Over 60 on the Costa Blanca: ED tablets and everything else you take

A lot of men on the Costa Blanca have retired here from the UK, Ireland or northern Europe. Some are used to buying Viagra differently at home: in the UK, for example, a 50 mg sildenafil tablet called Viagra Connect is sold by pharmacists without a prescription. Spain has nothing like that. Every tablet in this group needs a prescription here.

The bigger question after 60 is rarely age itself. It is the rest of the medicine box: something for blood pressure, something for the prostate, a blood thinner, perhaps an antidepressant. This page goes through what the Spanish product information (the ficha técnica, published by the medicines agency AEMPS in its CIMA database) says about older men and the commonest combinations, and how the local health system works for a resident.

What the Spanish product information says about men over 65

So there is no upper age limit. What the figures do suggest is that a sensible doctor will start low and adjust, and will want to see a recent blood test showing how well your kidneys are working.

Common combinations, one at a time

Angina treatment

Nitrates rule out all four tablets, whatever the form: spray, tablet, slow-release capsule or patch. In Spanish pharmacies you will see names such as Cafinitrina, Trinispray or Uniket. The Las Palmas de Gran Canaria page deals with heart medicines in detail.

Prostate tablets

Alpha-blockers such as tamsulosin, doxazosin or alfuzosin also lower blood pressure. You should be settled on the dose before adding an ED tablet; with sildenafil, starting at 25 mg is worth considering, and the tadalafil ficha advises against combining it with doxazosin and asks for caution with other alpha-blockers, starting on the lowest dose. If you already take tadalafil 5 mg every day for your prostate, do not add a second tablet from this group: no combination of two has been studied.

Blood pressure

Most blood pressure medicines can be taken alongside, but the effects add up a little. When sildenafil 100 mg was given with amlodipine, blood pressure fell on average by a further 8 mmHg (top figure) and 7 mmHg (bottom figure).

A course of antibiotics or antifungals

Clarithromycin, erythromycin, itraconazole, ketoconazole and the HIV medicine ritonavir push up the level of these tablets in the blood. Depending on the pair, the dose has to come down or the combination is off. Worth remembering if a dentist or a GP back home prescribes one.

Heart rhythm drugs and blood thinners

Vardenafil slightly lengthens the QT interval, so it should be avoided with amiodarone, sotalol or quinidine. For bleeding disorders or an active stomach ulcer, the sildenafil and vardenafil fichas have no safety data and leave it to the doctor; in the tadalafil interaction study, warfarin worked as usual.

When another medicine is part of the problem

Erection or sex-drive problems are listed in the leaflets of some antidepressants, of finasteride and dutasteride for the prostate, of hormone treatment for prostate cancer and of some blood pressure drugs, thiazide diuretics and certain beta-blockers among them. Don't stop anything on your own, but do ask: swapping one medicine can sometimes help more than adding another. And it isn't always “just age”: diabetes and low testosterone play a part too (see our pages on Valencia and Gijón).

The public system in Alicante, step by step

Getting into the public system. Once your right to public healthcare is recognised by Spain's social security institute (INSS), for example through an S1 form if you draw a UK or other EU state pension, you sign up at your local centro de salud (health centre) and are given the Valencian health card, the tarjeta SIP. You are assigned a GP, the médico de familia, who can prescribe these tablets.

Specialist care. If needed, the GP refers you to Urology. The urology department at Hospital General Universitario Dr. Balmis, the city's main public hospital, lists andrology, male sexual health and erectile dysfunction among its services, and also holds clinics at the Babel and San Vicente specialist centres. The regional health department has a procedure for requesting a free choice of doctor or specialist service. These pages are in Spanish.

Paying. Even with a SIP card, you pay the full price, because none of these tablets is funded by the public system (the Health Ministry records this in its BIFIMED database). A prescription from a private doctor in Spain is valid at any pharmacy. Spanish pharmacies also accept prescriptions from other EU countries. They are not obliged to accept a UK prescription; some pharmacists may, at their discretion.

Out of hours. The Alicante pharmacists' college publishes the duty pharmacy list (farmacias de guardia) by date and town. Some duty pharmacies work “on call”, which means you phone the number shown on the list rather than just turning up. The same college lists pharmacies that prepare weekly dosette packs (SPD), handy if you juggle a lot of tablets.

Questions from Costa Blanca residents

Four products we list, and what age changes

• Viagra Generic (sildenafil in 25, 50 or 100 mg). The 25 mg tablet matches the dose the ficha suggests considering alongside an alpha-blocker or with badly impaired kidneys. It may come from a different maker, in different packaging, from the EFG generics sold in Spanish pharmacies.
• Cialis Generic (tadalafil in 5, 10 or 20 mg). There is also a 40 mg version, double the authorised ceiling, which we advise against; with poor kidney function the limit drops to 10 mg.
• Levitra Generic (vardenafil in 10 or 20 mg). Ruled out with heart rhythm drugs, and after 65 the ficha asks for caution with 20 mg.
• Viagra Original: sold here in 100 mg only, the top dose, whereas the ficha suggests 50 mg to begin with.

Other cities: Málaga for travelling with medicines, the prostate and daily tadalafil in Valladolid, heart medicines in Las Palmas de Gran Canaria.

Sources: the AEMPS medicines register CIMA (fichas técnicas for sildenafil, tadalafil, vardenafil and avanafil); the Health Ministry's BIFIMED funding database; Generalitat Valenciana health department (SIP card; urology department of the Alicante-Hospital General health area); Alicante pharmacists' college (Colegio Oficial de Farmacéuticos de Alicante); UK Government guidance on healthcare for residents in Spain. Use this page to prepare for your appointment, not instead of one. 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.