Last updated 14 September 2023

On 14 March 2023, the UK Medicines regulator approved an application to reclassify the erectile dysfunction medication Cialis. When marketed asCialis Together(tadalafil 10mg), it will be a ‘P’ (pharmacy) medication, and so available ‘over the counter’ in pharmacies – see. This follows the 2018, ‘P’ classification of (sildenafil 50mg) which has been available OTC, without a prescription, since then.

This decision is good news for men’s health …. Erectile dysfunction can be a debilitating condition, so it’s important men feel they have fast access to quality and legitimate care

Dr Laura Squire, MHRA’s Chief Officer for Healthcare, Quality and Access

Unfortunately, there is a strong black market in the UK for ED medicines, which are often unlicensed or counterfeit. UK Border Force and the MHRA seize millions of pounds of these fake products from criminals annually. This new classification of tadalafil 10mg will enable men who suffer from ED to obtain it safely from a local pharmacy.

Sanofi, the drug manufacturer, is expected to launch Cialis Together later in 2023. Cialis Together will be available to purchase in pharmacies without a prescription by men over 18 with erectile dysfunction. Cialis Together tablets will contain 10mg tadalafil and the maximum pack size will be 8 tablets. Other doses and pack sizes of Cialis and tadalafil will still be available on prescription through doctors and specially trained pharmacists. Before purchase in a pharmacy there must be an assessment with a pharmacist, who will check that Cialis Together is appropriate and safe, or whether consultation with a GP is necessary.

What does this mean for patients?

Men suffering with ED will have another treatment option with the convenience of purchasing it in their local pharmacy, including pharmacies found inside supermarkets (eg. Tesco, Asda, Sainsbury’s). The pharmacist will ask some health questions, may check blood pressure, and will advise on treatment with Cialis Together or Viagra Connect, or the need to consult a GP. Pharmacies usually have a private room for such discussions.

Cialis Together is a 10mg tadalafil product for use at least 30 minutes prior to anticipated sexual activity. Its effects can last. It is not recommended for daily use. The maximum recommended dose of Cialis Together will be one tablet in 24 hours. Prescription Cialis and tadalafil will still be available at different doses.

Dr Fox welcomes the wider access to ED medication for men that Cialis Together classified as a ‘P’ OTC medication will provide. We at Dr Fox are aware of the difficulties men have in discussing ED with their GPs and in accessing ED medication. We know that Cialis is effective and safe for most men and this change provides another option for obtaining ED treatment. Pharmacists are health professionals who are able to give ED advice but they will also know when to refer men who would benefit from a doctor’s assessment. ‘P’ medicines can also be supplied on prescription, and we will offer Cialis Together, when available, alongside our other competitively priced ED products.

Dr Claire Pugh, Dr Fox Medical Director

Categories of medicine

In the UK have 3 categories:

• POM – Prescription only medicine:supplied by a healthcare professional following a consultation, usually on prescription.
• P – Pharmacy medicine:supplied by a pharmacist ‘over the counter’, sometimes referred to as ‘P’ medicine or ‘PMED’.
• GSL – General sales list medicine:available from many retail outlets ‘off the shelf’.

Our list of 3 categories is based on. This includes all products that are sale or product selection has been published by the manufacturer, or have become available on the market.

Categories of medicines people tend to share

• supplied by a healthcare professional by pct use on a regular basis, with an option to be used on an annual basis.

VIAGRA

VIAGRA tablets are used to treat erectile dysfunction (impotence) in men. Impotence may be a sign of more serious problems such as cardiovascular problems, high blood pressure, diabetes, and certain cancers. It is important to note that VIAGRA does not work to relieve erectile dysfunction. VIAGRA tablets must be used together with nitrates (medicines that lower blood pressure).

VIAGRA tablets are also used to help treat pulmonary arterial hypertension (high blood pressure in the lungs) and to reduce the risk of stroke in heart failure. VIAGRA tablets must not be used in patients with a recent heart attack, recent heart surgery, recent stroke, high blood pressure (BP) levels of more than 45o/three times the upper normal (urine) or with a recent history of priapism (prolonged and painful erection). VIAGRA tablets should not be used in the elderly.

Size

62.25mg VIAGRA Tablets

Box Contents

At home in Italy

Directions

Clean and ready the VIAGRA Tablets with a strong kitchen spoon and a clean, dry parmigemol. Do not crush, break, or chew the tablets. Do not use a kitchen teaspoon; it will not do justice to the taste and smell of VIAGRA.• Clean the VIAGRA Tablets with mild soap and water.• Do not use a kitchen spoon.• Clean the liquid with a clean, clean cleanser.• Do not use a kitchen wash.• Clean the tablet strip(s) thoroughly with mild soap and water.• If you cannot use the clean and clean mind-body exercises described in this leaflet, please consult your doctor or pharmacist. Do not use VIAGRA without doctor's advice, even if you feel well.• Take VIAGRA tablets with a full glass of water.• The tablets should be swallowed whole, without chewing, without any loss of appetite, without any unpleasant taste in the mouth.

Safety Information

Caution

Do not use VIAGRA (Viagra®) if you have ever had a heart attack, or if you have a heart failure.• Consult your doctor if you have heart disease, high blood pressure, asthma, diabetes, or a recent history of stroke.• Do not use VIAGRA (Viagra®) if you have heart problems, high blood pressure, heart disease, high cholesterol, or if you are a smoker.

Directions for the use of male impotent men...

Bulk Box Contents

Warning

Consult your doctor before taking VIAGRA, especially in the elderly, and consult him or her, if you have any concerns.• Do not use VIAGRA without doctor's advice.• Be careful, if in the last few months of pregnancy.

Read the Patient Information Leaflet from the manufacturer for more information about VIAGRA, including information on how to use the tablets. VIAGRA tablets should not be taken by men under 18 years of age.Read the Patient Information Information Leaflet from the manufacturer for more information about VIAGRA, including information on how to use the tablets. Read the Patient Information Information Leaflet from the manufacturer. VIAGRA tablets should not be used during pregnancy unless he or she advises you not to do so.• VIAGRA (Viagra®) tablets must not be taken by the patient if he or she is taking any medicines called nitrates (medicines used to treat angina) or nitric oxide donors (medicines used to lower blood pressure).• Be careful, VIAGRA tablets should not be used by men under the age of 18 years.

Sildenafil is a drug that can increase the effects of nitric oxide. This leads to the relaxation of the smooth muscle in the penis. Nitric oxide then activates the enzyme guanylate cyclase. This results in the production of cGMP, which allows the smooth muscle to relax. This process allows for more rigidity in the penis, making it easier to achieve and maintain erections.

Viagra is a generic medicine called sildenafil, which has the same active ingredient as the brand-name drug Viagra. Both of these medications work similarly to treat erectile dysfunction (ED).

Viagra is available only by prescription. If you are looking for a generic version, Viagra is not available at this time. You can still buy Viagra from a legitimate pharmacy if it is in stock.

You should be able to buy generic Viagra from an online pharmacy if:

You are experiencing erectile dysfunction (ED).

You are taking sildenafil. You have been taking sildenafil for some time. Your erectile dysfunction is increasing and needs to be addressed.

Sildenafil can cause a dangerous drop in blood pressure. It can also lead to heart attacks and strokes.

If you experience any side effects you should contact your doctor.

If you are taking any other medications, including over-the-counter (OTC) medications, supplements, or herbal products, please inform your doctor or pharmacist. You may need to discontinue use of sildenafil if your doctor prescribes another.

You should only use sildenafil if you have taken sildenafil for the past 3 months or longer.

Please note that Viagra is not approved for the treatment of erectile dysfunction. It is only approved to treat ED.

Pfizer

Erectile dysfunction (ED) can be caused by many reasons including:

• You may be taking sildenafil for several months or longer. Sildenafil should only be used for the treatment of ED if it has been shown to improve your sexual desire or sexual performance.
• Sildenafil may interact with some prescription medications and drugs, so it is important to tell your doctor about all the medications you take, and tell them about all the products you use.
• Sildenafil can interact with certain vitamins and minerals, so it is important to tell your doctor if you are taking any of these or have any other supplements.
• Sildenafil may be causing side effects that are not listed. Please discuss them with your doctor. If you experience any side effects that are not listed, please contact your doctor.

Erectile dysfunction is a common condition that affects men of all ages. It can be caused by many factors, including:

• You may be taking certain medications that can cause ED, such as nitrates or alpha-blockers. These medications can interact with sildenafil, which can cause dangerous drops in blood pressure.
• You may have a heart condition or other heart problems. Your doctor may want to treat your ED with a lower dose of sildenafil or a combination of the two.
• You are currently taking medication to treat a condition called pulmonary arterial hypertension (PAH). This condition can cause chest pain, shortness of breath, and difficulty breathing. If you are currently taking medication to treat PAH, your doctor may want to increase the dosage of sildenafil or a combination of the two.
• You are currently taking certain heart medications and have had heart attack or stroke in the past.
• You are currently taking certain diet medications, such as a low-fat diet. It can also lead to weight loss and increased blood sugar levels.
• You are currently taking certain supplements, including vitamins and minerals. These supplements may interact with sildenafil, which can cause dangerous drops in blood pressure.
• You are currently taking sildenafil for the treatment of pulmonary arterial hypertension (PAH). If you are currently taking sildenafil for the treatment of PAH, your doctor may want to increase the dosage of sildenafil or a combination of the two.
• You are currently taking certain medications to treat your erectile dysfunction. These medications can cause dangerous drops in blood pressure.

Viagra has been shown to cause some mild side effects. Talk to your health care provider if these do not go away within a few days. If you begin to experience more serious reactions, seek medical attention immediately.

Common side effects reported from Viagra use include:

• Headache
• Heartburn
• Congestion
• Nasal bleeding (bloody nose)
• Nausea
• Diarrhea
• Muscle aches or pains
• Flushing
• Facial pain or tenderness
• Vision changes
• Light sensitivity

More severe side effects include:

• Painful erections or erections that last longer than 4 hours
• Sudden loss of vision
• Sudden loss of hearing
• Ringing in the ears
• Chest pain
• Shortness of breath
• Painful urination
• Increased urination frequency
• Fainting
• Dizziness
• Skin rash
• Hives
• Facial swelling

If you experience any of these side effects, seek medical attention immediately. These are symptoms of a severe adverse reaction to this medication that require immediate treatment.

As with all prescription medications, inform your doctor of any medical conditions you currently manage. Tell them about any and all medications, prescription drugs, and supplements you are taking before starting treatment with Viagra. Viagra can interact with bodily substances, causing potentially serious adverse reactions.

Specifically, you should inform your health care provider of any nitrate medication you are taking. Remember to mention any herbal products you use, especially St. John’s wort.

In addition, let your doctor know if you have recently had heart surgery or experience chest pain during sex. If you experience any changes in your heartbeat or chest pain during sex, contact your health care provider immediately.

BE packs of five and eighticumicumumumumumumumumumumumumumumumumumumumumicumicumicumicumicum BE packs of eighticumicumicumicumicumicumicumicumTalk to your pharmacist about any side effects you experience

If you have not told your health care provider about a prescription for Viagra, you should wait at least 6 hours before order.

If you have not told your doctor about any of the above, you should not be considered a health professional.

If you require any updates to a product, condition information or brand information about- orename product, you should notify your doctor on contact.

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