Fit to sell over the counter

Men with erectile dysfunction often turn to the internet to avoid having to ask for treatment from their doctors. The catch is that counterfeit medicines are rife online — the likelihood of men obtaining dodgy pills is high. Such tablets might have no active drug or contain goodness-only-knows-what; and men are also putting themselves at risk by not finding out from a healthcare professional whether erectile dysfunction medicines like sildenafil (Viagra) or tadalafil (Cialis) are safe for them to take at all.

So the announcement that Cialis could be heading for over-the-counter status might appear to be good news as far as choice, convenience and safety are concerned (see News feature). Men would be able to obtain the authentic product from their pharmacy with minimal fuss. The appropriate safety checks would need to be in place. However, community pharmacy has not had a faultless record when it comes to giving advice over the counter.

“What we don’t need is a Which?-type scenario,” a Pharmaceutical Journal reporter was told by the Proprietary Association of Great Britain’s director of health policy and public affairs Gopa Mitra. She was referring to the lambasting community pharmacy got from the consumer watchdog Which? in 2013 — the quality of counter advice was found to be unsatisfactory in 58% of independent pharmacies and 34% of multiple or supermarket pharmacies. The results were worse than those reported by Which? in 2008.

The Royal Pharmaceutical Society took the findings seriously. It ran a workshop in conjunction with the General Pharmaceutical Council to look at current practice in medicines advice and how it could be improved. A year on, and the two organisations are bringing stakeholders together again to see what progress has been made. Attendees at the event on 3 July will consider what more can be done to ensure patients and the public get the best possible advice in community pharmacies.

There is no guarantee that Cialis would be a successful POM-to-P switch. Very few switches have come through the European Medicines Agency’s centralised process; Pfizer got the thumbs down when it applied to the EMA in 2008 for Viagra to be made available over the counter.

Whatever the outcome for Cialis, the profession needs to be equipped to support future drug reclassifications. Without consistently high advice for all medicines transactions, it is tough to argue that a POM-to-P decision is any better than a switch direct to the general sales list. Consumers cannot be left wondering why the medicine isn’t available from their local off-licence — or on eBay.