Viagra Connect - Sidena Pharmacist Consultation
In order for our pharmacists to asses whether you can safely take Viagra Connect or Sidena, please complete the following 15 questions. All answers are strictly confidential.
It is recommended that all men starting this medication see their GP without delay and certainly within 6 months. This is to check that your symptoms of erectile dysfunction are not being caused by any underlying conditions.
The person intending to take this medication must be the person to complete this form.
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Email *
Your Name *
1) Are you experiencing erectile dysfunction (ED) (i.e. difficulty in getting and/or maintaining an erection satisfactory for sexual performance) *
2) Has your doctor advised that you are not fit enough for any physical and/or sexual activity? *
3) Do you feel very breathless or experience chest pain with light or moderate physical activity, such as walking briskly for 20 minutes or climbing two flights of stairs? *
4) Have you had a heart attack or stroke within the last 6 months? *
5) Are you taking nitrates or any medication (nicorandil or other nitric oxide donors e.g. glyceryl trinitrate, isosorbide mononitrate or isosorbide dinitrate) for chest pain? *
6) Are you using drugs called ‘poppers’ for recreational purposes (e.g. amyl nitrite)? *
7) Are you taking riociguat or other guanylate cyclase stimulators for lung problems? *
8) Are you taking ritonavir (for HIV infection)? *
9) Are you taking any CYP3A4 inhibitors, e.g. saquinavir (to treat HIV infection), cimetidine (a heartburn treatment), itraconazole or ketoconazole (to treat fungal infections), erythromycin or rifampicin (antibiotics) or diltiazem (for high blood pressure)? *
10) Are you taking any alpha-blockers, such as alfuzosin, doxazosin or tamsulosin, which are medicines to treat urinary problems due to enlarged prostate (benign prostatic hyperplasia) or occasionally to treat high blood pressure? *
11) Do you have Peyronie’s disease or any other deformation of the penis? *
12) Have ever had loss of vision because of damage to the optic nerve (such as non-arteritic anterior ischaemic optic neuropathy [NAION]) or have an inherited eye disease (such as retinitis pigmentosa)? *
13) Do you have galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption? *
14) Do you have previously diagnosed hepatic (liver) disease (including cirrhosis of the liver) or severe renal (kidney) impairment? *
15) Do you have any bleeding issues (e.g. haemophilia) or have active stomach ulcers? *
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