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Despite PDE-5 inhibitors’ prescription-only status in most countries, they are sold online without a prescription. People buy them on the Internet either because drugs, especially generic, cost up to 90% less online or to protect their privacy. Not all medications on the Internet are safe, so certain countries are trying to fight the distribution of illegal drugs by allowing their citizens easier access to PDE-5 inhibitors. The list of sildenafil-based ED drugs that are sold without prescription includes Viagra Connect in the UK, Silvasta in New Zealand, Viagra and its generics in Turkey and Mexico. In the US and Canada, on the other hand, ED meds are available only by prescription. Importing ED drugs purchased abroad without a prescription is also illegal in countries like the US, Canada and Australia – even for personal use, although certain exception exist.

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Buying ED Drugs Online Without a Prescription

Drugs available online are up to 90% cheaper than in a pharmacy next door – 79% of US-based customers buying meds online say they do it because it saves them money. Still, in case of medications used to treat erectile dysfunction, price is not the only concern. In many countries including the US, Canada and Australia, impotence meds are available only by prescription and men are reluctant to obtain one because of the social stigma associated with ED. That’s why they go for impotence meds that are easily obtained OTC online – for instance, in 2016 the authorities seized more than £15mln worth of such drugs in the UK alone. Considering that most online orders make it to the customers safely, the total size of Internet market of no-prescription impotence drugs is much larger than £15 million.

But why are PDE-5 inhibitors , which are the most common type of ED meds, available only by prescription? There are two reasons for that:

PDE-5 inhibitors are a class of medications used to treat erectile dysfunction and pulmonary arterial hypertension. Most common PDE-5 inhibitors are sildenafil, vardenafil and tadalafil, the latter also used to treat benign prostatic hyperplasia. They work by dilating the blood vessels supplying the cavernous structures inside the penis the penis in response to sexual stimulation, which results in a healthy erection.

  1. PDE-5 inhibitors interact with drugs like nitrates causing potentially dangerous side effects. Therefore, people suffering from cardiovascular disorders should only begin ED treatment after a consultation with a doctor.
  2. Erectile dysfunction is one of the symptoms of more serious conditions such as heart disease, hormonal disorders or poorly managed diabetes, so addressing this problem without looking at its cause is risky.

It is also believed that PDE-5 inhibitors cause cardiovascular problems on their own but recent studies such as the one by Daniel Peter Andersson et al show that these medications, on the contrary, may reduce the risk of death after myocardial infarction.

Current Prescription Status of PDE-5 Inhibitors in Different Countries of the World

Risks associated with ED medications are lower when the patient follows the directions for their use. Hence, New Zealand allowed to sell sildenafil in pharmacies without prescription in 2014 and the UK – in 2018. Healthcare professionals in the US, like Dr. Philip Werthman, for instance, agree that sildenafil ‘is generally not a dangerous drug’. Dr. Miles J Jones conducted a research advocating for easier access to ED meds.It’s still unclear whether the prescription-only status of PDE-5 inhibitors will change in the States in the nearest future or not though.

The table below lists the countries that online pharmacies are based in along with the local prescription statuses of PDE-5 inhibitors.

Prescription status
Country Prescription status of PDE-5 inhibitors
United States All PDE-5 inhibitors are available by prescription only, prescriptions can be obtained online
Canada All PDE-5 inhibitors are available by prescription only
United Kingdom Viagra Connect is available without prescription. Other PDE-5 inhibitors require a prescription – electronic prescription is enough.
New Zealand Sildenafil is available without prescription, other PDE-5 inhibitors require a valid prescription.
India All PDE-5 inhibitors are classified as prescription-only drugs although, in fact, they are sold over the counter in most pharmacies.
Singapore All PDE-5 inhibitors are available by prescription only
Turkey All PDE-5 inhibitors are available over the counter
Mexico All PDE-5 inhibitors are available over the counter

One will need a prescription to buy sildenafil or other PDE-5 inhibitors from an Internet pharmacy based in the US, Canada or Singapore. An online interview with a doctor is necessary when buying from the UK or New Zealand. No prescription is required when buying from India, Turkey or Mexico.

Is It Legal to Order ED Drugs without Prescription from Abroad?

Let’s assume that you live in a country where PDE-5 inhibitors are available only by prescription, but you decide to save money and order them from abroad. The website you’re ordering from does not ask you for a prescription. The legal status of this purchase will depend on where you are currently based.

Legal to Order ED Drugs without Prescription
Country of your citizenship Is it okay to order prescription drugs from abroad without a prescription?
United States Technically, it is illegal, so your order may be refused entry or seized by the US Customs. However, this law is rarely enforced given that about 19 million Americans are buying meds from abroad on the Internet. Still it’s best to have a prescription from a licensed US healthcare specialist should any questions arise.
Canada Canadian citizens are not allowed to import medications from the Prescription Drug List including sildenafil, vardenafil or tadalafil by mail or courier. Since the list doesn’t include other PDE-5 inhibitors, such as udenafil, avanafil or mirodenafil, a 90-day supply of these can be imported.
United Kingdom Viagra Connect is available without prescription. As per other ED drugs – whilebuying them without a consultation with a doctor is illegal if the pharmacy you’re buying it from is UK-based, the law doesn’t apply to pharmacies operating from abroad. Note that it is only legal to import prescription medicines for personal use.
Australia You can’t import ED drugs if you don’t have a prescription from an Australian doctor. If you do have a prescription, you have the right to import a maximum of 90 days’ worth of ED meds.

Although ED drugs are sold without prescription online, buying them is still technically illegal in most of the developed countries. The main reason behind this ban is the concern for people’s health and safety as there are rogue pharmacies that sell potentially dangerous counterfeit medications. The lists containing the examples of such rogue pharmacies are published on the FDA website and on Pharmacy Checker. If you decide to take the risk and try getting your impotence pill from a foreign online drugstore that doesn’t require a prescription, take the time to search for and read reviews from its customers. Choose independent third-party review websitesthat are not affiliated with online pharmacies or drug manufacturers.It’s best to order from either licensed online stores or at least those verified by Pharmacy Checker or similar resources. You are also recommended to review your country’s policy on importing ED drugs for personal use without a valid prescription.

Sources:

  1. International online pharmacy prices vs local US pharmacy prices, select medications - https://www.pharmacychecker.com/
  2. Hazardous substances in fake Viagra - https://www.forbes.com/sites/melaniehaiken/2013/09/12/buying-viagra-online-its-very-likely-fake-and-possibly-dangerous-new-data-say/#7ef2839446e0
  3. US FDA personal importation basics - https://www.fda.gov/forindustry/importprogram/importbasics/ucm432661.htm
  4. Facts and numbers on personal importation of medications into the US, a survey - https://personalimportation.org/understand-the-issue/survey-importation-from-canada-is-safe-and-affordable/
  5. Over £15mln worth of unlicensed and counterfeit ED meds seized in the UK in 2016 - https://www.theguardian.com/lifeandstyle/2017/aug/11/viagra-prescriptions-on-nhs-triple-in-10-years-as-stigma-fades
  6. ED as a symptom of various serious health conditions - https://www.webmd.com/erectile-dysfunction/features/erectile-dysfunction-as-warning-sign#1
  7. Treatment with PDE-inhibitors may reduce mortality in male patients after the first myocardial infarction - http://www.onlinejacc.org/content/69/11_Supplement/136
  8. Sildenafil becomes available without prescription in New Zealand - https://www.pharmaceutical-journal.com/news-and-analysis/new-zealand-allows-access-to-sildenafil-through-pharmacy/20066904.article?firstPass=false
  9. Viagra Connect becomes available without prescription in the UK - https://www.independent.co.uk/life-style/health-and-families/viagra-buy-without-prescription-over-counter-uk-pharmacies-male-impotence-erectile-dysfunction-a8275461.html
  10. Dr. Philip Werthman on the possibility, benefits and risks of making Viagra available over the counter in the US - https://www.healthline.com/health-news/viagra-over-the-counter-drug#2
  11. M.J. Jones, Internet-based prescription of sildenafil, a case study - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761892/
  12. FDA on importing medications into the United States - https://www.fda.gov/AboutFDA/Transparency/Basics/ucm194904.htm
  13. Laws defining the imports of prescription drugs into the US and current status of the market - https://www.webmd.com/healthy-aging/features/letter-and-spirit-of-drug-import-laws#3
  14. 8% US respondents admit that they or someone in their household has imported drugs for personal use at least once - https://khn.org/news/faced-with-unaffordable-drug-prices-tens-of-millions-buy-medicine-outside-u-s/
  15. Canada Prescription Drug List - https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/prescription-drug-list/list.html
  16. Regulations regarding the import of drugs for personal use into Canada - https://www.canada.ca/en/health-canada/services/drugs-health-products/compliance-enforcement/importation-exportation/policy-health-products-under-food-drugs-act-regulations-0060.html
  17. Rogue online pharmacies list from the FDA - https://www.fda.gov/Drugs/DrugSafety/DrugIntegrityandSupplyChainSecurity/ucm348680.htm
  18. Rogue online pharmacies list from Pharmacy Checker - https://www.pharmacychecker.com/rogue-pharmacies/
  19. It’s legal to import prescription drugs for personal use into the UK - https://www.justanswer.com/uk-law/4yum5-legal-ti-buy-vigera-siderafil-line-deliver.html
  20. Therapeutic Goods Administration of the Ministry of Health of Australia on importing prescription medicines for personal use without a valid prescription - https://www.tga.gov.au/can-i-import-it
  21. The official website of Pharmacy Checker - http://pharmacychecker.com/

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