To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.

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If yes:

  • Have you experienced any side effects to these medicines?
  • What side-effects did you experience?
  • What medicine and dose have you previously tried?







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

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  • Heart conditions or had any major health incidents involving the heart? (e.g. Heart attack or stroke)
  • Kidney Problems
  • Liver Problems
  • Stomach or Duodenal Ulcer
  • Vision Loss due to optic nerve damage or poor circulation
  • Retinitis Pigmentosa
  • Myeloma, leukaemia, sickle cell disease
  • Inflammation or any physical abnormality of the penis.
  • An erection that lasted more than 4 hours

If yes, please list your medical conditions.


If yes, please describe the product/reaction.


  • 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





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  • 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.
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