Erectile Dysfunction

About The Condition

Please answer the following questions to help us confirm that you'll follow the guidelines for this medicine.

Do you have trouble achieving an erection that lasts long enough for satisfactory penetrative sex?

Yes

Have you had a serious reaction to an Erectile Dysfunction medicine before?

If yes, please describe the product/reaction.

Yes

Do you take any of the following medications?

Any treatment for erectile dysfunction apart from sildenafil , vardenafil or tadalafil
Medicinal nitrates such as glyceryl trinitrate, nicorandil, isosorbide mononitrate or isosorbide dinitrate (including oral, transdermal and sublingual)
Recreational drugs
Recreational nitrates such as "poppers"
Alpha blockers (such as alfuzosin, tamsulosin, doxazocin, prazocin terazocin & indoramin)
Blood thinning medicines including anticoagulants, antiplatelets or Warfarin
Anti-virals (such as indinavir, nelfinavir, ritonavir, saquinavir)
Anti-fungals (such as Ketoconazole or itraconazole)
Quinidine, procainamide, amiodarone
Theophylline, cimetidine
Anticonvulsants (such as phenobarbital, phenytoin and carbamazepine)
Erythromycin, Clarithromycin, Riociguat, Rifampicin

Yes

The Agreement and Consent

Please answer the following questions to help us confirm that you'll follow the guidelines for this medicine.

Is there any other information you would like to share with our prescribing team?

Yes

Do you consent to us sharing consultation information with your GP? (optional)

Yes

Do you agree to the following?

To Inform both us and your GP about any treatment-related side effects, the initiation of new medication, or changes in your medical conditions during the course of treatment.
You must read the patient information leaflet provided with your medication before using your new treatment. If you have any questions you can contact our support team or your GP.
The prescribed treatment is intended exclusively for your personal use.
You have provided accurate and truthful responses to all the preceding questions.
You acknowledge that our prescribers rely on your responses as truthful and honest to make prescribing decisions and recognise that inaccurate information may result in serious health risks.

Yes