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.
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
In the UK have 3 categories:
WhenALE. UK comes to Dr Fox’s table with the most frequently grantedrosseconditolia (Cialis Together).
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Quick OverviewAbout Cialis:Cialis is a widely recognized and trusted medication that contains the active ingredient Tadalafil. It is primarily prescribed to help men overcome the challenges of erectile dysfunction (ED), a common condition that can affect intimacy and overall well-being.
How Cialis Works:Cialis works by increasing blood flow to the penis, allowing men to achieve and sustain an erection when sexually stimulated. It is known for its long-lasting effectiveness, providing up to 36 hours of response to sexual stimulation.
Benefits of Cialis:
Usage and Dosage:Cialis should be taken as directed by a healthcare professional. The typical starting dose is 10mg, taken at least 30 minutes before anticipated sexual activity. The dosage may be adjusted based on individual response and tolerability.
Safety:Cialis is generally well-tolerated, but it's essential to follow your healthcare provider's recommendations. Discuss any medical conditions or medications you are taking with your doctor to ensure Cialis is safe and suitable for you.
Consultation:If you have questions or concerns about Cialis or its suitability for your condition, our licensed pharmacists and healthcare professionals are here to provide guidance and support.
Remember, Cialis is a prescription medication, and it's crucial to consult with a healthcare provider before starting any new medication. Our pharmacy is committed to helping you access the right treatment for your needs, promoting a healthier, happier, and more fulfilling life.
How to use:1 tablet before sexual activity once daily. The effect should give the ability for erection for 36 hours. Otherwise refer to physician's prescription
Precautions:Do not take another tablet except after 48 hours pass after the first tablet
LESS HEATED than normal.1.Nitrates (e.g., nitroglycerin, isosorbide dinitrate): Cialis and nitrates both lower blood pressure. Taking them together can cause a significant and potentially life-threatening drop in blood pressure (hypotension), leading to dizziness, fainting, or even heart attack or stroke. It is contraindicated to use Cialis with nitrates or recreational "poppers" (amyl nitrites).
2.Alpha-blockers (e.g., prazosin, terazosin, tamsulosin): Both Cialis and alpha-blockers relax blood vessels, which can lead to excessive blood pressure reduction when used together. This may result in dizziness, fainting, or orthostatic hypotension (a sudden drop in blood pressure when standing). If needed, your doctor may adjust the dosage or recommend spacing the medications.
3.Other antihypertensive drugs (e.g., atenolol, propranolol, enalapril, lisinopril): Cialis can enhance the blood-pressure-lowering effects of these medications. While this interaction is usually less severe than with nitrates or alpha-blockers, it can still cause dizziness or fainting in sensitive individuals. Close monitoring of blood pressure is recommended.
Cialis (tadalafil) can interact with certain foods and beverages, potentially altering its effectiveness or increasing the risk of side effects. Here are the key drug-food interactions to be aware of:
Note:kept mostly in medical tourism discussions are the interactions between taking the medication and certain foods and beverages off-label. Here is a general idea: “Avoid taking with high caffeine levels”. Avoid these beverages while using.
Cautions
Whether you can take Tadalafil at the same time as your other medications will depend on which medications you are taking.
You are required to complete a short medical consultation questionnaire that asks for any medications that you are prescribed from your GP and will indicate the medications that can’t be taken alongside Tadalafil.
There are several medicines which should not be taken concurrently with Tadalafil. Medicines which can have potentially serious interactions with Tadalafil include :-
• Any alpha-blocker medicines e.g. doxazosin (Cardura), alfuzosin (Xatral), tamsulosin, terazosin, or Flomax, that you can buy in the pharmacy. (These medicines may be used to treat prostate problems or high blood pressure).
• Isosorbide mononitrate, isosorbide dinitrate, or use a GTN spray or tablets
for chest pain or use Rectogesic ointment?
• Nicorandil (Ikorel), used to treat angina
• Cimetidine, used to treat stomach or duodenal (peptic) ulcers
• Theophylline, used to treat asthma
• Antibiotics:- Clarithromycin, Erythromycin and Telithromycin
• Anti-fungals such as itraconazole and ketoconazole
• Seizure medication:- carbamazepine, oxcarbazepine, phenobarbital, phenytoin and primidone
• Heart or blood pressure medication:- disopyramide, amiodarone, quinidine and procainamide
• Anti-viral medication:- telaprevir, atazanavir, retonavir, indinavir, saquinavir and cobicistat
• Recreational drugs:- amyl nitrate (poppers)
If you are taking any prescribed medication from your GP then you can simply write those in the “Is there any other medical information that you think our doctor should know?” section on the medical questionnaire. Then, our doctor will know whether the Tadalafil is safe for you to take.
How to split a medical questionnaire medicine three times daily from a single psychiatry clinicHow to get prescribed TadalafilYour doctor will qualitative the medicine and nature of the medication's purpose and use the DNA evidence to decide whether the medicine is safe for you to take. A DNA evidence score of 10 is considered as the the best the quality of DNA evidence.
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