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such as unstable angina, uncontrolled
hypotension/ hypertension/ arrhythmia,
recent myocardial infarction, stroke or
life-threatening arrhythmia or those in
whom sexual intercourse is inadvisable.5
Looking in the wrong places
With increasing rates of erectile
dysfunction has come a plethora of
treatment vendors - both online and
on the street. These unregistered
and counterfeit products can contain
unknown and potentially harmful
ingredients and have been associated
with adverse reactions and even deaths.
The Therapeutic Goods Administration
(TGA) is well aware of the situation and
is working with other agencies to seize
illegal products and effect convictions
for importation of counterfeit medicines.
Recent advisories for products such as
Wolfish Shark Viagra tablets8 and Man
King capsules9 state these products pose
a serious risk to health and should not
But the quality of these products is not
the only risk. Online and backstreet
shopping circumvents any screening
or discussion with a healthcare
professional about underlying
conditions, comorbidities and
It’s distressing that men are needlessly
putting their health at risk when TGA-
approved PDE-5 inhibitors are readily
available on prescription. However we
also know that many Australian men
commonly delay or avoid consulting
their GP, particularly regarding the
sensitive issue of erectile dysfunction.
Providing access to erectile dysfunction
advice and treatment via another
accessible healthcare professional
- the pharmacist – from my clinical
perspective, expands the options for
men and will hopefully encourage safer,
more sensible sourcing of medicines.
The pharmacy skillset
Pharmacy is perfectly positioned to take
an expanded role in men’s health and
the management of erectile dysfunction
if PDE-5 inhibitors are rescheduled to S3.
Pharmacists have a long history of
counselling and managing patients
on a wide range of health conditions
including chronic conditions such as
asthma and diabetes. They also have
significant, relevant experience in
other sensitive health issues such as
emergency contraception for women.
Importantly, pharmacists already have
extensive knowledge of the correct
use of erectile dysfunction therapies,
which they have been dispensing for
Many pharmacies are also set-up
with specific counselling areas that
provide the necessary privacy for
Experience in New Zealand since 201411
demonstrates that pharmacists can
manage erectile dysfunction safely
Pharmacists will be supported by
educational and training resources.
Bayer for example is working on
comprehensive assessment algorithms,
decision support tools and additional
training to ensure men with erectile
dysfunction are carefully screened for
risk factors such as metabolic syndrome
or comorbidities and referred as
necessary to a GP for further assessment.
In line with pharmacy’s comprehensive
healthcare approach, men may also
receive health recommendations –
for example, around diet and exercise
modifications – with possible referral
to other health professionals such as
dietitians, counsellors and GPs.
Expanding pharmacy’s involvement in
the management of erectile dysfunction
is in my view, a timely response to
a growing problem that men are
inappropriately searching for treatment
outside the healthcare system.
Consumer research has clearly indicated
that pharmacy is a destination men
will consider for erectile dysfunction
Making erectile dysfunction medicines
more accessible through pharmacy
has the potential to reduce delays in
receiving effective treatment and the
risk of their problem becoming more
Targeted screening of men requesting
erectile dysfunction treatments may
also support prompts for further
investigations and referral, increasing
interactions with other healthcare
professionals, notably GPs, for
Faith, trust and confidence are
important factors in sexual performance.
From my experience, PDE-5 inhibitors
work best when there is a good
relationship between a patient and
healthcare professional - ensuring
comprehensive discussion about how
the treatment works, what to expect,
potential side effects and more.
Strengthening the role of pharmacists in
men’s health will I believe, extend men’s
interactions with the health system
and enhance outcomes for those with
1. Schwartz BG & Kloner RA. Clinical Cardiology : Physician
Update: Erectile Dysfunction and Cardiovascular Disease.
Circulation 2011; 123:98–101
2. Andrology Australia. Erectile Dysfunction. At: https://
dysfunction/ Last accessed 30 Sep 2016.
3. Weber, et al. Risk factors for ED in a cohort of 108 477
Australian men. Med J Aust. 2013 Jul 22;199(2):107–11
4. Australian Institute of Health and Welfare. Overweight and
Obesity. At: www.aihw.gov.au/overweight-and-obesity/
Last accessed 30 Sep 2016.
5. Bayer Australia Ltd. Levitra Product Information. 12 Nov
6. Tsertsvadze A, et al. Oral phosphodiesterase-5 inhibitors
and hormonal treatments for erectile dysfunction: a
systematic review and meta-analysis. Ann Intern Med 2009;
7. Andrology Australia. Counterfeit phosphodiesterase
type 5 inhibitors pose significant safety risks. At:https://
safety-risks Last accessed 30 Sep 2016.
8. Australian Government Department of Health TGA website.
Safety Information/ Current year alerts at: https://www.
tga.gov.au/alert/wolfish-shark-viagra-tablets Accessed 30
9. Australian Government Department of Health TGA website.
Safety Information/ Current year alerts at: https://www.tga.
gov.au/alert/man-king-capsules Accessed 30 Sep 2016.
10. Holden CA, et al. Men in Australia Telephone Survey
(MATeS): a national survey of the reproductive health and
concerns of middle-aged and older Australian men. Lancet
2005; 366: 218–24.
11. New Zealand Gazette. 16 Oct 2014. No 127: p3556
12. Bayer commissioned FiftyFive5 Quantitative Australian
Market Research 2015.
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