Buying erectile dysfunction medicines safely in the UK

Erectile dysfunction is one of the most counterfeited medicine categories in the world, for obvious reasons: demand is high, embarrassment is common, and a lot of people would rather not have the conversation. That combination is exactly what illegal sellers rely on.

The good news is that checking whether a UK seller is legitimate takes about two minutes.

What’s legally available, and how

Prescription only medicines. Sildenafil (including branded Viagra), tadalafil, vardenafil and avanafil are prescription only in the UK. They can be supplied by a pharmacy — including an online one — after a prescriber has assessed you ^[5].

Pharmacy medicines. Viagra Connect (sildenafil 50 mg) is classed as a pharmacy medicine and can be supplied without a prescription following a consultation with a pharmacist, who checks it is suitable. Viagra Connect Melts and Cialis Together are also available this way. The pharmacist consultation is the safety step that replaces the prescription.

Nothing else. Any other route — a website with no questions, a gym, a social media seller, a product marketed as “herbal Viagra” — is outside the legal supply chain.

How to check a UK online pharmacy

1. Find the GPhC registration. Every registered pharmacy in Great Britain has a premises registration number, and the site should display it along with the name of the superintendent pharmacist. Search the pharmacy on the GPhC register to confirm ^[1].
2. Look for a UK address. Not a contact form, an actual registered address.
3. Expect to be asked questions. A legitimate service asks about your symptoms, your medical history, every medicine you take, allergies, and specifically about heart problems and nitrates. If the only question is which product and how many, walk away.
4. Expect the option of being refused. A service that can never say no is not assessing anything.
5. Check the prescriber. Online prescribing services in England are regulated by the CQC (with equivalents elsewhere in the UK) and their inspection reports are public ^[3].
6. Be suspicious of the price. Prices well below everyone else’s are not a bargain in this category.

Why it matters more than it sounds

The obvious risk is that counterfeit tablets contain nothing, or the wrong dose. Regulators have seized products containing a fraction of the stated dose, several times the stated dose, and none at all, as well as contaminants from unregulated manufacturing ^[2].

The less obvious risk is the bigger one. PDE5 inhibitors must never be taken with nitrates (such as glyceryl trinitrate or isosorbide mononitrate) or nicorandil, because the combination can cause a severe and dangerous fall in blood pressure. A pharmacy asks about this. A website that asks nothing does not — and a man with undiagnosed angina, or one who takes a GTN spray occasionally, has no way of knowing from the packaging.

This is also why “herbal” products are a particular problem. The MHRA has repeatedly found undeclared sildenafil or similar compounds in supplements sold as natural ^[2]. Someone avoiding prescription medicines specifically because they take nitrates could end up taking one without knowing.

What a good consultation asks about

If you are filling in an online questionnaire, these are the things it should cover — and it is worth answering them accurately even where the honest answer feels like it might disqualify you:

• heart disease, angina, recent heart attack or stroke
• nitrates, nicorandil, riociguat
• alpha blockers for blood pressure or prostate symptoms
• blood pressure, both high and low
• diabetes
• liver or kidney problems
• eye conditions, particularly any previous sudden loss of vision
• sickle cell disease, myeloma or leukaemia
• any anatomical condition of the penis, including Peyronie’s disease
• all other medicines, including anything bought over the counter

Understating a condition to get a prescription is the one shortcut that can actually hurt you.

The case for not skipping the GP

An online supply route is convenient and legitimate. But erectile dysfunction can be the first symptom of cardiovascular disease, sometimes years before anything else appears — which means a first episode is a reason to have blood pressure, cholesterol and glucose checked, not just to obtain a tablet ^[4].

Plenty of men use both: a GP assessment for the underlying picture, and a pharmacy for ongoing supply. Our guide to ED and heart disease explains why that first check matters.

If something goes wrong

Report suspected counterfeit or substandard medicines to the MHRA, and report suspected side effects through the Yellow Card scheme. Keep the packaging.

And if an erection lasts more than four hours, go to A&E — that is an emergency regardless of where the medicine came from.

This article is for general information and isn’t a substitute for advice from your own clinician. If you feel unwell, contact your GP or NHS 111. In an emergency, call 999.