Supply scenarios
Supply scenarios
In most situations, the decision on whether Cialis Together can be supplied to a patient will be uncomplicated. However, there are a few situations where the decision may be less obvious.
Consider each of the scenarios below and whether you would supply Cialis Together to the patient.
Scenario 1 The middle-aged office worker
Mr M is 50 years old and works long hours with a major corporation. He is aware that his lifestyle could be healthier and thinks that his difficulty getting an erection could be a symptom of his working pattern and lifestyle, but he cannot change this at the moment and would like to try Cialis Together to see if it helps. He sometimes experiences chest pain when he runs for the train but puts it down to not being very fit.
Symptoms suggest underlying cardiovascular disease
Do not supply Cialis Together. Refer Mr M to his doctor for an assessment of his chest pain on exertion, and to confirm his suitability before supplying him with Cialis Together.
Explain to Mr M that the chest pain he experiences when he runs could be a sign of a cardiovascular condition, therefore he needs to see his doctor for advice and to assess his suitability for taking Cialis Together.
Scenario 2 The late-night drinker
Mr A is a 45-year-old chef who works long hours in a busy restaurant in town. He tends to socialise late after his shift, and drinks heavily. He has noticed that he sometimes has difficulty maintaining his erection but is confident it can be resolved with medication and would like to try Cialis Together. He is otherwise fit and healthy with no cardiovascular disease or other contraindications and is not taking any medication.
Lifestyle advice required
Cialis Together can be supplied to Mr A but he should be advised not to drink heavily while taking it. The combination of large volumes of alcohol and Cialis Together could cause a drop in his blood pressure when standing up, leading to dizziness.
Explain that alcohol can be a cause of erection problems, especially in large quantities and provide lifestyle advice to help him manage his ED.
Scenario 3 The pensioner who has had a mild heart attack
Mr J is 67 years old and is a retired teacher who had a mild heart attack 15 months ago. He is now fully recovered and starting to enjoy life again. Since his heart attack, however, he sometimes experiences problems getting an erection. He has come to the pharmacy to see if he can buy something to help. He has no cardiovascular symptoms and is able to exercise without chest pain or breathlessness. He is taking aspirin, an ACE inhibitor and a statin.
CVD is stable but watch out for further symptoms
Cialis Together can be supplied to Mr J. His heart attack was more than 3 months ago and his CVD is stable and well managed on his current medication.
Check whether he has been given a short-acting nitrate (GTN) as a ‘rescue medication’ should he experience chest pain and ensure he understands that he must not use nitrates if he is taking Cialis Together because of the risk of a dangerous fall in blood pressure.
Advise him to tell his doctor that he is taking Cialis Together and to seek immediate medical help should he experience chest pain within 48 hours of taking Cialis Together, or dizziness or nausea during or after sex.
Scenario 4 BPH and finasteride
Mr Y, who is 62 years old, has BPH for which he has been taking finasteride for the last 3 years. Over the past 12 months he has experienced problems with erections and sometimes has difficulty maintaining the erection. This is causing some stress in his relationship with his wife, and he is keen to see whether Cialis Together can help.
A medical benefit/risk assessment is needed
Mr Y may be suitable for Cialis Together but should be referred to his doctor to confirm suitability before use.
No drug-drug interaction studies have been performed for concomitant use of 5-alpha reductase inhibitors like finasteride so a medical benefit/risk assessment should be conducted before use.
Scenario 5 Controlled hypertension
Mr L has recently met someone having been alone for the last 5 years following his wife’s death. He is now 67 years old and has not had sex since his wife died. He is very nervous about what will happen in this new relationship because the last few times he had sex with his wife, he had problems maintaining his erection. He has seen the adverts for Cialis Together and thinks that this might be the solution.
He is generally fit and well but has high blood pressure which has been difficult to manage. However, his current medication - a combination of an angiotensin-II receptor antagonist and a thiazide diuretic - which he has been taking for the last 6 months, seems to be working and his doctor is happy that his blood pressure is sufficiently controlled on this treatment.
Tell the GP and be alert for medication changes
You can supply Cialis Together to Mr L. His hypertension has been well controlled on medication for the last 6 months and he is not taking any contraindicated medication.
Explain to Mr L that he should tell his doctor that he is taking Cialis Together, especially if his blood pressure medication needs to be changed again.