Viagra and alcohol in Mallorca: what drinking does to ED pills and to you

Whether you live in Palma year-round or come over for long summers, evenings here tend to run late: dinner at ten, drinks on a terrace, maybe a club or a boat party in July. So the question people ask about Viagra here is often a practical one: if I take it tonight, can I still have a drink?

Short answer: a couple of drinks won't cancel the tablet, but alcohol works against erections on its own and, in larger amounts, adds dizziness and a drop in blood pressure. Below is what Spain's official product information, the ficha técnica, says about each ED drug and alcohol, what it doesn't cover, and where to get help in Palma.

Spanish measures are not UK units

If you count your drinking in UK units, recalibrate. A UK unit is 8 g of alcohol. Spain's Health Ministry uses the unidad de bebida estándar (UBE), which is 10 g: a 250 ml caña of beer, 125 ml of wine or a 30 ml shot of spirits. A standard mixed drink, a combinado, counts as two. The ministry's low-risk limit for men is 20 g a day, so two UBE, and it stresses that no level of drinking is risk-free.

The Viagra leaflet is blunt about the effect on performance: alcohol can temporarily make it harder to get an erection, so to get the most from the medicine, don't drink large amounts beforehand. The Cialis leaflet adds that alcohol can temporarily lower your blood pressure.

What the studies found, drug by drug

Sildenafil (Viagra). At 50 mg, it did not increase the fall in blood pressure caused by alcohol in healthy volunteers whose blood alcohol peaked at an average of 80 mg/dl.

Tadalafil (Cialis). At 10 or 20 mg it did not change blood alcohol levels, and at 20 mg it did not deepen the average drop in blood pressure caused by 0.7 g of alcohol per kilo, which for a man weighing 80 kg is about 180 ml of vodka. Some volunteers did feel dizzy on standing up and had orthostatic hypotension. The patient leaflet says not to drink so much that your blood alcohol reaches 0.08% or higher.

Vardenafil (Levitra). At 20 mg, with blood alcohol peaking at 73 mg/dl, it did not add to alcohol's effect on blood pressure or heart rate.

Avanafil (Spedra). Alcohol can increase the chance of symptomatic low blood pressure, and the ficha asks doctors to warn patients about it.

Put the tadalafil figure in bar terms: 180 ml of vodka is six 30 ml shots, or three combinados. In other words, the dizziness showed up at an amount many people reach on a night out without noticing. And these were short, controlled tests in healthy volunteers, not a long evening with food, heat and a late finish.

The things the fichas don't test

Poppers. They are nitrites, which release nitric oxide just like heart nitrates do. The fichas for sildenafil, vardenafil and avanafil name amyl nitrite as a contraindication; the tadalafil one rules out any organic nitrate. Combined with an ED tablet, the drop in blood pressure can be severe.

Recreational drugs. There are no data in the product information on cocaine, ecstasy or other party drugs, so nobody can tell you the mix is safe.

A tablet from a friend. A loose pill or a sachet of jelly passed round in a bar comes with no leaflet and no reliable dose. Sildenafil jellies are not authorised in Spain, and the AEMPS has found hidden sildenafil in several “natural” potency products.

A second dose. All four drugs are once a day at most. If nothing happens after a few drinks, the alcohol is the likelier culprit, not the dose.

The morning after, and the drive home

The Viagra and Cialis leaflets both warn about dizziness, and Viagra's about changes in vision, so you should know how a tablet affects you before driving. After a night of drinking, don't drive at all. An erection that lasts 4 hours or longer needs emergency care, however good the evening was.

Questions from Mallorca

What we sell, one to avoid, and getting it to Mallorca

• Viagra Generic (sildenafil, in 25, 50 or 100 mg): slower to work after a heavy meal.
• Cialis Generic, offered as 5, 10 or 20 mg of tadalafil. Its effect was studied up to 36 hours, which is not a licence to drink more. The 40 mg strength is double the authorised maximum; we don't recommend it.
• Levitra Generic: vardenafil 10 and 20 mg; in its alcohol study the effect on blood pressure was not increased.
• Kamagra Oral Jelly: the sachet that turns up on nights out. 100 mg sildenafil in a form not authorised in Spain; we would avoid it.

As for orders, we have no shop or pharmacy in Palma or elsewhere on Mallorca, and we don't sell in person. Parcels are posted or sent by courier as set out on the delivery conditions page; delivery times aren't promised here, as on an island they depend even more on transport. Customs can hold a parcel, and no one checks whether you have a prescription.

Doctors, hospitals and duty chemists in Palma

Living here and in the public system? The Balearic health service is IB-Salut. Once you are entitled to public healthcare (through work, a Spanish pension, or an S1 registered with the INSS if your pension comes from another country), your local centro de salud gives you a family doctor, the médico de familia. They can write the prescription and, if needed, send you on to urology. Two public hospitals in Palma, Son Espases University Hospital and Son Llàtzer University Hospital, have urology departments.

Here for the season? Visitors' cards, the EHIC (TSE) and the UK GHIC, cover state care that turns out to be medically necessary during a temporary stay. A routine ED prescription usually isn't that, so plan to use your own doctor before you travel or see one privately here.

Privately insured? A prescription from a private doctor practising in Spain is filled at any Spanish pharmacy, exactly like a public one; your policy decides whether the consultation is covered.

Whatever your cover, the tablets themselves are paid in full: Spain's public system doesn't fund ED medicines. For a late-night or holiday chemist (farmacia de guardia), the Balearic pharmacists' college, COFIB, publishes the duty rota and a map of open pharmacies. Opening hours change, so check before setting off.

Other cities: heat, dehydration and low blood pressure in Seville, fake ED pills in Barcelona, travelling with medicines in Málaga.

Sources: CIMA, the AEMPS database (fichas técnicas and patient leaflets of Viagra, Cialis, Levitra and Spedra); Spanish Health Ministry, low-risk drinking limits and standard drink (UBE) equivalents; AEMPS notices on illegal products containing sildenafil; IB-Salut; Official Bulletin of the Balearic Islands (urology departments at Son Espases and Son Llàtzer); Col·legi Oficial de Farmacèutics de les Illes Balears. Information only; your doctor knows your situation better than any web page. 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.