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💡 Help: For example sildenafil, tadalafil, avanafil or Viagra
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💡 Help: Nitrate medicines for chest pain or heart problems such as GTN spray, isosorbide mononitrate or isosorbide dinitrate
Riociguat
Recreational poppers
Alpha blockers such as tamsulosin, alfuzosin, doxazosin or terazosin
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💡 Help: Angina, chest pain on exertion, or you have been told sexual activity is not safe for you
Heart attack in the last 3 months
Stroke in the last 6 months
Low blood pressure, or uncontrolled high blood pressure
Significant heart failure or serious heart disease
Loss of vision in one eye due to poor blood flow, or an inherited retinal condition
Severe liver disease
Severe kidney disease
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💡 Help: Sickle cell disease
Leukaemia
Multiple myeloma
Peyronie’s disease, penile curvature, or another significant penile abnormality
Severe pelvic or genital pain
An erection lasting more than 4 hours
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💡 Help: Please include prescribed medicines, over the counter medicines, inhalers, creams, supplements and herbal products
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💡 Help: I understand that erectile dysfunction medicines must not be taken with nitrate medicines or poppers.
I understand that I must seek urgent medical help if I develop chest pain after taking treatment, sudden loss of vision or hearing, or an erection lasting more than 4 hours.
I confirm that the information provided in this assessment is accurate and complete to the best of my knowledge.
I understand that a prescriber or pharmacist may need to contact me or my GP before treatment can be supplied.
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