Fundamental the crownic in perspective and clues
The so called Mega ED Pack is a bundled supply aimed at men who are treating erectile dysfunction. It groups three established phosphodiesterase type 5 (PDE5) inhibitors that are intended for use when sexual activity is planned, to help achieve and maintain an erection when stimulated. Indication: failure to achieve an erection therapy for adult men.
The active molecules included are sildenafil, tadalafil and vardenafil. For precise tablet strengths and quantities see the pack breakdown at Contents of the pack revealed and explained. For projected costs conjoined with the rules that apply in Australia, jump to Australian currency a guide to prices and Regulations for access under the Australian legal framework.
Contents of the pack explained
Typical composition marketed as a combined supply is one tablet strength of each drug per dose line: 100 mg sildenafil, 20 mg tadalafil and 20 mg vardenafil. A common commercial pack contains:
- Viagra (sildenafil) 100 mg, usually 30 tablets
- Levitra (vardenafil) 20 mg, often supplied as 30 tablets
- Cialis (tadalafil) 20 mg, typically 30 tablets
All three agents act by relaxing vascular smooth muscle to increase penile blood flow during sexual arousal. Never take two PDE5 inhibitors together; choose one at a time. See When this should not be used for critical risk warnings.
Dose amount and schedule
Stick with the instructions your prescriber has issued. These medicines in this type of pack are intended for on-demand use. Do not take more than one dose of any single PDE5 inhibitor in a 24 hour period.
- Tadalafil 20 mg: can be taken about 30 minutes before sexual activity; its effect can last up to 36 hours. Daily low-dose tadalafil is a separate regimen and is not part of this combined pack.
- Sildenafil 100 mg: commonly taken 30 to 60 minutes before sex. The onset may be delayed by fatty meals and it can remain effective for several hours.
- Vardenafil 20 mg: usually used 30 to 60 minutes ahead of sexual activity.
If you use medicines for angina or pulmonary hypertension consult Conditions where use is not advised and Social exchanges among drugs to keep an eye on before taking any product in this pack.
Before you start up, heed these precautions
Tell your clinician about past or current health issues that may influence safety. Relevant medical history includes:
- Heart disease: prior heart attack, heart failure, irregular heart rhythm, angina, or uncontrolled blood pressure
- Lung vascular disease such as pulmonary hypertension or pulmonary veno-occlusive disease
- Significant liver impairment or advanced kidney disease, including dialysis
- Serious eye disorders such as a history of sudden vision loss or inherited retinal disease
- Blood disorders including sickle cell disease, leukemia or multiple myeloma
- Penile structural problems like Peyronie disease or a history of prolonged erections
- Active bleeding, stomach ulcers or any medical condition that makes sexual activity unsafe
If you get chest pain, sudden visual change, sudden hearing loss, fainting or an erection lasting longer than 4 hours seek emergency medical care. See Potential event risks to obtain more details.
Temperature warnings and this therapy is not suitable under these conditions
Do not use any product in this pack if any of the following apply:
- Allergic reaction to sildenafil, tadalafil, vardenafil or any ingredient in the tablet
- Concurrent use of nitrates or recreational amyl nitrite and similar nitrite "poppers"
- Riociguat in the treatment of PAH.
- Taking more than one PDE5 inhibitor at once
Combining PDE5 inhibitors with nitrates or riociguat may precipitate severe hypotension. For a broader list of interacting medicines, see Interacting drug effects to track.
Possible treatment adverse reactions
Most accompanying effects are mild to moderate and short lived. Prevalent accompanying effects include:
- A headache accompanied by facial flushing
- The nose is congested and runny nose
- Abdominal cramps along with indigestion and nausea
- Back pain syndrome, muscle aches or limb pain
- Wooziness or unsteadiness
Although uncommon, urgent medical assessment is required for chest pain, fainting, sudden hearing or vision loss, or an erection that persists beyond 4 hours.
Drug the dynamics of interaction related risks to watch for
Provide your doctor and pharmacist with a full list of the medicines and supplements you take. Distinctive exchanges include:
- Any nitrate-containing drugs and riociguat - see Situations that preclude therapy
- Strong inhibitors of CYP3A4 such as ketoconazole, itraconazole, clarithromycin, erythromycin, ritonavir and some other protease inhibitors which can raise blood levels of PDE5 inhibitors
- Alpha-blockers and other antihypertensives which may increase the risk of low blood pressure
- Other erectile dysfunction treatments including injectable alprostadil unless directed by a clinician
- Certain antivirals, some antibiotics, antifungals and anticonvulsants which can alter PDE5 inhibitor metabolism
- Grapefruit or grapefruit juice which may elevate drug concentrations
Advice when a dose is missed
On-demand medicines do not usually have a scheduled dose. If you are using tadalafil in a prescribed once-daily regimen separate from this pack and you miss one dose, skip the one dose was skipped and take the next dose at the usual time. Do not give yourself a double dose at the next interval to replace a one dose was skipped.
Interventions for overdose and emergency response steps
If someone swallows an excessive amount or if there is any concern about an fatal overdose seek emergency care. In Australia call 000 for immediate emergency assistance. For non-life threatening guidance contact the Poisons Information Centre on 13 11 26.
Recommendations for proper modular storage systems allow easy reconfiguration.
- Keep at room temperature, away from dampness and direct heat
- Retain in original blister or packaging and store out of reach of children and pets
- Do not use medicines past their expiry date; return expired or unwanted tablets to a pharmacy for safe disposal
Different therapeutic strategies and similar medications
If the Mega ED Pack is not suitable, optional choices to discuss with your healthcare provider include:
- Avanafil brand Spedra - a PDE5 inhibitor with rapid onset; availability and tariff schedule in Australia vary by supplier
- Alprostadil delivered by injection (Caverject) or urethral suppository (MUSE) for men who cannot take or do not respond to oral PDE5 inhibitors
- Erection devices that use vacuum combined with a constriction ring - a non-pharmacological option
- Addressing lifestyle factors such as quitting smoking, weight loss, regular exercise and review iting other medicines that may impair sexual function
- Psychosexual therapy or counselling if psychological or relational issues contribute to erectile problems
Your prescriber can help compare onset, duration, likely ripple effects and cost. For a quick cost comparison, see here Price guide for Australian dollars.
Australian dollar wholesale pricing guide
Costs depend on brand versus generic status, pharmacy choice and pack size. Note that most ED indications are not subsidised by the PBS so purchases are often out of pocket.
- Sildenafil 100 mg, 30 tablets: generic brands commonly range from about AUD 40 to 120; original brand prices can be substantially higher, sometimes AUD 200 to 600
- Tadalafil 20 mg, 30 tablets: generic options often cost around AUD 60 to 150; branded products may be AUD 250 to 700
- Vardenafil 20 mg, 30 tablets: availability and price vary; expect roughly AUD 180 to 450 depending on brand or supplier
- Mega ED Pack equivalent (three generics, 30 tablets each): indicative total between AUD 120 and 300; if all are originator brands the combined cost can exceed AUD 600 and growth potentially run to AUD 1500 or more
These figures are indicative and will change over time. For lawful purchasing see Regulations for access to the law in Australia.
Australia-wide access within legal bounds rules
Key regulatory and access points in Australia:
- Scheduling: Sildenafil, tadalafil and vardenafil are Schedule 4 medicines (Prescription Only) governed by the Therapeutic Goods Administration (TGA).
- Prescription requirement: A valid Australian prescription is required to lawfully obtain and use these products for erectile dysfunction.
- PBS coverage: Erectile dysfunction is generally not covered by the Pharmaceutical Benefits Scheme (PBS), so most people pay privately.
- Online supply: Use only Australian-registered pharmacy networks. Legitimate services will request a valid prescription and typically display appropriate registration or accreditation details.
- Personal importation: Under the Private Importation Scheme you may import a limited supply for personal use with a prescription (commonly up to three months). Products must be lawful in Australia and usually retained in original packaging; customs may seize noncompliant goods.
- Telehealth: Prescriptions from eligible telehealth consultations are permitted, subject to standard prescribing rules.
- Age and safety: These medicines are intended for adults. Avoid driving or operating heavy machinery if you feel impaired after dosing.
- Advertising restrictions: Direct-to-consumer advertising of prescription medicines is strictly controlled somewhere in Australia.
Always follow your prescriber and local laws when obtaining and using prescription medicines. See Guide to prices in Australian dollars for budgeting key information.
Note for your attention
This page is intended for general informational purposes and does not replace personalised medical advice. Your healthcare professional will assess whether these medicines are appropriate for you and recommend the correct dosing and tracking and monitoring of performance.
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