NEXAROUSE™ - Mood Enhanced Erectile Function Supplement
Ketamine 15 mg, Apomorphine 2 mg, Sildenafil 50 mg, Oxytocin 50 units
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Have you ever used ketamine recreationally, or have you ever been diagnosed with a substance use disorder involving ketamine, dissociatives, or anesthetics?
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Are you currently undergoing any drug testing (employment, professional licensing, athletic competition, military service, child custody, parole, or probation), or do you anticipate being drug-tested in the next 90 days?
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Cardiovascular HealthDo you have a history of heart attack (myocardial infarction)f or stroke?Have you ever been diagnosed with congestive heart failure (CHF) or a low ejection fraction?Do you currently experience chest pain, shortness of breath, or palpitations with exertion?Have you ever been diagnosed with arrhythmia such as atrial fibrillation, valvular disease, or uncontrolled hypertension?Do you currently take nitrate medications (e.g., nitroglycerin, isosorbide mononitrate)?Have you had a stroke or transient ischemic attack (TIA) in the past?Have you ever fainted or felt dizzy after taking erectile dysfunction medications (Viagra, Cialis, etc.)?
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Have you ever been diagnosed with schizophrenia, schizoaffective disorder, or psychotic disorder?Have you ever experienced hallucinations, delusions, or paranoia?Do you have a history of bipolar disorder or manic episodes?Have you ever been hospitalized for mental health reasons?Do you currently experience suicidal thoughts?
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Do you currently use recreational drugs, including cocaine, amphetamines, stimulants or hallucinogens?Do you drink alcohol at least 5 days per week?Do you take opioid pain medications (e.g., oxycodone, hydrocodone, fentanyl)?
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Have you been diagnosed with liver or kidney disease?Do you have uncontrolled diabetes or hyperthyroidism?Do you have any neurological disorders such as epilepsy or seizure history?Do you have eye disease, such as retinitis pigmentosa or optic neuropathy?Do you have penile anatomical abnormalities (Peyronie’s disease, fibrosis, or scarring)?Have you ever had a prolonged erection lasting more than 4 hours (priapism)?
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Are you allergic to ketamine, oxytocin, apomorphine, or sildenafil (or viagra)?
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Please list all current prescription medications, including psychiatric, cardiac, and blood pressure drugs and any over-the-counter supplements or herbal products you take regularly. Dosages not needed.
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Understanding of Treatment Purpose and LimitationsI understand that NexArouse™ is a compounded medication and not FDA-approved as a combination therapy.I understand that results are not guaranteed and that the medication may not improve sexual performance.I understand that this medication is intended for mood-related erectile dysfunction, but may be used for physical ED as well. I understand that emotional, psychological, and relational factors can affect response to treatment.I understand that improvement may require more than one dose or adjunctive therapy.I understand that this medication is for personal use only and not to be shared.
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Safety & Activity RestrictionsI understand I must not drive, operate heavy machinery, or perform tasks requiring full alertness for at least 2 hours after taking NexArouse™, assuming you have taken only 1 tablet. I understand I must avoid alcohol, opioids, or sedatives on the day I take the medication.I understand I must not combine NexArouse™ with nitrates or recreational “poppers”.I understand that I should take only one tablet at a time, and never more than one in 24 hours unless instructed.I understand that if I experience chest pain, vision changes, or an erection lasting longer than 4 hours, I must seek immediate medical attention.
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Informed Consent Statements I have reviewed the potential benefits, risks, and side effects of this medication.I have disclosed all relevant medical history and current medications truthfully.I understand that no permanent benefit is guaranteed, and results may vary.I understand that off-label use is common in medical practice and that NexArouse™ is compounded specifically for my use.I consent to proceed with NexArouse™ therapy under the supervision of my prescribing clinician.
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Are you currently taking any of the following medications? Levodopa, carbidopa, or other Parkinson's medication, Pramipexole (Mirapex), ropinirole (Requip), rotigotine (Neupro), Other dopamine agonists for restless legs syndrome, Ondansetron (Zofran), granisetron, or other 5-HT3 antiemetics. Antipsychotic medications (risperidone, olanzapine, quetiapine, aripiprazole, haloperidol)?
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Have you ever fainted or felt severely lightheaded when standing up quickly? (orthostatic hypotension)
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Are you allergic to sulfites, or have you ever had a severe reaction to a medication containing sulfites or metabisulfite?
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Type option 3
Type option 4
Are you currently taking any of the following medications? Tamsulosin (Flomax), doxazosin (Cardura), terazosin (Hytrin), alfuzosin (Uroxatral), or other alpha-blockers, Riociguat (Adempas) for pulmonary hypertension, Any other PDE5 inhibitor: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra/Staxyn), avanafil (Stendra), HIV protease inhibitors (e.g., ritonavir), Strong CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin, erythromycin)
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NexArouse
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NexArouse
30 Sublingual Tablets
$
250.00
Quantity
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NEXAROUSE™ — I confirm that I am male, age 18 or older, and the person who will be using this medication. ☐ I acknowledge that NexArouse contains ketamine, a federally controlled substance (Schedule III). I have not misrepresented my medical history, identity, or reasons for requesting this medication. ☐ I will not share this medication with any other person, including a sexual partner, spouse, or friend. Sharing a controlled substance is a federal offense. ☐ I will store this medication securely, out of reach of children, household members, and pets, and will dispose of unused medication through a DEA-authorized take-back program or pharmacy disposal program. ☐ I understand that ketamine and its metabolites can be detected on certain drug screens, and I am responsible for any consequences this may have. ☐ I will refrain from driving, operating heavy machinery, or performing safety-sensitive tasks for at least 4 hours after taking NexArouse. NEXAROUSE™ PATIENT CONSENT AND ACKNOWLEDGMENTNexArouse™ is a compounded sublingual tablet formulated with ketamine, oxytocin, apomorphine, and sildenafil, prescribed by Dr. David Mahjoubi, MD and prepared by a licensed compounding pharmacy.I understand that ketamine is a Schedule III controlled substance under federal law, and that the other ingredients in NexArouse™ have individual FDA-approved indications for unrelated uses (sildenafil for erectile dysfunction, oxytocin in injectable form for labor and postpartum care, apomorphine in injectable form for advanced Parkinson's disease). The combination of these four ingredients in a sublingual compounded tablet is NOT FDA-approved as a finished product, and its use for mood-related erectile dysfunction is considered off-label.DOSING: Place one tablet under the tongue and allow it to fully dissolve. Do not chew or swallow the tablet whole. Onset typically occurs within 15 to 30 minutes, with effects lasting 1 to 3 hours. Take only one tablet at a time, and never more than one tablet in any 24-hour period.ACTIVITY RESTRICTIONS: I will not drive, operate heavy machinery, or engage in any hazardous or safety-sensitive activity for at least 4 hours after taking NexArouse™. I will not combine NexArouse™ with alcohol, benzodiazepines, opioids, sedating antihistamines, cannabis, or any other sedative substance on the day I take it. I will not take NexArouse™ with nitrate medications (including nitroglycerin, isosorbide, and recreational "poppers") under any circumstances — this combination can cause life-threatening hypotension.By signing below, I acknowledge that I have been informed of the purpose, potential benefits, and possible side effects of NexArouse™, that I understand the formulation is compounded and not approved by the FDA as a combined product, and that I am consenting to receive and use this medication. UNDERSTANDING OF TREATMENT PURPOSE AND LIMITATIONSI understand that NexArouse™ is intended to address erectile dysfunction in which mood, anxiety, or stress is believed to be a contributing factor, and that it may not be appropriate or effective for erectile dysfunction caused primarily by vascular, neurological, hormonal, or anatomical factors.I understand that:- Results are not guaranteed. NexArouse™ may not improve sexual performance, and some users experience no benefit at all.- Improvement may require more than one trial, dose adjustment, or adjunctive therapy. The first dose is not necessarily representative of subsequent doses, particularly with respect to side effects such as nausea or orthostatic hypotension.- Emotional, psychological, and relational factors can significantly affect the response to this medication, and addressing those factors with appropriate professional support may improve outcomes.- The published research on this specific four-ingredient combination is limited; use of this combination is based on clinical judgment and the individual pharmacology of each component, not on randomized clinical trials of the combination.- This medication is for my personal use only. I will not share, sell, or transfer it to any other person.- I should continue to receive routine medical care, including evaluation for cardiovascular, hormonal, urological, and psychological causes of erectile dysfunction, from my primary care provider or specialist. SAFETY AND ACTIVITY RESTRICTIONSI understand and agree that:- I will not drive, operate heavy machinery, or perform tasks requiring full alertness for at least 4 hours after taking NexArouse™.- I will avoid alcohol, benzodiazepines, opioids, cannabis, and any sedating substance on the day I take this medication.- I will not combine NexArouse™ with nitrates of any kind, including nitroglycerin, isosorbide mononitrate, isosorbide dinitrate, or recreational "poppers" (alkyl nitrites). The combination of sildenafil and nitrates can cause life-threatening hypotension. If I require emergency treatment for chest pain, I must inform the treating clinician that I have used NexArouse™ within the past 48 hours.- I will not combine NexArouse™ with riociguat (Adempas) or other soluble guanylate cyclase stimulators.- I will exercise caution if I am taking alpha-blocker medications (e.g., tamsulosin, doxazosin, terazosin, alfuzosin), as the combination with sildenafil can cause low blood pressure and fainting. I have informed the clinic if I take any such medication.- I will take only one tablet at a time, and never more than one in any 24-hour period, unless specifically instructed otherwise by my prescribing clinician.- I will rise slowly from sitting or lying positions for at least the first hour after taking the medication, due to risk of orthostatic hypotension from the apomorphine component.- I will seek immediate medical attention if I experience any of the following: chest pain, shortness of breath, fainting, severe dizziness, sudden vision changes or loss of vision, sudden hearing loss or ringing in the ears, severe headache, an erection lasting longer than 4 hours (priapism), severe nausea or vomiting, confusion, or any allergic reaction (rash, swelling, difficulty breathing).If I experience an erection lasting longer than 4 hours, I will go to an emergency department immediately. Untreated priapism can cause permanent damage. INFORMED CONSENT AND TRUTHFUL DISCLOSUREI have reviewed the potential benefits, risks, and side effects of NexArouse™. I have disclosed all relevant medical history, current medications, supplements, and substances truthfully and completely on the intake form, and I understand that withholding or misrepresenting this information may put my safety at serious risk and may waive certain claims arising from undisclosed conditions or medications.I understand that:- No clinical outcome is guaranteed, and individual responses to compounded medications vary significantly.- Off-label use of medications is a legally permitted aspect of medical practice when based on clinical judgment, but off-label use carries different risk and benefit profiles than the FDA-approved use of the same ingredients.- NexArouse™ has been compounded specifically for my use under the prescription of Dr. David Mahjoubi, MD.- My care relationship with Dr. David Mahjoubi, MD for this medication is conducted via telehealth and is limited in scope to the prescribing of NexArouse™. No physical examination is being performed.- I may discontinue this medication at any time, and I agree to inform the clinic if I do so or if I experience any new or concerning symptoms.- In the event of a medical emergency, I will call 911 or go to the nearest emergency room rather than wait for a clinic response.I consent to proceed with NexArouse™ therapy under the supervision of my prescribing clinician. CONTROLLED SUBSTANCE AND APOMORPHINE-SPECIFIC ACKNOWLEDGMENTI acknowledge that NexArouse™ contains the following active ingredients, each with its own risk profile:KETAMINE — A federally controlled substance (Schedule III, U.S. Drug Enforcement Administration). I understand that:- Ketamine has potential for misuse, dependence, and addiction. I have not misrepresented my history of substance use.- Ketamine and its metabolite norketamine can be detected on certain drug tests, and I am responsible for any consequences related to employment, licensing, professional certification, athletic eligibility, custody proceedings, parole, probation, or other contexts in which I may be tested.- I will not share, sell, transfer, or otherwise distribute this medication to any other person. Doing so is a federal crime.- I will store the medication in a secure location, out of reach of children, household members, partners, and pets.- I will dispose of unused medication through a DEA-authorized drug take-back program or pharmacy disposal program, not in household trash or wastewater.- Long-term frequent ketamine use has been associated with bladder and urinary tract complications (ketamine-induced cystitis). I will report any new urinary symptoms (frequency, urgency, pain, blood in urine) to the clinic promptly.APOMORPHINE — A dopamine agonist with a unique side-effect profile. I understand that:- Apomorphine commonly causes nausea, sometimes severe, particularly with the first dose.- Apomorphine can cause significant orthostatic hypotension (sudden drops in blood pressure when changing position). I will rise slowly from sitting or lying positions, especially in the first hour after taking the medication, and I will be cautious about using the medication when I am alone.- Dopamine agonists, including apomorphine, have been associated with the emergence of impulse-control disorders, including pathological gambling, hypersexual behavior, compulsive shopping, and binge eating. If I or my family notice changes in my impulse-control behavior, I will report it to the clinic and discontinue the medication.- Apomorphine can rarely cause hallucinations, particularly in older patients or those with predisposing conditions.- Apomorphine formulations may contain metabisulfite, a sulfite to which some patients are severely allergic. If I have a known sulfite allergy, I should not take this medication.SILDENAFIL — A PDE5 inhibitor with several specific risks. I understand that:- Sildenafil has been associated with rare but serious cases of sudden vision loss (non-arteritic anterior ischemic optic neuropathy, or NAION) and sudden hearing loss. If I experience sudden changes in vision or hearing, I will discontinue use immediately and seek medical evaluation.- Sildenafil interacts dangerously with nitrates and with riociguat. I have disclosed all of my current medications.- Sildenafil interacts with alpha-blockers (such as tamsulosin) and may cause low blood pressure and fainting in combination.- Priapism (an erection lasting more than 4 hours) is a medical emergency. I will go to an emergency room immediately if this occurs.OXYTOCIN — A hormone with primarily uterotonic activity in its FDA-approved injectable form. I understand that the systemic absorption of sublingual oxytocin is uncertain and that side effects of oxytocin in compounded sublingual form are not fully characterized.I have read each section of this acknowledgment and understand the specific risks of each ingredient. I am voluntarily consenting to take NexArouse™ with full knowledge of these risks. I am at least 18 years of age. I confirm that I am male and that this medication is for my personal use only. Important Safety InformationNexArouse™ is a compounded prescription medication formulated under physician direction by a licensed compounding pharmacy (Novel Pharmacy, Sylmar, California). Compounded preparations are not FDA-approved as finished products, although the individual active ingredients — ketamine, apomorphine, and sildenafil — are FDA-approved for related uses. NexArouse™ is dispensed only after physician evaluation and is not a substitute for in-person medical care.Ketamine is a Schedule III controlled substance under the federal Controlled Substances Act and carries a risk of dependence and misuse. Because controlled substances may only be prescribed in states where Dr. Mahjoubi is licensed, NexArouse™ is currently available only to patients residing in: Arizona, California, Connecticut, Florida, Illinois, Massachusetts, New Jersey, New Mexico, New York, Texas, Utah, Virginia, and Wisconsin. Prescriptions cannot be issued to patients in any other state.NexArouse™ combines three active ingredients, each with distinct safety considerations. Apomorphine can cause severe nausea and vomiting (an anti-nausea agent is sometimes recommended), sudden drops in blood pressure that can lead to fainting (orthostatic syncope), excessive daytime sleepiness, and — as a dopamine agonist — rare but serious impulse-control disorders including pathological gambling, hypersexuality, compulsive shopping, and binge eating. Patients or their partners noticing any new or unusual urges should stop the medication and contact Dr. Mahjoubi immediately. Sildenafil can rarely cause non-arteritic anterior ischemic optic neuropathy (NAION) with sudden vision loss in one or both eyes, sudden hearing loss, and prolonged erection (priapism lasting more than four hours requires emergency care to prevent permanent injury). Sildenafil interacts dangerously with nitrate medications and can cause life-threatening hypotension. Ketamine at therapeutic sublingual doses is generally well tolerated but may cause dissociation, dizziness, transient elevated blood pressure or heart rate, nausea, and — with chronic misuse — bladder and cognitive effects.Do not take NexArouse™ if you use any nitrate medication (including nitroglycerin, isosorbide, or recreational "poppers"), guanylate cyclase stimulators such as riociguat, opioids, or are actively consuming alcohol. Do not drive, operate machinery, or perform tasks requiring full alertness for at least 6 hours after a dose, or until any sedation, dizziness, or dissociation has fully resolved. Seek emergency medical care immediately for sudden vision loss, sudden hearing loss, an erection lasting more than four hours, chest pain, fainting, severe persistent nausea or vomiting, allergic reaction, or new compulsive behaviors. Discontinue use and contact Dr. Mahjoubi for any side effect you cannot tolerate. NexArouse™ is intended for adult patients only.
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