ED tablets in our shop: what each one is, and which are licensed in Spain

Erectile dysfunction means repeatedly being unable to get or keep an erection firm enough for satisfying sex. It becomes common after 40 and it is treatable. Almost everything listed here contains a PDE5 inhibitor (sildenafil, tadalafil or vardenafil), the group that includes Viagra, Cialis and Levitra. These medicines help the penis fill with blood when you are sexually aroused; without arousal, nothing happens.

If you were prescribed one of these back home, the brand names will look familiar, but the rules may not. In the UK, for example, a low-dose sildenafil (Viagra Connect) can be bought from a pharmacist without a prescription. Spain has nothing like that: every medicine for erectile dysfunction is prescription-only here, whatever the strength. This page goes through our range item by item so that you know what you are looking at. The facts come from the Spanish product information (the ficha técnica) in the AEMPS register, CIMA, and from each product's own page.

All 20 products, one by one

They fall into three groups. The licensed brands (Viagra, Cialis, Levitra) are sold in Spanish pharmacies, although we don't state where our packs come from. The generics contain licensed active ingredients, but without the manufacturer's name nobody can check them in CIMA. Everything else is unlicensed: Indian brands, forms that no pharmacy stocks, and names such as “Professional”, “Soft” or “Super Active” that the companies behind Viagra, Cialis and Levitra have never used.

Choosing with your doctor

A good doctor will ask why it is happening before talking about brands. Erection problems can be an early sign of narrowed arteries, diabetes, high blood pressure or high cholesterol, and they can also be a side effect of something you already take. Expect a blood pressure check and probably a blood test.

In Spain, that conversation usually starts with your médico de familia (GP) at the centro de salud where you are registered with your tarjeta sanitaria (public health card), or with a private doctor or urologist if you have private cover. Four active ingredients are licensed here and all work the same way: sildenafil, tadalafil, vardenafil and avanafil (sold as Spedra, which we do not stock). They differ in how quickly they start, how long they last and whether a big meal slows them down. For a side-by-side comparison, see our guide to choosing between sildenafil, tadalafil, vardenafil and avanafil.

Worth having ready for the appointment:

• every medicine you take, especially nitrates, blood pressure or prostate tablets (alpha-blockers), antifungals, antibiotics such as clarithromycin, and HIV treatment;
• any heart trouble, heart attack or stroke, and any sudden loss of sight in one eye;
• whether you plan sex in advance or would rather not watch the clock, in which case a low daily dose of tadalafil (5 mg) is an option;
• anything you have tried before, the dose, and any side effects.

The Spanish product information starts men on a middle dose: 50 mg of sildenafil, or 10 mg of tadalafil or vardenafil. The dose is only increased if needed and well tolerated, and you never take more than one dose a day. If the first medicine does not work, give it several tries at the right dose and with sexual stimulation before moving on, and never switch on the same day.

Who should not take them

• Anyone using nitrates (glyceryl trinitrate, isosorbide mononitrate or dinitrate), poppers or riociguat: blood pressure can drop dangerously.
• Anyone with a heart condition that makes sexual activity inadvisable, or a recent heart attack or stroke.
• Anyone with very low blood pressure (below 90/50).
• Anyone who has lost sight in one eye from ischaemic optic neuropathy (NAION).

Never combine two of these medicines, or take the same one twice in a day. The usual side effects are headache, flushing, a blocked nose, dizziness and indigestion; tadalafil also causes back or muscle pain more often.

Prescriptions, cost and delivery

A Spanish pharmacy can dispense these medicines with a prescription from a doctor in Spain or, provided it contains all the required details, from another EU country. A prescription from the UK or the US is not covered by those rules, so plan on seeing a doctor here. The Spanish health system does not fund ED medicines, so you pay the full price even with a GP's prescription; EFG generics are usually much cheaper than the brands.

We have no shop or pharmacy. Orders go out by post or courier under our delivery conditions.

Common questions

Sources: Spanish product information for sildenafil, tadalafil, vardenafil, avanafil and Priligy (CIMA, AEMPS); EMA product information; BIFIMED funding database, Spanish Ministry of Health; Ministry of Health guidance on prescriptions from other EU countries; European Association of Urology guidelines on erectile dysfunction. This page is general information and does not replace a consultation. In Spain, prescription-only medicines may not be sold online, and customs can hold a parcel that contains them. We do not check prescriptions: talk to your doctor before you order.