Erectile dysfunction (ED), sometimes still referred to as impotence, is defined as: “The inability to achieve or maintain an erection sufficient for satisfactory sexual performance”. Episodes can occur occasionally or frequently and can vary in severity from mild (a soft erection) to severe (no erection at all). Treatment is usually indicated in those with more persistent symptoms

When Viagra (sildenafil) was first made available on prescription in 1998 it was seen to be a major advance in the treatment of this condition but, as it was expensive and with demand expected to be high, restrictions were placed on its availability. This meant that only men with ED related to certain medical conditions could get prescriptions under the ‘selective list’ scheme (via SLS prescription endorsement).

When the drug came off patent in 2014 and cheaper versions became available, these restrictions were lifted for generic sildenafil (they still apply for some other drugs). The MHRA has now allowed a brand of sildenafil called Viagra Connect to be sold by a pharmacist (as a Pharmacy-only medicine) over the counter to men over the age of 18 years following careful assessment.

It is hoped that making sildenafil available OTC via pharmacy will go some way to reducing ‘black market’ purchases of the drug or counterfeit product over the internet, and should therefore improve safety. To ensure patient suitability and enable appropriate supply, a pharmacy checklist has been produced by manufacturer Pfizer Consumer Healthcare (although use is not mandatory and pharmacists should use their professional judgement). This asks questions about the cardiovascular health of the patient and concomitant medication use/conditions.

If there are safety doubts, the patient should be referred to his GP for further assessment. The checklist also provides counselling advice. Booklets are available for pharmacists and pharmacy teams giving essential information on supply. These materials are available on the electronic Medicines Compendium website under Viagra Connect.