The guidance also outlines the public health benefits of the medicine’s reclassification: namely, the opportunity for early identification of cardiovascular risk.

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All patients provided written informed consent before study participation. Following UK Medical Research Council’s (MRC) ethics assessment tools or questionnaires, ethics approval was not required. The authors acknowledge Precision Marketing for logistic support. In addition, the authors acknowledge Dr Mamatha K and Dr Shanthakumar V, employees of buy soft viagra Viatris, for editorial support. This study was sponsored by Pfizer and Upjohn, a legacy division of Pfizer, now merged with Mylan to form Viatris.

Survey population

UBC LLC received financial support from Pfizer and Upjohn in connection with the study. Shaantanu S. Donde, and Kelly H. Zou are employees of Viatris who may own stocks/shares, merged between the Upjohn Division of Pfizer Inc and Mylan. Jim Z Li is a former employee of Viatris Inc. The full ‘Sildenafil 50mg film-coated tablets, P medicine quick reference guide’ can be downloaded from the RPS website.

Product	Dosage	Quantity + Bonus	Price
Viagra Soft Tabs	100mg	30 + 4 Pills	83.06€ 79.10€
Viagra Professional	100mg	180 + 4 Pills	337.30€ 321.24€
Viagra Generic	150mg	90 + 6 Pills	147.18€ 140.17€
Viagra Generic	150mg	120 + 8 Pills	177.58€ 169.12€
Viagra Generic	150mg	30 + 2 Pills	72.32€ 68.88€
Viagra Super Active	100mg	180 + 20 Pills	280.97€ 267.59€
Viagra Generic	200mg	120 + 8 Pills	204.80€ 195.05€
Viagra Generic	150mg	60 + 4 Pills	111.25€ 105.95€
Viagra Professional	100mg	120 + 4 Pills	262.83€ 250.31€
Viagra Professional	100mg	20 Pills	71.14€ 67.75€
Viagra Original	100mg	76 + 4 Pills	306.59€ 291.99€
Viagra Professional	100mg	90 + 2 Pills	207.09€ 197.23€

A national additional risk minimization measures (aRMMs) program was implemented to train pharmacists for safe supply of non-prescription Viagra Connect® (VC) to erectile dysfunction (ED) patients in United Kingdom (UK).

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There is also potential subjectivity and bias in patient responses which are inherent in surveys with self-reported data. Patients may have answered the survey questions in a socially desirable rather than truthful manner thus giving misleading answers to the pharmacist about their health status. Also, without knowing the exact characteristics of patients requesting VC from the pharmacy, it is not possible to draw concrete conclusions as to whether or the extent to which this sample in this study reflected the general population of ED patients purchasing VC in pharmacies. While participants reported being asked specific questions by pharmacists, the study lacks verification or confirmation of these interactions through direct observation or independent assessment. This absence of objective verification limits the validity of the reported experiences.

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Overall, the results from this survey provide reasonable confirmation of the effectiveness of the VC aRMMs program and assurance that ED patients, when requesting and purchasing VC in UK pharmacies, are assessed appropriately for suitability of VC and receive the appropriate advice from pharmacists. Inherent limitations of surveys, including selection bias, reliance of respondent recall and self-reported data, should be considered. aRRMs, Additional risk minimization measures; BP, Blood pressure; CIs, Confidence intervals; CVD, Cardiovascular disease; DCP, Decentralized procedure; ED, Erectile dysfunction; EMA, European medicines agency; EU, European Union; MHRA, Medicines and healthcare products regulatory agency; PDE-5, Phosphodiesterase type 5; UBC, United bioSource; UK, United Kingdom; VC, Viagra connect®. This study was conducted in accordance with the principles of good clinical practice and the Declaration of Helsinki. It did not require approval of institutional review boards or ethics committees at the study sites. A survey aimed to evaluate the effectiveness of aRMMs.

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Joanna Lem is a former employee of Pfizer Inc. Muhammad Younus is an employee of Pfizer Inc. Janine Collins is an employee of UBC. The authors report no other conflicts of interest in this work. Epidemiology update liquid viagra of erectile dysfunction in eight countries with high burden.

Survey sample

doi:10.1016/j.sxmr.2019.06.008 doi:10.1016/S0140-6736(12)60520-0 Bjerkeli PJ, Mulinari S, Zettermark S, Merlo J. Sociodemographic patterns in pharmacy dispensing of medications for erectile dysfunction in Sweden. doi:10.1007/s00228-017-2361-9 Miner MM, Kuritzky L. Erectile dysfunction: a sentinel marker for cardiovascular disease in primary care. doi:10.3949/ccjm.74.Suppl_3.S30 Modifying risk factors in the management of erectile dysfunction: a review. A cross-sectional, web-based survey enrolled ED patients who purchased at least 1 supply of VC in UK, using a structured self-administered questionnaire.

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Associations between lifestyle, erectile dysfunction and healthcare seeking: a population-based study. Prevalence, comorbidities, and risk factors of erectile dysfunction: results from a prospective real-world study in the United Kingdom. Burri A, Porst H. Results from an online survey investigating ED patients’ insights and treatment expectations. EAU guidelines on sexual and reproductive health.

Patients’ Experience with Visiting or Planning to Visit Their Doctor

Padma-Nathan H. Sildenafil citrate (Viagra) treatment for erectile dysfunction: an updated profile of response and effectiveness. Medicines & Healthcare Products Regulatory Agency M. Public assessment report – prescription only medicine to pharmacy medicine reclassification: Viagra Connect® 50mg film-coated tablets, Sildenafil Citrate (PL 00165/0392 – 0001, 2017). A web-based survey of UK pharmacists to assess the effectiveness of Viagra Connect® additional risk minimisation measures. The final sample had 297 patients, who reported that pharmacists inquired about blood pressure and heart comorbidities (91.9%), relevant illnesses (87.9%), medications (86.5%), ED diagnosis (82.2%), and were advised to consult their doctor regarding ED (51.2%).

Platform	Type	Availability	Contact Support	Notes
Official Pharmacy Website	E-commerce website	24/7	Online chat, email	Verified sources
Mobile App	App-based ordering	Business hours	In-app support	Convenience for repeat customers
Telehealth Consultation	Doctor-assisted purchase	Limited regions	Phone or video chat	Requires medical consultation
Third-party Pharmacy Websites	Online retailers	Varies	Support varies	Verify authenticity before purchase

A majority (68.7%) also indicated that they had received advice on lifestyle modifications to manage their ED-related health risks.

Viagra Connect offers a discreet way to manage ED.
It works best when taken on an empty stomach.
Full effect may take up to an hour to manifest.
Avoid heavy meals immediately before taking.
Regular use does not lead to dependency.
An active lifestyle may improve results.

This survey provided a reasonable confirmation of the effectiveness of the VC aRMMs program and assurance that ED patients, when requesting and purchasing VC in UK pharmacies, are assessed appropriately for suitability of VC and receive the appropriate advice from pharmacists.

Data Type	Description	Usage
Personal Details	Name, DOB, Address	Confirm identity
Medical History	Past health conditions, current medications	Assess suitability
Payment Details	Credit/debit card information	Process payment
Contact Info	Phone number, email address	Order updates, notifications

A national additional risk minimization measures (aRMMs) program was implemented to train pharmacists for safe supply of non-prescription VC to erectile dysfunction (ED) patients in United Kingdom (UK).

The packaging includes clear dosing instructions.
Pharmacists can advise on proper usage and precautions.
Do not share medication with others.
Discontinue use if side effects worsen.
Report any adverse reactions to a healthcare provider.
Keep track of your dosage schedule for safety.

The final sample had 297 patients, who reported that pharmacists inquired about blood pressure and heart comorbidities, relevant illnesses, medications, ED diagnosis, and were advised to consult their doctor regarding ED.

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A Web-Based Survey of Patients Dispensed Viagra Connect Behind the Counter in the UK: An Evaluation of the Effectiveness of Additional Risk Minimization Measures. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, 3.0) License. By accessing the cheap viagra with dapoxetine work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Ethics approval

For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms. A new quick reference guide to the supply of Viagra Connect (sildenafil) as a pharmacy (P) medicine has been released by the Royal Pharmaceutical Society (RPS). In November 2017, 50mg tablets of Viagra Connect were reclassified from a prescription-only medicine to P status. The tablets went on sale as a P medicine on 27 March 2018. The guide explains what pharmacists and pharmacy staff need to consider before supplying Viagra as a P medicine, and provides advice on how to undertake the patient consulation. A majority also indicated that they had received advice on lifestyle modifications to manage their ED-related health risks.

The drug improves quality of life for many men with ED.
It is part of a broader treatment approach, including counseling.
Mental health can impact erectile function.
Lifestyle changes can enhance medication effectiveness.
Support groups may provide additional help.
Consult your doctor if ED persists despite treatment.

Erectile dysfunction (ED) is the inability to achieve or maintain an erection that is sufficient for satisfactory sexual performance.Citation1 The overall prevalence of self-reported ED in men across aged 40–70 years has been estimated to be 45.2%.Citation2 Organic (ie, neurogenic, endocrinological, vasculogenic, or drug-induced), psychogenic, or mixed causes may attribute to ED.Citation3,Citation4 ED may be a presenting symptom of undetected or underlying cardiovascular disease (CVD) in men.Citation5 ED and CVD share several risk factors including advanced age, tobacco use, excessive alcohol consumption, diabetes mellitus, hyperlipidemia, obesity, depression among others.Citation6,Citation7 Additionally, ED is also known to cause substantial negative effects on the patient’s self-esteem, quality of life and emotional status.Citation8,Citation9 There are several treatment options recommended by European guidelines for ED management including intracavernosal injection, vacuum device, oral therapy with phosphodiesterase type 5 (PDE-5) inhibitors, topical/intra-urethral alprostadil along with lifestyle modification and patient education.

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The response rate in this survey could not be calculated. Although, a pre-specified number of invitations were distributed to pharmacies, we do not know how many invitations were passed between pharmacist and patient. Also, it was not possible to determine if there were multiple responses from one pharmacy or whether the responses were well distributed across the participating pharmacies. Although, measures were taken to avoid multiple survey completions, there are possibilities of patients receiving and responding to more than one survey invitation in pharmacies. Due to non-availability of baseline data prior to the pharmacist education program which included training guide and checklist from the VC aRMMs program, the improvement in patient experience cannot be determined or directly attributed to this program.

Possible Side Effects

There is a potential for selection bias, which was an inherent limitation to any survey study based on volunteer participation, as those patients who participated the survey might differ in demographic and clinical characteristics from those who chose not to participate. The patients were asked to recall their encounters with the pharmacist when they received their first supply of VC which introduces a certain amount of recall bias. Additionally, the patient’s experience may change with repeated supplies for VC. Furthermore, patients who reported they intend to visit their doctors might not actually make the visits. To ensure consistency, the survey asked patients to answer questions related only to their first purchase of VC.