Erectile Dysfunction Treatment

A licensed doctor reviews your answers before issuing this prescription.

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01Details

Prescription

Erectile Dysfunction Treatment

€25 — reviewed by a licensed doctor before your prescription is issued.

Patient details

Patient full nameEmailPhone

Date of birth

Enter a date up to 17/10/2026.

PPS number (optional)

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Preferred pharmacy (optional)

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IE · Erectile dysfunction · Full

This form is for ongoing erectile difficulties. Please answer the cardiovascular and medication questions carefully and completely — some combinations with erectile dysfunction treatment can be dangerous, and the doctor needs the full picture even if it feels like an odd thing to be asked.

Your treatment

Do you have a preference between the available treatments, or would you like the doctor to recommend the most suitable one?These work in a similar way but differ in how quickly they act, how long they last, and whether food affects them. Sildenafil and vardenafil are better for planned, occasional use and are less effective on a full stomach. Tadalafil lasts much longer, and its daily low-dose form is an option if you'd prefer not to time things around sexual activity.

How long has this been happening — is this something you've had difficulty with your whole life, or is it a newer change? Does it happen in every situation, or only sometimes (e.g. with a partner but not otherwise)?

Your heart and medicines

Are you currently taking, or do you use recreationally, any of the following: nitrate medication (GTN spray or tablets, isosorbide mononitrate/dinitrate) for angina, or recreational "poppers" (amyl or butyl nitrite)?

Do you have heart disease — angina, a previous heart attack, heart failure, or an abnormal heart rhythm?

Have you had a heart attack, stroke, or an episode of unstable angina within the last 6 months? Or do you have heart failure that leaves you breathless with minimal activity (e.g. getting dressed)?

Do you have a heart valve problem (particularly a narrowed valve, "aortic stenosis") or a thickened heart muscle condition (hypertrophic cardiomyopathy)?

Is your blood pressure well controlled?

Are you currently taking an alpha-blocker medication (commonly used for prostate symptoms or blood pressure — e.g. tamsulosin, doxazosin, alfuzosin)?

Do you have retinitis pigmentosa, or has a doctor ever told you that you suddenly lost vision in one eye due to a blood-flow problem in the optic nerve (NAION)?

Do you have sickle cell disease, multiple myeloma, leukaemia, or any curvature or deformity of the penis (e.g. Peyronie's disease)?

Have you ever had an erection lasting longer than 4 hours?

Do you have severe liver or kidney disease?

Are you currently taking ketoconazole, itraconazole, ritonavir, or any other antifungal or HIV medication?

Do you have a current, active stomach ulcer?

Are you taking medication for depression, blood pressure, or any other condition that you suspect might be contributing to this?Write "None" if not.

Do you have diabetes, or has your blood sugar/cardiovascular risk never been checked?

Patient address

Required for medical documents and any physical materials.

Street addressApt / unit (optional)CityEircode (optional)

Data sharing consent (GDPR)

I confirm the details above are accurate and consent to a video consultation with the selected clinician.I consent to my personal and medical data being processed by Global Health and shared with its treating clinics and medical network — including clinics in other countries — for the purpose of my care, service improvement, and security. Privacy PolicySend me appointment updates via WhatsApp (optional)