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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’.
As with the list of things in - - There is a wide range of medicines available over the counter, usually at a cost cutting point - branded and generic versions of which are then typically denied H2 medicine. A sometimes recognise that ‘off-brand’ medicines are a sign of good manufacturing practice.Some medicines sold for Erectile Dysfunction in online retailers work than others. This includes some of the following.

IMPORTANT NOTICE: Please be aware, prior to sale, you are advised to have a short phone call consultation with our Pharmacist. Automatic purchase consents the Pharmacist to give you a quick call.

Viagra Connect is available without a Prescription but requires a brief consultation with the Pharmacist. It is available in a 4 pack or an 8 pack. Viagra Connect contains Sildenafil 50mg which works by relaxing the penis blood vessels, allowing blood to flow when you get aroused causing erections and potency. Viagra Connect will only help men become erect if you are aroused. Only for adult use, men 18 years plus.

How to be taken:

  • The recommended dose is one 50 mg tablet taken with water approximately one hour before bedtime activity
  • The maximum recommended dosing frequency is once per day
  • The onset of sexual activity may be delayed if Viagra Connect is taken with food, compared to without food
  • Please read Instructions provided with the product carefully before taking.

VIAGRA CONNECT is not to be taken if:

  • There is no problem with gaining erections.
  • Nitrate medicine is taken for chest pain or heart failure
  • Amyl nitrite, so-called “poppers”, is taken as recreational drugs
  • Riociguat (or other guanylate cyclase stimulators) is taken for high blood pressure in the lungs
  • Ritonavir is taken for the treatment of HIV
  • Your Doctor has advised you to avoid activity because of a problem with your heart or blood vessels
  • You have a heart problem such as a recent heart attack or stroke (within the last 6 months), Chest pain (Angina) or severe Heart failure (reduced pumping capacity of the heart)
  • You have a liver problem
  • You have low blood pressure (below 90/50 mmHg) which can cause symptoms such as tiredness, dizziness, light-headedness, feeling sick, clammy skin, depression, loss of consciousness, or blurry vision
  • Loss of vision has occurred before because of nerve damage in the eyes, such as non-arteritic anterior ischaemic optic neuropathy (NAION); or have a rare inherited eye disease, such as retinitis pigmentosa
  • You have a deformed penis
  • You are a woman
  • You are under 18 years of age
  • You are allergic to sildenafil or any of the other ingredients of this medicine

Please read instructions carefully provided.

Viagra Connect is a fast acting drug for erectile dysfunction which can last up to 4 hours and takes effect within 30 minutes after administration.

Sildenafil Citrate 50 mg Tablets: This tablet is specifically formulated to treat the symptoms of erectile disfunction and is highly effective in treating it, the most common sexual disorder affecting men over the age of 40 years. Provides a solution to erectile dysfunction in men who suffer from impotence due to conditions such as heart disease or diabetes, or who have problems with their physical or mental health.

Viagra Connect ensures fast and effective results that last as long as 36 hours and come without side effects. It works by relaxing the blood vessels in the penis, allowing blood to flow into the phallus when you get sexually excited and causing the desired stiffness.

Add this Medicine to your diet after taking this Meds FDA only medicine so be sure to talk to your doctor about any side effects you may have.We are able to offer Viagra Connect in many ways, but it is important to be aware of the following: Dose: This medicine is taken orally, usually as needed before sexual activity or as a short product such as an extended-release tablet when taking medicine as aQGnpepepeagraagra Connect is taken between 30 minutes to 4 hours before sexual activity.

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.

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Viagra can interact withSildenafil. If you are using Viagra or any medication you are taking, call your doctor immediately or go to to a different pharmacy to obtain the actual medication that you are using. This may not work if your doctor has not received any side effects.

As with all prescription medications, inform your doctor!

Cautions

Do NOT take Viagra if you are allergic to any of the components in Viagra.

If you are taking any other medicines, including other products that are available from your pharmacy, tell your doctor before you start taking this medication.

If you experience any changes in your vision, please contact your doctor.

Warnings

Let your doctor know if you are having an event that is not listed. Do not take Viagra if you are using nitrates such as isosorbide dinitrate or isosorbide mononitrate medications. Viagra can cause a serious drop in blood pressure if used with nitrates. Viagra should not be taken if you are using riociguat or any medication that contains nitrates such as isosorbide dinitrate or isosorbide mononitrate medications. Viagra may cause potentially dangerous drops in blood pressure if Viagra is taken with certain medications.

Viagra may raise potassium levels in your blood. Tell your doctor if you have potassium levels in your blood elevated or not. Viagra can cause potassium loss if Viagra is taken with certain medications.

Sildenafil citrate, commonly known by the brand name, is a prescription-only medicine used to treat erectile dysfunction (ED) in adult men. It works by improving blood flow to the penis, helping to achieve and maintain an erection during sexual activity.

Dosage and Administration

Sildenafil is available in 25mg, 50mg, and 100mg strengths.

  • The usual starting dose is 50mg, taken approximately one hour before sexual activity.
  • Dosage can be adjusted depending on individual response and tolerability.
  • Take only one tablet in 24 hours, with or without food.
  • Avoid grapefruit juice, as it can increase the risk of side effects.
  • A high-fat meal may delay onset of action.

Effectiveness

Sildenafil has been shown to be effective in up to 80% of men with ED, with effects typically noticeable within 30 to 60 minutes, and lasting for up to 4–5 hours.

Side Effects

Common side effects include:

  • Headache
  • Flushing
  • Nasal congestion
  • Indigestion

Less common but serious effects include visual disturbances, hearing changes, or prolonged erections. Seek medical attention if severe or persistent side effects occur.

Contraindications

Sildenafil should not be used by those:

  • Taking nitrates for chest pain
  • With severe heart or liver conditions
  • Under 18 years of age
  • With certain medication interactions (e.g. alpha-blockers, antifungals, antibiotics)

Interactions

Inform your doctor of all medications and supplements before use. Interactions may occur with:

  • Nitrates
  • Alpha-blockers
  • Some antibiotics and antifungal medicines

Alcohol and Heart Conditions

Avoid excessive alcohol while taking sildenafil, as it can lower blood pressure and increase side effect risk. Use with caution if you have any heart-related conditions.

Availability and Cost

Sildenafil is available by prescription only in the UK.

  • Generic versions are more affordable than branded Viagra.
  • Supplied by licensed UK pharmacies such as Online Chemist.
  • Avoid counterfeit products from unregulated websites.

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