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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’.
AO allowed, POM3220

Categories of Viagra Connect

In 2023, Viagra Connect will be the expensive combination product in the UK. Most pharmacists only recommend one at a time tube of 50mg of Viagra Connect, and will not supply any other combination product. Some men will require a 25mg dose or require a 20mg dose of Viagra Connect, and others may require a lower dose version of Viagra Connect, or a supply of two tablets in the future, before a particular men’s visit.

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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Side Effects of Sildenafil (Viagra)

    Less common side effects but serious effects include vision changes, hearing changes, or prolonged erections.

    Sildenafil is effective in up to 80% of men with ED, with effects typically noticeable within 30 to 60 minutes, and lasting for up to 4 hours.

    Product Name:Viagra

    Ingridients:Sildinafil 100mg

    Product Type:Tablet

    Product size:6's

    Company:Pfizer

    Used for:

    • Viagra Tabs is approves for the treatment of men who have difficulty having and maintaining an erection, Otherwise know as impotence.
    • Viagra Tab work faster only 20 minutes as compared to traditional Viagra pills that takes 60 to +0 minutes become effective.

    How to take tablets

    Swallow tablets whole with a drink of water or juice (but not grapefruit juice).

    For erectile dysfunction, it's best to take sildenafil on an empty stomach. It may take longer to work if you take it with food.

    How to take liquid

    If you or your child are taking sildenafil as a liquid, 1ml is usually the same as taking a 10mg tablet, but it's important to always check the medicine label.

    Liquid sildenafil will usually be made up for you by your pharmacist.

    The medicine will come with a plastic syringe or spoon to help you take the right amount. If you do not have a plastic syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

    If you take too much

    Taking too much sildenafil can cause unpleasant side effects.

    Talk to your doctor if you take too much sildenafil and you're worried about any of these side effects:

    • headaches
    • dizziness
    • indigestion
    • blocked nose
    • changes to your vision
    You may also experience such side effects as frustration over not taking a dose, difficulty swallowing or unpleasant rash around the eyes.

    If you're experiencing any of the following side effects, stop taking and see your doctor immediately:

    • upset stomach
    • back pain
    • changes in color tinge (indigestion)
    • difficulty speaking
    • fainting
    • muscle aches or painful headaches
    • chills
    • breast tenderness or enlargement from pain in or around the nipple

    Avoid taking too much sildenafil and contact your doctor if you have any of these serious side effects:

    • trouble swallowing
    • sudden loss of vision
    • breast pain or tenderness
    • other side effects listed at the end of this leaflet.

    Avoid taking sildenafil with a heavy meal, use on least three days before taking it, and share the medicine with your doctor when taking it.

    Side effects may go away while it's taking treatment if they stay treatment as they get better.

    If you take too muchanskiypill generic sildenafil

    Sildenafil will not cause unexpectedilantro which is the odor of a upheldanum (itch). Instead, it can be expensive.

    If you do not want a plastic syringe or spoon, do not use a kitchen teaspoon.

    Taking sildenafil as a liquid can cause unpleasant side effects. Some of the side effects include:

    • urge or][]{sticeran} enlargement or tenderness.

    These are all non-negotiable side effects. Always check the side effects as directed.

    Sildenafil will not cause any side effects.

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    Herb Viagra Green Box 20 mg

    Herb Viagra Green Box 20mg

    TheHerb is made with the same active ingredient as Pfizer Viagra and is the brand name for a medicine known as the Red Viagra. This brand is used to treat Erectile Dysfunction (ED) in men. It contains the same active ingredient, Sildenafil Citrate, as Pfizer Viagra. This medicine works by increasing blood flow to the penis. This helps men to achieve and maintain an erection. It is important to remember that this medicine has been prescribed for you only and is not a substitute for sexual arousal. It should only be taken as advised by your doctor. The usual adult dose for ED is 50mg taken as needed about an hour before sexual activity. The dose may be increased to a maximum of 100mg or decreased to a lower dose of 25mg. The maximum recommended dosing frequency is once per day, but this medicine is not recommended for continuous daily use. It is recommended that you consult your doctor, nurse or pharmacist before taking this medicine, if you are allergic to its components or if you have any other medical conditions.

    If you are not sure whether you are experiencing ED, it is important to consult your doctor or nurse. They will need to adjust the dosage or suggest an alternative treatment. The doctor or nurse will ask you questions about your health, medical history, and instructions for using the medicine. You may be asked to share the medicines with your patients. This includes herbal supplements and recreational drugs. You are encouraged to ask your doctor or nurse before taking this medicine. The medicine may be taken with or without food, but it is recommended to take it with a full glass of water. You should swallow the whole with a large glass of water. If your erection lasts for more than 4 hours, or if it becomes painful, consult your doctor or nurse. The doctor or nurse will try and determine if the medicine is the right treatment for you.

    Always read the label. Follow the directions and use it as directed. Do not take this medicine in larger or smaller amounts or for longer than recommended. It is best to take the medicine at regular intervals. You may experience side effects such as headache, tiredness, flushing, stomach upset, and stuffy nose. Inform your doctor if you experience chest pain or trouble breathing. Do not take this medicine with any other ED medicine, as it may affect how it works. If you are taking any other medicines, including prescription and non-prescription medicines and herbal products, you should inform the pharmacist before using this medicine.

    TheHerb GreenBox 20mg capsules are a medicine used for the treatment of Erectile Dysfunction (ED) in men. The medication contains the same active ingredient as Pfizer Viagra and is known as Red Viagra. The recommended dose for ED is 50mg. The recommended dose for ED is 100mg. The usual adult dose for ED is 25mg taken as needed about an hour before sexual activity. The maximum recommended dose of Red Viagra is 100mg. The maximum recommended dose of Viagra is 100mg. The maximum recommended dose of Red Viagra is 50mg.