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You will be offered treatment for you and the prescriber to jointly consider. However, the final decision always will be the prescriber's.
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Erectile dysfunction (also known as impotence) is a very common condition, which affects the majority of men at some point in their lives. Up to 50% of men aged 40 - 70 and up to 70% of men over the age of 70 suffer from erectile dysfunction to some extent. There are several options, which are currently licensed for the treatment of erectile dysfunction in the UK. Modern treatments are safe, affordable and effective and can help up to 80% of men treat erectile dysfunction.

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ABOUT YOU

Are you male between the ages of 18-75?

Do you smoke or drink?

YOUR SYMPTOMS

Do you sometimes or always have difficulty getting and keeping an erection?

YOUR HEALTH

Do you have high blood pressure (above 160/90), or are you currently on treatment for high blood pressure?

  • If you do not know your blood pressure you can have this measured at your local pharmacy/GP surgery.

Do you have low blood pressure (below 90/50)?

  • If you do not know your blood pressure you can have this measured at your local pharmacy/GP surgery.

Have you been advised to avoid heavy exercise?

Would it be difficult for you to walk at a fast pace for 5 minutes?

Do you suffer from depression that you have not seen your GP about?

Do you have any allergy to Viagra (sildenafil), Levitra (vardenafil), Spedra (avanafil) or Cialis (tadalafil) or have you experienced any adverse reaction to any erectile dysfunction medication previously?

Have you ever suffered from any of the problems listed below?

  • Any heart problems including angina, chest pain, heart failure, irregular heart beats, heart attack (myocardial infarction), left-ventricular outflow obstruction, cardiomyopathy or valvular heart disease (e.g.aortic stenosis).
  • Stroke
  • Sight loss due to poor circulation
  • Sight loss because of non-arteritic anterior ischemic optic neuropathy (NAION)
  • Blood problems such as haemophilia, sickle cell anaemia (an abnormality of red blood cells),leukaemia (cancer of blood cells) or multiple myeloma (cancer of bone marrow)
  • Stomach ulcers (e.g. peptic/gastric ulcer)
  • Liver problems
  • Kidney problems
  • An erection that lasted more than 4 hours
  • Any physical condition affecting the shape of the penis (e.g. angulation, Peyronie’s disease and cavernosal fibrosis)
  • Inherited eye disease - retinitis pigmentosa
  • Multiple myeloma (cancer of the bone marrow)
  • Galactose intolerance, Lapp Lactase deficiency or glucose-galactose malabsorption
  • Any serious medical condition which may require immediate hospitalisation

YOUR MEDICATION

Are you taking any medicines known as nitrates (often taken for chest pain/angina) or nitric oxide donors ('poppers')?

  • Often taken for chest pain/angina
  • Can be administered as a spray, tablet or patch.
  • Include glyceryl trinitrate, isosorbide mononitrate or isosorbide dinitrate

Are you currently taking any medication (including over the counter, prescription or recreational drugs)?

AGREEMENT

Do you agree with the following?

  • You will read the patient information leaflet supplied with your medication
  • You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • The treatment is solely for your own use
  • You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.