Medical Disclaimer

About your treatment

Medy prescribes medicines called PDE5 inhibitors: sildenafil, tadalafil (on demand or daily), vardenafil and avanafil. They increase blood flow to the penis, which helps you get and keep an erection when you are sexually aroused. They do not work without sexual stimulation and do not increase sex drive.

These medicines do not protect against sexually transmitted infections or prevent pregnancy.

Who should not use these medicines

Do not use these medicines, and tell your clinician, if you:

• take any nitrate medicine (such as GTN spray or tablets, isosorbide mononitrate or isosorbide dinitrate), nicorandil or riociguat
• use "poppers" (amyl nitrite or similar)
• have been advised by a doctor not to have sex because of a heart problem
• have had a heart attack or stroke in the last 6 months
• have very low blood pressure, or uncontrolled high blood pressure
• have severe liver problems
• have ever lost sight in one eye because of reduced blood flow to the optic nerve (NAION), or have an inherited eye condition such as retinitis pigmentosa

Tell your clinician if you have any heart condition, a condition affecting the shape of your penis (such as Peyronie's disease), a blood disorder such as sickle cell anaemia, or a bleeding disorder or stomach ulcer.

Rules for taking your medicine

• One dose in 24 hours. Never take more than one dose in 24 hours. If you are on daily tadalafil, take one tablet at about the same time each day and do not take extra doses.
• One medicine at a time. Do not take more than one erection medicine, or combine them, even from different suppliers.
• Timing. Follow the instructions on your label. As a guide:
  • Sildenafil: take about 1 hour before sex. Works for around 4 to 5 hours.
  • Tadalafil (on demand): take at least 30 minutes before sex. Can work for up to 36 hours.
  • Vardenafil: take about 25 to 60 minutes before sex. Works for around 4 to 5 hours.
  • Avanafil: take about 15 to 30 minutes before sex. Works for up to around 6 hours.
• Food. A heavy or fatty meal can slow down how quickly sildenafil and vardenafil work.
• Alcohol. Drinking a lot of alcohol can make it harder to get an erection and increases the risk of dizziness and low blood pressure.
• Grapefruit. Avoid grapefruit and grapefruit juice, as they can increase the amount of medicine in your blood.

Other medicines

Tell us about every medicine you take, including those bought over the counter and recreational drugs. In particular:

• nitrates, nicorandil and riociguat - never take with these
• alpha-blockers (such as doxazosin, tamsulosin or alfuzosin) and other blood pressure medicines - can cause dizziness or fainting
• some HIV medicines (such as ritonavir), some antifungals (such as itraconazole or ketoconazole) and some antibiotics (such as clarithromycin)
• some heart rhythm medicines (such as amiodarone, sotalol, quinidine or procainamide) - tell us if you take these, especially if you are prescribed vardenafil
• other medicines containing sildenafil, tadalafil, vardenafil or avanafil, including those prescribed for pulmonary hypertension or an enlarged prostate

Side effects

Common side effects are usually mild and short-lived:

• headache
• flushing
• indigestion
• blocked or runny nose
• dizziness
• back or muscle pain (more common with tadalafil)
• changes in colour vision, such as a blue tinge (more common with sildenafil)

When to get urgent help

Call 999 or go to A&E if you have:

• an erection lasting more than 4 hours (priapism), which can permanently damage the penis if not treated quickly
• chest pain during or after sex - stop sexual activity, and tell the ambulance crew or hospital staff that you have taken an erection medicine and when, as some heart medicines must not be given with it
• sudden loss or reduction of sight in one or both eyes
• sudden loss or reduction of hearing, sometimes with ringing in the ears or dizziness
• signs of a severe allergic reaction, such as swelling of the face, lips or throat, or difficulty breathing
• fainting or a fit (seizure)

Stop taking your medicine and contact us once you are safe.

When to contact us or your GP

Contact us, or speak to your GP or NHS 111, if:

• side effects are troubling you or not going away
• the medicine is not working after several attempts
• you start any new medicine or are diagnosed with a new condition, especially a heart condition

Your general health

Erection problems can be an early sign of other health conditions, such as heart disease, high blood pressure, high cholesterol or diabetes. We recommend you see your GP for a health check, even if treatment works well for you.

We do not automatically share your treatment with your GP. We recommend you tell them so your medical record is complete.

Ongoing treatment

Your treatment renews monthly. After 12 supplies you will be asked to complete a new consultation so a clinician can check the treatment is still right for you. Tell us before your next order if anything about your health or medicines changes.

About your treatment

Medy prescribes two treatments for male pattern hair loss, which can be used alone or together:

• Finasteride 1mg tablets - taken once a day. Finasteride lowers the level of a hormone (DHT) that shrinks hair follicles.
• Minoxidil foam (Regaine) - applied to the scalp. Minoxidil increases blood flow to the hair follicles.

These treatments work best on early hair loss. They can slow or stop hair loss and may regrow some hair, but results vary and are not guaranteed.

Important safety information about finasteride

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued warnings about finasteride. A patient alert card is included in every pack. Please read it.

Mood changes and suicidal thoughts. Finasteride has been linked to depression, low mood, anxiety and suicidal thoughts. These can happen in people with no history of mental health problems. If you notice any change in your mood, stop taking finasteride and contact us or your GP straight away. If you have thoughts of harming yourself, get help immediately (see below).

It can help to tell someone close to you that you are taking finasteride and ask them to let you know if they notice changes in your mood.

Sexual side effects. Finasteride can cause reduced sex drive, erection problems and ejaculation problems, including a lower amount of semen. In some men, these effects have continued after stopping treatment. Tell us if you notice any of these.

Pregnancy. Finasteride is for men only. Women who are pregnant or may become pregnant must not touch crushed or broken tablets, as finasteride can be absorbed through the skin and may harm a male baby. Whole, coated tablets are safe to handle. Small amounts of finasteride can be found in semen; your leaflet explains this further.

PSA tests. Finasteride lowers the level of PSA in your blood, which is used to check for prostate problems. If you have a PSA test, tell the doctor you are taking finasteride.

Breast changes. Tell us or your GP straight away if you notice any changes in your breast tissue, such as lumps, pain, enlargement or nipple discharge.

Blood donation. Tell the blood donation service that you take finasteride before donating blood.

Who should not use these treatments

Finasteride is not suitable for:

• women
• anyone under 18
• men with severe liver problems

Minoxidil foam is not suitable if:

• you are under 18
• your hair loss is sudden, patchy or you do not know the cause - see your GP
• your scalp is red, inflamed, infected, irritated or sunburnt
• you have heart disease or high or low blood pressure, unless a clinician has said it is safe

Tell your clinician if you have, or have had, depression or another mental health condition, prostate problems, or liver problems.

Rules for using your treatment

Finasteride

• Take one tablet a day, with or without food.
• Do not crush or break the tablets.
• Keep tablets away from women who are or may become pregnant.

Minoxidil foam

• Apply to a dry scalp only, as directed in the leaflet. Wash your hands afterwards.
• Do not apply to other parts of the body.
• The foam is flammable. Do not smoke or use near a flame or heat until it has dried.
• Keep away from pets, especially cats, as minoxidil is very poisonous to them. Do not let pets lick your scalp, hands or pillow, and wash your hands after applying.
• You may notice more hair shedding in the first few weeks. This is common and usually settles as new hair grows.

Results

It usually takes 3 to 6 months to see results, and can take up to 12 months to see the full effect. If you stop treatment, any hair you have kept or regrown is usually lost within about a year.

Side effects

Finasteride: reduced sex drive, erection or ejaculation problems, breast tenderness or enlargement, mood changes (see above).

Minoxidil foam: itching, dryness or flaking of the scalp, headache, temporary hair shedding, unwanted hair growth on the face or body (more likely if foam touches other areas).

When to get urgent help

Call 999 or go to A&E if you have:

• thoughts of harming or killing yourself. You can also call Samaritans free, any time, on 116 123
• chest pain, or a very fast or irregular heartbeat
• fainting or severe dizziness
• signs of a severe allergic reaction, such as swelling of the face, lips or throat, or difficulty breathing

Stop your treatment and contact us once you are safe.

When to contact us or your GP

Stop treatment and contact us, or speak to your GP or NHS 111, if you have:

• low mood, anxiety or any change in your mental health
• sexual side effects that worry you
• breast lumps, pain or nipple discharge
• sudden weight gain, or swelling of your hands, ankles or feet (minoxidil)
• a scalp reaction that does not settle

We do not automatically share your treatment with your GP. We recommend you tell them so your medical record is complete.

Ongoing treatment

Your treatment renews monthly. After 12 supplies you will be asked to complete a new consultation so a clinician can check the treatment is still right for you. Tell us before your next order if anything about your health or medicines changes.

About your treatment

Norethisterone is a hormone tablet (a progestogen) that can delay your period, for example for a holiday or special event. It is taken for a short time only.

Norethisterone is not a contraceptive. It will not stop you getting pregnant. Use condoms or another reliable method of contraception while taking it if you could get pregnant.

If you take the combined contraceptive pill, you may be able to delay your period by taking packs back to back instead. Speak to us or your GP or pharmacist about whether this is suitable for your pill.

Who should not use this medicine

Do not take norethisterone, and tell your clinician, if you:

• are pregnant or could be pregnant
• have had a blood clot in a leg, lung or elsewhere, or have a close family member who had one at a young age
• have had a heart attack, stroke or angina
• have migraines with aura
• have liver disease, or had jaundice or severe itching during a previous pregnancy
• have, or have had, breast cancer or another hormone-sensitive cancer
• have unexplained vaginal bleeding
• have porphyria

Tell your clinician if you smoke, have a high BMI, have high blood pressure, diabetes or epilepsy, or are due to have surgery or a long flight, as these can increase the risk of blood clots.

Rules for taking your medicine

• Dose. Take one 5mg tablet three times a day.
• Start 3 days before your period is due. Starting later may not delay your period.
• Maximum time. Do not take for longer than 20 days in total.
• After stopping. Your period should start 2 to 3 days after your last tablet. If it does not start within a week of stopping, take a pregnancy test.
• Missed doses. If you miss a dose, you may have some bleeding or spotting.

Other medicines

Tell us about every medicine you take. Some medicines can make norethisterone less effective or interact with it, including:

• some epilepsy medicines (such as carbamazepine, phenytoin or topiramate)
• rifampicin and rifabutin (antibiotics)
• some HIV medicines
• St John's wort
• ciclosporin

Side effects

Common side effects:

• bloating or feeling sick
• breast tenderness
• headache
• mood changes
• spotting or light bleeding

Blood clots

Hormone medicines like norethisterone can slightly increase the risk of a blood clot. The risk is higher if you smoke, have a high BMI, are immobile (for example on a long flight or after surgery), or have a personal or family history of clots. On long journeys, keep moving and drink plenty of water.

When to get urgent help

Call 999 or go to A&E if you have:

• pain or swelling in one leg, especially the calf, which may feel warm or look red (possible clot in the leg)
• sudden chest pain, breathlessness or coughing up blood (possible clot in the lung)
• a sudden severe headache, weakness or numbness in your face, arm or leg, slurred speech, or sudden problems with your sight (possible stroke)
• yellowing of your skin or the whites of your eyes
• signs of a severe allergic reaction, such as swelling of the face, lips or throat, or difficulty breathing

Stop taking your medicine and contact us once you are safe.

When to contact us or your GP

Contact us, or speak to your GP or NHS 111, if you have:

• a migraine for the first time, or migraines that are worse than usual
• heavy or prolonged bleeding while taking norethisterone
• no period within a week of stopping, and a negative pregnancy test

Repeat use

Each supply is for one period delay. If you need it again, you will be asked to complete a new consultation. Frequent use is not recommended; speak to your GP if you often need to delay your period.

About your treatment

Medy prescribes dapoxetine (Priligy), a medicine that helps delay ejaculation. It is licensed for men aged 18 to 64. It is taken only when needed, before sex, and not every day.

This medicine does not protect against sexually transmitted infections or prevent pregnancy.

Who should not use this medicine

Do not use dapoxetine, and tell your clinician, if you:

• have a heart condition, such as heart failure, heart rhythm problems, heart valve disease or a previous heart attack
• have a history of fainting
• have had mania, bipolar disorder or severe depression
• have moderate or severe liver problems
• take any of the medicines listed under "Other medicines" below

Tell your clinician if you have epilepsy, glaucoma, a bleeding or clotting disorder, kidney problems, low blood pressure, or any mental health condition.

Rules for taking your medicine

• Before sex only. Take one tablet 1 to 3 hours before sex. Never take more than one dose in 24 hours. It is not for daily use.
• Water. Swallow the tablet whole with a full glass of water.
• No alcohol or recreational drugs. Alcohol increases the risk of dizziness and fainting. Recreational drugs such as ecstasy, cocaine and cannabis can cause serious reactions, including serotonin syndrome.
• Fainting. Fainting is most likely with your first dose. If you feel light-headed, lie down straight away or sit with your head between your knees until you feel better. Do not drive or operate machinery if you feel dizzy, drowsy or have trouble concentrating.
• Erection medicines. If you also use an erection medicine (such as sildenafil or tadalafil), tell your clinician, as the combination can increase dizziness.

Other medicines

Do not take dapoxetine with, or within 14 days of stopping:

• antidepressants, including SSRIs (such as sertraline or fluoxetine), SNRIs (such as venlafaxine), tricyclics (such as amitriptyline) and MAOIs
• lithium, linezolid, thioridazine or tramadol
• triptans for migraine (such as sumatriptan)
• St John's wort or tryptophan supplements

Do not take dapoxetine with strong "CYP3A4 inhibitors", including some antifungals (such as ketoconazole or itraconazole), some antibiotics (such as clarithromycin or telithromycin) and some HIV medicines (such as ritonavir).

Tell us about every other medicine you take, including blood thinners and blood pressure medicines.

Side effects

Common side effects:

• dizziness, headache or feeling sick
• diarrhoea
• difficulty sleeping, tiredness or feeling anxious
• blocked nose, sweating or yawning

When to get urgent help

Call 999 or go to A&E if you have:

• fainting, especially if you are injured, or a fit (seizure)
• chest pain, or a very fast or irregular heartbeat
• a combination of agitation, confusion, fever, sweating, muscle twitching or shaking (possible serotonin syndrome)
• signs of a severe allergic reaction, such as swelling of the face, lips or throat, or difficulty breathing
• thoughts of harming yourself

Stop taking your medicine and contact us once you are safe.

When to contact us or your GP

Contact us, or speak to your GP or NHS 111, if:

• you feel low, anxious or notice changes in your mood
• side effects are troubling you or not going away
• you start a new medicine or are diagnosed with a new condition

We do not automatically share your treatment with your GP. We recommend you tell them so your medical record is complete.

Ongoing treatment

Your treatment renews monthly. After 12 supplies you will be asked to complete a new consultation so a clinician can check the treatment is still right for you. Tell us before your next order if anything about your health or medicines changes.

About your treatment

Medy prescribes these UK-licensed weight loss medicines:

• Mounjaro (tirzepatide) - weekly injection
• Wegovy (semaglutide) - weekly injection
• Wegovy tablets (semaglutide) - daily tablet
• Foundayo (orforglipron) - daily tablet

They reduce appetite and help you feel full sooner. They are licensed for weight management alongside a reduced-calorie diet and increased physical activity, for adults who meet the eligibility criteria your clinician will check.

Results

Weight loss varies from person to person. Some people lose less weight than expected, and some lose very little. If you stop treatment, weight often returns, especially without lasting changes to diet and activity. Your clinician may recommend stopping treatment if it is not working for you or is no longer safe.

Who should not use these medicines

Tell your clinician if any of the following apply to you. These medicines may not be suitable if you:

• are pregnant, trying to get pregnant or breastfeeding
• have had pancreatitis (inflammation of the pancreas)
• have, or have a family history of, medullary thyroid cancer or multiple endocrine neoplasia type 2 (MEN2)
• have severe stomach or bowel problems, such as gastroparesis (slow stomach emptying)
• have type 1 diabetes, or take insulin or a sulfonylurea (such as gliclazide) for type 2 diabetes
• have diabetic eye disease (retinopathy)
• have, or have had, an eating disorder
• have severe kidney or liver disease
• are taking another weight loss medicine

Rules for taking your medicine

• One at a time. Use only one weight loss medicine at a time. Do not combine Medy treatment with medicine from another provider or with any unlicensed weight loss product.
• Follow your dose. Take the dose on your label. Do not increase or change it without a clinician's approval. Request dose changes through your weight submission.
• Missed doses. Follow the instructions in your patient information leaflet. Do not take a double dose to make up for a missed one. If you have missed several doses, contact us before restarting, as you may need to restart at a lower dose.
• Injections. Use a new needle for every injection and dispose of it in a sharps bin. Never share your pen, even with a new needle.
• Tablets. Some weight loss tablets must be taken on an empty stomach with a small amount of water. Follow the instructions in your leaflet exactly, as they affect how well the medicine works.
• Storage. Store your medicine as described in the leaflet. Injection pens should normally be kept in the fridge and must not be frozen.

Pregnancy and contraception

There is not enough information to know whether these medicines can harm an unborn baby. You must not use them while pregnant, while trying to get pregnant, or while breastfeeding.

• If you could get pregnant, use effective contraception throughout treatment.
• Mounjaro and the contraceptive pill: Mounjaro may make the pill less effective. Use condoms as well, or switch to a non-pill method such as a coil or implant, for 4 weeks after starting Mounjaro and for 4 weeks after each dose increase.
• Planning a pregnancy: stop Mounjaro at least 1 month before trying to conceive, and Wegovy at least 2 months before. Keep using contraception during this time.
• If you think you may be pregnant: stop your medicine and contact us or your GP straight away.

Other medicines

Tell us about every medicine you take, including those bought over the counter, herbal remedies and supplements. In particular:

• Diabetes medicines such as insulin or gliclazide, as your blood sugar could fall too low
• Oral contraceptives, as above
• Medicines that need careful dosing, such as warfarin or levothyroxine, as these medicines can affect how other tablets are absorbed

Surgery and sedation

These medicines slow down how quickly your stomach empties. This can increase the risk of stomach contents entering the lungs during a general anaesthetic or deep sedation. Always tell the doctor, dentist or anaesthetist that you are taking a weight loss medicine before any procedure.

Side effects

Common side effects usually happen when you start or increase your dose, and often improve over time:

• feeling or being sick, diarrhoea, constipation, indigestion or stomach pain
• reduced appetite, burping, bloating or wind
• tiredness, dizziness or headache
• hair thinning
• redness or itching where you inject

Drink plenty of fluids, especially if you are vomiting or have diarrhoea. Losing too much fluid can lead to dehydration, which can affect your kidneys.

Less common but serious side effects include pancreatitis, gallstones, a blocked bowel, and low blood sugar in people taking diabetes medicines.

When to get urgent help

Call 999 or go to A&E if you have:

• severe stomach pain that does not go away, with or without vomiting, which may spread to your back (possible pancreatitis)
• severe pain in the upper right side of your stomach, with fever or yellowing of your skin or eyes (possible gallbladder problem)
• severe constipation with a swollen stomach, vomiting, or being unable to pass wind (possible blocked bowel)
• signs of a severe allergic reaction, such as swelling of the face, lips or throat, or difficulty breathing
• vomiting or diarrhoea so severe that you cannot keep fluids down, or signs of dehydration such as passing very little urine, feeling faint or confused
• thoughts of harming yourself

Stop taking your medicine and contact us once you are safe.

When to contact us or your GP

Contact us, or speak to your GP or NHS 111, if you have:

• sickness, diarrhoea or constipation that is not improving
• low mood or changes in your mental health
• changes in your eyesight, if you have diabetes
• symptoms of low blood sugar, such as shaking, sweating or confusion, if you take diabetes medicines
• a new diagnosis, a new medicine, or planned surgery
• become pregnant or plan to

Ongoing treatment

• Before each monthly order you must submit your current weight and confirm your dose. We may ask you for verification.
• All dose changes are reviewed by a clinician before they are approved.
• We may pause or stop your treatment if it is no longer suitable, for example if your weight falls below a safe level, you are not losing weight, or your health changes.