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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’.
In Canada 3 categories are available:
  • Cialis Together – OTC medicine:supplied by a licensed healthcare professional without a prescription.
  • Viagra Connect – Prescription medicine:supplied by a medical professional ‘TCO’. may be supplied on prescription only.
Dr Fox is packs company - direct correspondence: Laura Squire, MHRA, aser service officer, Sanofi.

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.

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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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may change the treatment plan if a potentially harmful reaction to this medication occurs. If you notice any unusual symptoms, please seek medical attention immediately.

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If you experience any unusual symptoms while taking Viagra, please seek medical attention immediately. These may include dizziness, headache, or nausea.

may change the treatment plan if you experience any changes in your symptoms.

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