PATIENT INFORMATION LEAFLET
About Erectile Dysfunction
How to take ED tablets
Your Pharmacist can supply Viagra/sildenafil, Cialis and Levitra tablets
Note: Viagra a brand name for sildenafil. If a UK licensed sildenafil tablet
becomes available, Pharmacists may offer this as an alternative to Viagra.
IMPORTANT: All men with Erectile Dysfunction MUST inform their GPs
Viagra/sildenafil, Cialis and Levitra work by temporarily increasing the
about it and about their treatment.
blood flow to the penis. They work only when sexual arousal is also
Erectile Dysfunction (ED) is very common. About half of men between
present. If there is no arousal there wil be no erection.
40 and 70 get ED at least once. ED can be distressing. It is often simple to
Usual starting doses are Viagra/sildenafil 50mg, Cialis 10mg or Levitra
10mg. Your Pharmacist may recommend half doses to start with.
Anything that interferes with the circulation or with the nervous system
It may be necessary to increase doses to obtain the best results. The
maximum single dose for Viagra/sildenafil is 100mg, and for Cialis and
Most men with ED are in reasonable health. ED can have physical and
Tablets should be taken about 60 minutes before their action is needed.
• Heart disease and high blood pressure (hypertension)
Levitra starts to work a little more quickly than the others and can take
as little as 20 minutes to become active. Taking ED medication with food
can delay the onset of action to 2 hours.
• Hormonal problems including under active thyroid• Some medications (GPs or Pharmacists can advise if regular
Viagra/sildenafil works for about four hours, Cialis for 36 hours and Levitra
for 12 hours. Tablets should not be taken more than once in 24 hours.
• Stress, anxiety, depression and relationship problems
The dose instruction for low dose daily Cialis 2.5mg or 5mg is: “One
• Abdominal and prostate surgery and spinal and head injury,
tablet daily taken around the same time each day”.
• Deformity of the penis, Peyronie’s disease (severe angulations of the
Men who need regular ED medication twice or more a week have the
option to take low dose Cialis either 2.5mg or 5mg tablets once daily on
• Lifestyle, obesity, smoking, alcohol and tiredness & recreational drugs
a continuous basis. The daily dose is low; however Cialis stays in the body
Sometimes, ED occurs only in certain situations. This suggests the
for 36 hours and builds up to effective levels when taken daily.
underlying cause is likely to be psychological. If erections do not occur
Combinations of Viagra/sildenafil, Levitra and Cialis should not be taken
under any circumstances, the underlying cause is likely to be physical.
in combination without a break of 36 hours between one medication
Anxiety usual y makes ED symptoms worse.
When to see a GP
Cautions and warnings and side effects
Men must inform their GPs if ED lasts more than a few weeks. GPs will
You MUST read the ‘Patient Information Leaflet’ supplied with tablets.
assess the general state of health. ED can be a sign of problems such as
Serious side effects are rare. Possible side effects include: headaches, hot
flushes, indigestion, a blocked, or runny, nose, back pain, and temporary
GPs wil ask about symptoms, overal physical and mental health, sex life,
alcohol consumption, drugs, and any medication.
There are a few serious side effects requiring immediate medical help:
A physical examination may be needed to look for a deformity of the
penis known as Peyronie’s disease where the penis is markedly bent to
• Chest pain with nausea and discomfort (Possible heart pain, rare)
• Continuous painful erection lasting 4 or more hours (Priapism, rare)
Glucose, cholesterol and thyroid tests may be needed. More extensive
tests are not usual y required in men over 40 in whom ED is common.
Alternatives to ED medication
Treatment of erectile dysfunction
ED sometimes improves without the need for treatment. Briefly, other
treatments include: Hormone therapy (Occasional y used in men with
Where there are underlying conditions these should be treated. This
measured hormone deficiency), Penis pumps and penile implants
does not always help the symptoms of ED. The fol owing may also help:
(Mechanical devices which stiffen the penis), Alprostadil (A medication
injected directly into the penis, or a smal tablet placed inside the penis
• Changes in lifestyle can sometimes reduce ED
usual y producing an erection that lasts for between 5-30 minutes),
Surgery (usual y reserved for special cases), Psychosexual counsel ing
(A form of relationship therapy where sexual, or emotional issues are
discussed), Cognitive behavioural therapy (CBT is based on the principle
that the way we feel is partly dependent on the way we think about
ED treatment on the NHS
Most men with ED are not eligible for treatment on the NHS. Where men
are eligible for NHS treatment a few tablets a month only are al owed.
Men with the fol owing are sometimes eligible; diabetes, multiple
sclerosis, Parkinson’s disease, poliomyelitis, prostate cancer, severe pelvic
injury, single gene neurological disease, spina bifida, or spinal cord injury
or men receiving dialysis for renal failure or where there is a history of
radical pelvic surgery, prostatectomy (including transurethral resection
of the prostate), or kidney transplant were receiving Caverject®, Erecnos®,
MUSE®, Viagra®, or Viridal® for erectile dysfunction, at the expense of
the NHS, on 14 September 1998 or in men suffering severe distress as a
result of impotence (prescribed in specialist centres only)Treatment for ED is not usual y covered by private medical insurance.
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