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 other medicine items, the online consultation is private, and the doctor may not be able to provide patient information such as in order to whom medications be supplied and asked to minimize the risk of side effects.idespread adoption of non-prescription treatments

Do – medicine not required

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Erectile Dysfunction

Erectile dysfunction (ED) is more common than you may realize. It can stem from various factors, including:

• Physical health conditions like heart disease, high blood pressure, and diabetes
• Other health issues such as high cholesterol, high blood sugar, and high blood pressure
• Medication use
• Family history of ED

For the majority of men, ED is a chronic condition that affects nearly their entire lives. It can have a profound impact on a person’s quality of life and relationships.

If you’re struggling with ED, you’re not alone. According to the American Urological Association, ED affects nearly 6 million men in the United States. ED affects approximately 4.3 million men each year.

Thankfully, there are effective treatments available for ED. Erectile dysfunction treatment options may include lifestyle changes, dietary changes, and medications. In some cases, ED medications may be used alongside ED treatment.

Lifestyle Changes to Treat ED

While ED can be a frustrating condition, there are lifestyle changes that can help. Some common lifestyle changes include:

• Regular exercise.Erectile dysfunction can lead to a reduction in blood pressure, which can help improve blood flow and promote better erections.
• Stress management.Erectile dysfunction can reduce the amount of stress that can contribute to ED.
• Reducing alcohol use.Consuming alcohol can help reduce the negative effects of alcohol, such as nausea and dizziness.
• Maintaining a healthy weight.Erectile dysfunction can cause weight loss, which may help men achieve a healthy weight.
• Reducing stress and anxiety.Excessive stress can contribute to ED, which can be a source of anxiety and depression.

For those who struggle with ED, some lifestyle changes may help manage ED symptoms. These changes include:

• Getting enough rest.
• Losing weight.
• Reducing stress.
• Quitting smoking.
• Avoiding alcohol.
• Avoiding caffeine.
• Being physically active.
• Getting enough sleep.

For men with ED, lifestyle changes may help alleviate their symptoms.

• Regular exercise can help improve blood flow, which can help men with ED improve their erectile function.
• Quitting smoking can help men with ED improve their erectile function.
• Stress- Management techniques such as mindfulness, meditation, or yoga can help men with ED improve their erectile function.
• Drinking less alcohol.Drinking less alcohol can help men with ED improve their erectile function.

Treating ED

If you’re experiencing ED, it’s important to talk to your doctor. They can help determine if ED treatment is the best option for you.

Finding the Right ED Treatment

ED treatments can be quite invasive and may not be the best option for everyone.

• Medications.Medications can help men with ED achieve and maintain erection firmness and a healthy erection quality.
• Lifestyle changes.A healthy lifestyle can help improve ED symptoms and manage ED symptoms.
• Physical therapy.A physical therapy approach that combinesED exercises with ED therapy may be effective for treating ED symptoms.

If you’re struggling with ED, talk to your doctor. They can determine if ED treatment is the right treatment option for you.

Dosage

The standard dose for ED is one tablet of Viagra®. It can be taken as needed, about 30 minutes before sexual activity.

The maximum recommended dose is one tablet per day. It may take approximately 30 minutes to take effect.

Your doctor may prescribe a lower dose for ED if you have:

• Low blood pressure (hypotension), which is usually treated with a nitrate medication or alpha-blockers, and blood pressure medications
• Diabetes (low blood sugar).

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