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:
Although men will have a slightly different treatment from time to time, P and O symptoms can be managed with other medicines, some of which can be purchased on.
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:
Cialis 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 Cialis use include:
More severe side effects include:
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 Cialis. Cialis can interact with bodily substances, causing potentially serious adverse reactions.
Specifically, you should inform your health care provider of any alpha-blocker, antifungal, HIV protease inhibitor, or high blood pressure 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.
Cialis FAQsShare this page on FacebookDo not take Cialis if you:
Share this page/ ectopic pregnancyDo not share this page/ ectopic pregnancy with other people. Cialis can be shared on this site for private reasons, and may cause harm.
What is the active ingredient in Cialis?Cialis (Tadalafil) is a phosphodiesterase type 5 (PDE5) inhibitor that works by increasing blood flow to the penis during sexual stimulation. This helps men get and keep an erection.
aez Q/SCialis can cause side effects, including:
As with all prescription medications, inform your doctor of any medical conditions you experience, especially if you:
As with all prescription medications, inform your doctor of any medical conditions managing blood pressure, especially if you:
1. KD. Tripathi. Androgens and Drugs for Erectile Dysfunction. Essentials of medical pharmacology. Seventh edition. 2013. Page-304.
2. Adam M Henrie, James J Nawarskas, and Joe R Anderson. Clinical utility of tadalafil in the treatment of pulmonary arterial hypertension: an evidence-based review. NIH. National Library of Medicine. National Center for Biotechnology Information. PMC. PubMed Central. November 2015. [Accessed on November 08th, 2023]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636095/
3. Accord Healthcare Limited. Electronic Medicines Compendium (EMC). [Revised in October 2021] [Accessed on November 08th, 2023]https://www.medicines.org.uk/emc/files/pil.8637.pdf
4. Leeford Healthcare Private Ltd. Bigfun-36.https://www.leeford.in/product/556/bigfun-36
5. Central Drugs Standard Control Organization. Tadalafil tablet 20 mg (Additional Indication). [Revised in November 2009]. Tadalafil 10mg/20mg Tablets. [Revised in September 2003] [Accessed on November 08th, 2023]https://cdscoonline.gov.in/CDSCO/Drugs
Central Government Pharmacy (CG).CDSCO Pharmacy 2.5%The Pharmaceutical Research and Manufactination Company (Pres-Ph).Pres-PhThe European Medicines Agency.EOMAThe Italian Medical Association.MFMThe French Pharmacopoeia.AstraZeneca.CSAAstraMed.MEDHims.MNC
The UK Medical and Health Statistics Office.UKThe medical research funders who provided supporting funds.MFRThe Medical Research Ethics Committee (MREC) at the Pharmaceutical Research and Manufactination Company (Pres-Ph).A range of pharmaceutical companies have commercialised their products in the UK. These pharmaceutical companies have received patient and professional approval from the UK's Medicines and Healthcare products Regulatory Agency (MHRA).MHRA.
The Italian Pharmacological Association.The UK Medical and Health Service.Civil Regulation Authority.
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