Lady Era

Lady Era is the name of a generic tablet that contains sildenafil, 100 mg in each. Sildenafil inhibits the enzyme PDE5, which lets the smooth muscle in blood-vessel walls relax and permits more blood to reach tissue involved in arousal. Those who sell the product to women rely on that effect. It is not a hormone, though, and it does not create desire; at most it affects blood flow. This is an imported product, and its packaging was prepared for a market outside Britain.

British authorisations for sildenafil cover two things: erectile dysfunction in men, and pulmonary arterial hypertension in separate products. The erectile dysfunction SmPC states that sildenafil is not indicated for women, and 100 mg tablets are prescription-only. Lady Era itself has never been authorised here. A clinician who considered it for a woman would be prescribing an unlicensed product for an unlicensed purpose, which calls for a thorough individual assessment. Hormonal change, low mood, stress, a long-term illness and the effects of other medicines are the usual things to explore first, beginning with a GP.

Lady Era tablets never vary in strength. Counts of 12, 20, 32, 48, 80 and 100 are listed, but every tablet carries 100 mg, which is the largest single dose the SmPC allows in men. When the pack arrives, check the strip for the word sildenafil, the strength and a legible expiry date. Foil and leaflet may differ visibly from UK medicines. Keep the tablets dry, in their blisters and where children cannot reach them.

The central danger is low blood pressure. Nitrate medicines, including GTN spray and isosorbide mononitrate, and amyl nitrite can cause a steep fall when combined with it, and riociguat has the same effect. The SmPC also excludes people who have recently had a stroke or heart attack, who have low blood pressure or severe liver disease, or who have an inherited degenerative eye condition such as retinitis pigmentosa. Alpha-blockers add to the blood pressure effect. Medicines such as ketoconazole, itraconazole, erythromycin and ritonavir slow the breakdown of sildenafil and so push its level higher. In pregnancy, when trying for a baby or while breastfeeding, a doctor’s advice comes first.

There is no licensed dose or timing for women, so whatever a prescriber decided about Lady Era would be a judgement and not a label instruction. In men, licensed timing is about an hour before sex; nothing equivalent exists for women. Food and alcohol matter: a heavy meal may delay absorption and alcohol worsens light-headedness. A headache is very common, affecting one person in ten or more. Facial flushing, indigestion, a stuffy nose, dizziness, nausea, a sensation of warmth and visual disturbance are also common. Anyone who feels dizzy or notices vision changes should not drive.

Chest pain, a sudden loss of sight or hearing, or an allergic reaction with swelling and breathlessness means calling 999 or attending A&E. Milder suspected reactions can go to the Yellow Card scheme run by the MHRA.

Sexual arousal problems have many roots, so expect questions about how long they have lasted and whether they occur in every setting. A list of every medicine taken helps, particularly antidepressants, hormonal contraception and blood pressure treatment, as do notes on heart, circulation or eye conditions and allergies. Counselling or sex therapy may be offered, alone or with a medicine. Lady Era should be considered only if a doctor judges it suitable, and asking about alternatives is entirely reasonable.