and Hims combined.

So, Sparks occupies a specific price point for its strength, one that isn’t the best place for most men to start, whether or not they’re new to ED medications. If its specific dose turns out to be the sweet spot for your needs, it’s a fair price compared to slightly more potent alternatives.

Convenience

Convenience is at the heart of a recent surge in oral alternatives to traditional ED pills. The trend started when BlueChew began offering convenient, individually wrapped chewable tablets of the top generic medications. Hims soon followed suit with its Hard Mints and Sex Chews, and other companies jumped on the bandwagon.

Sparks differ from Hims or BlueChew in that they’re designed to dissolve under the tongue, much like Rugiet Ready’s lozenges. Sublingual administration makes them as convenient as the competition in that you don’t need a glass of water to take them, but that convenience can be a double-edged sword. For Sparks, the other edge is the time it takes for the tablets to dissolve: ten minutes.

If you wait too long to take it, you may have to spend those ten minutes on some kind of foreplay that involves neither your genitals nor your mouth. For some, this will spur creativity. For others, it will be a source of frustration and possibly a mood killer. Of course, the tadalafil in Sparks can work for up to 36 hours, so you don’t have to consume it as close to the event as possible. Even sildenafil should last for around six hours, giving you a fair window to consume the tablet before sex.3 There isn’t compelling data that this specific drug combination and delivery mechanism deliver a meaningful difference in onset time for effects, either.

Compared to Hims’ Hard Mints, which come grouped in a nice little tin, Ro Sparks are individually wrapped, which our testers found much more convenient. Rather than having a tin full of ED meds jangling around in your pocket, you can have a more discreetly packaged pill with you that takes up less space and is totally silent.

Ro Sparks is a prescription medication for ED that combines two of the most popular ED drugs on the market: sildenafil (generic for Viagra) and tadalafil (generic for Cialis). Both medications have been extensively studied and are FDA-approved for the treatment of erectile dysfunction, with well-established efficacy and safety profiles when used individually.

With Ro Sparks, both drugs are delivered in a single dissolving tablet that you hold under your tongue for approximately ten minutes as your saliva breaks it down. That sublingual (under the tongue) dissolution allows the drugs to pass through oral membranes and may enter the bloodstream more rapidly than with traditional oral administration.10 That’s because sublingual delivery can bypass hepatic metabolism, which is another way to say that you don’t have to digest it for it to start working. The result is an onset time of about 15 minutes, rather than the 30-60 minutes seen with traditional ED pills (though the specific combination of tadalafil and sildenafil as formulated by Ro has not been tested in this manner).

Ro’s company reputation

Despite being an accredited business with an A+ rating from the Better Business Bureau, Ro’s consumer rating on the BBB website isn’t great. It currently stands at 1.23 out of five stars. However, that’s from just 56 reviews, which isn’t quite enough to reach statistical significance of any kind. Many of the negative reviews here appear to arise from a misunderstanding around payment timing when you sign up. As soon as you’re approved for a prescription, you’ll get billed, which seems to take some people by surprise, though we found the policy to be pretty clear.

The picture on Trustpilot is much better, with nearly 1,200 reviews resulting in an even 4.0 rating out of five stars. Negative reviews here sometimes touch on the same payment timing issues that populated the reviews on the BBB site, but there are also numerous mentions of certain products lacking efficacy for customers without a lot of additional data on things like ailment, product, or dose.

Ultimately, this paints a picture of a company with a fairly good reputation marred at times by a lack of clarity in the eyes of customers who get billed unexpectedly, perhaps having missed some of Ro’s disclamatory language about payments.

Ro Sparks contains two ED drugs that both belong to the same drug class: phosphodiesterase 5 (PDE5) inhibitors. These medications don’t trigger erections independently — a common misconception driven by popular media portrayals; rather, they create a situation in the body that’s more conducive to establishing an erection as a response to erotic stimuli, be it physical or psychological.3

To get a sense of how this works, it helps to understand a little about what happens when arousal leads to an erection.

In response to stimuli, the male body releases additional nitric oxide, spurring an increase in cyclic guanosine monophosphate (cGMP, not to be confused with current Good Manufacturing Practices [also cGMP], a standard of supplement manufacture). cGMP relaxes the muscles responsible for blood vessel constriction in and around the penis, allowing blood to flood into the chambers of the penis’ muscular tissue, the corpus cavernosa, resulting in an erection.11

Phosphodiesterase type 5 (PDE5) enzymes degrade cGMP, thus diminishing the erection. After ejaculation, this enzymatic activity increases, contributing to detumescence (the loss of the erection).3 But timing and signaling issues can throw the dance out of whack, resulting in an erection that’s too soft for penetrative sex or completely preventing an erection from forming.

PDE5 inhibitors like the ones found in Ro Sparks inhibit the activity of PDE5 enzymes, allowing cGMP to accumulate enough that an erection becomes possible.

“PDE5 inhibitors enhance the body's natural erection mechanisms, but they don't function without sexual stimulation,” Dr. Kelepurovski says. “Ro Sparks has potential benefits for select patients with prior monotherapy failure. Ro Sparks is not meant to be a first-line option."

Who is Ro Sparks for, and who might want to look elsewhere?

Ro Sparks is only available as a combination therapy at one specific combination of doses. As a result, it’s really only ideal for a narrow band of men dealing with ED.

Here’s a simple breakdown to illustrate what men should try Sparks:

Those first two conditions — men new to treatment and those who’ve hit a wall with monotherapies — will apply to the vast majority of men with ED. There’s some evidence that long-term use of PDE5 inhibitors can result in a kind of tolerance, but the evidence for this is still somewhat poor.2 That said, if you were to develop a tolerance, graduating to a combination therapy might be a logical next step.

Ro Sparks should be relatively safe for men whose intake questionnaires lead Ro-affiliated medical professionals to deem them suitable for a prescription. That said, there are a few limitations regarding the ability to evaluate Ro Sparks’ safety with a high degree of accuracy.

Firstly, there are no studies looking specifically at this dose combination (50mg sildenafil combined with 22mg tadalafil). A dedicated study of this specific combination would give us a better sense of potential adverse effect rates.

Second, there are no studies looking at how this combination would be absorbed sublingually. There is at least one study combining sildenafil and tadalafil, but it used a low daily dose of tadalafil (typically 5mg) and a 50mg dose of sildenafil, and it administered them both via traditional oral tablets.9 The good news is that this study didn’t illustrate any meaningful increase in side effects when the two were combined compared to tadalafil on its own.

Another study looking at sublingual administration of sildenafil in two children with heart issues found an increase in plasma concentration of over 300%.12 These results don’t cleanly translate to adult men, as the participants were pediatric cardiac patients.

Still, Ro touts this potential increase in potency by advertising a 15-minute activation time, as compared to the usual 30-60 minutes it takes oral sildenafil and tadalafil tablets to kick in. Without any direct studies comparing that high-dose combination and sublingual delivery, the safety profile of Ro Sparks is unknown and should be taken at face value.

Third, studies looking at tadalafil’s safety often establish 20mg as the high dose, leading to a dearth of information about what a dose above 20mg could offer for safety (or efficacy).7 Studies looking at the range of 2.5-20mg have established a linear, dose-dependent relationship with adverse effects, so 22mg should follow that pattern.5 But that’s still conjecture at this time.

If you do experience side effects from Ro Sparks, they’ll likely take the form of headache, dyspepsia, flushing, muscle pain, or vision disturbances in blue-green color processing. These are mostly due to interactions with other PDE enzyme groups like PDE6 and PDE11.3 There are also certain cardiovascular risks associated with PDE5 inhibitors that you’ll go over in your questionnaire or with your consulting physician as you apply for a prescription. Specifically, patients with cardiovascular risk factors (e.g., unstable angina, recent MI, nitrate use) may be at higher risk and should be carefully screened before prescribing.

Many companies will offer you savings for buying more of a given product. They’ll usually increase those savings as the size of your purchase increases. But Ro’s model winds up working out in favor of smaller purchases, thanks to a $15 discount on all quarterly orders.

Here’s a quick look:

As you can see, the price per dose remains static at $12 for monthly orders, no matter how much you buy. If you opt for quarterly billing and shipping, you’ll save $15 on each quarter, and $15 is a much higher percentage of $48 than it is of $120. The result is a lower cost per dose at the four-dose-per-month level than at any other quarterly level.

Compare that to Hims Hard Mints, which has 45mg of sildenafil and 11mg of tadalafil for as little as $6/dose, and you’ll see why it makes more sense for most men to start there, especially if they're new to combination therapies.

Shipping from Ro is free, and there are no returns on prescription products unless they arrive damaged or otherwise unsuitable for consumption.

Ro Sparks is likely to be an appropriate treatment only for a limited group of men who have previously tried and did not get an adequate response from monotherapies, even with the oversight of a healthcare provider. Some of these are similar prescription medications, but there are also alternative approaches to ED treatment we’ll discuss briefly, ranging from medical devices to talk therapy.

Other prescription ED medications

If you’re new to ED medications, you’d likely be better off trying a monotherapy before taking something like Ro Sparks. Monotherapies have shown strong efficacy in many men with ED and are generally recommended as a first-line treatment option according to clinical guidelines. It’s also beneficial that a single drug should pose less of a side effect risk than two drugs would, especially because it’s easier to titrate your dose up or down as you discover its effects on you.3 Here’s a quick look at the top ED medications, along with some of their benefits and drawbacks.

Other ED medications from Ro

Sparks is one of Ro’s most recent ED medication offerings. The company has offered traditional ED meds for years, and it’s recently begun expanding that catalog. Here’s a look at some of the alternatives you can choose through Ro, with a little commentary about whether it’s the best place to get them.

Mental health care

Some research suggests that up to 40% of ED cases are psychogenic, meaning they originate from a psychological source and not a physical one.17 These are typically diagnosed after ruling out physical conditions through thorough history-taking, physical exams, and routine lab work. In some of these cases, PDE5 inhibitors may still be effective in psychogenic ED and can serve as a temporary aid while patients undergo psychological therapy. They could offer a bridge for men seeking psychological treatment, helping restore sexual function during the course of psychological treatment.

There are also prescription approaches to anxiety and depression available, as both issues can contribute to or even cause ED.18

Access to talk therapy and psychiatry has never been easier, thanks to a revolution in telehealth services that got a big boost in the last few years. Now, through companies like BetterHelp, Talkspace, and Cerebral, men can seek cognitive behavioral therapy, prescription medication, and more without leaving home. And pricing is such that many men without insurance can also get the help they need.

According to Dr. Kelepurovski, “While teletherapy can be super convenient, it is still valuable for men with ED and co-comorbid depression/anxiety to have physician oversight to manage their overall psychological and sexual health. Psychogenic erectile dysfunction is very common and often undiagnosed, and for these patients, improving emotional or psychological underlying factors, with or without medical support, can result in long-term resolution."

Testosterone treatment

Low testosterone (hypogonadism) is a potential cause of ED, especially when considering other symptoms like a reduced libido, fatigue, or mood changes.19 If you also find yourself with low libido, low energy, excess body fat, or moodiness, your testosterone levels might be low.20 You can take convenient at-home tests to determine if you have low testosterone, and once confirmed by a physician, you can treat it with everything from testosterone replacement therapy (TRT) to prescription pills and even nutritional supplements.

Testosterone Replacement Therapy (TRT) is a more extensive treatment, usually limited to clinically established hypogonadism in men, as it often involves injecting yourself with testosterone cypionate or a similar analog. Prescription medications like clomiphene or enclomiphene may prove superior for many men, allowing them to avoid the injections, the fertility risks, and the sometimes wild swings in testosterone levels that come with them.21 22

If you find your T levels are low, you can also reach for nutritional supplements like Innerbody Testosterone Support, a product we created to provide a better set of ingredients, at clinically relevant doses, than we could find anywhere on the market.

Ro also makes a testosterone supplement with a similar name (Roman Testosterone Support), which we recommend to men on tight budgets who are okay with slightly fewer ingredients and slightly smaller doses than some of what you’ll find in the Innerbody alternative. You can learn more about these and other competing products in our complete guide to testosterone boosters.

Shockwave treatment

Shockwave, or acoustic wave, treatment is relatively new to the ED space, at least for most men. Despite some confusion, shockwave therapy does not involve electrical stimulation. There’s no electrical current involved.

Shockwave treatment uses a powerful motor to deliver targeted shockwaves to tissue. Different frequencies of shockwave will penetrate to specific depths, with treatments targeting ED designed to reach the corpus cavernosum, where they can stimulate and improve blood flow.23

In most cases, these treatments are performed in a clinic under the care of a trained urologist, as the available literature still characterizes low-intensity extracorporeal shockwave therapy as investigational according to most major urology guidelines (AUA, EAU ). Still, some companies have begun producing at-home devices you can use to administer shockwaves yourself.

Most of the at-home shockwave devices we’ve seen are either too weak to be effective, too dangerous to recommend, or both. The Phoenix Shockwave device stands out among them as a viable option if you’re wary of attending in-person sessions with a urologist or your insurance won’t cover the expense. However, it’s critical to note that no FDA-approved shockwave treatment device for home use currently exists for the treatment of ED. Home use should be considered experimental and approached with caution.