Hezkue is a prescription-only oromucosal spray containing sildenafil citrate, the same active ingredient found in Viagra®. Each actuation (pump) delivers 12.5mg of sildenafil in a mint-flavoured suspension that is sprayed into the mouth and swallowed. It is licensed for the treatment of erectile dysfunction (ED) in adult men and is marketed in the UK, Germany, Ireland and the Netherlands. In Spain, the same product is sold under the brand name Bandol®.

Hezkue works in the same way as sildenafil tablets. Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor. It relaxes the smooth muscle in the blood vessels of the penis, allowing increased blood flow during sexual arousal, which helps you achieve and maintain an erection firm enough for sex. Sexual stimulation is still required for Hezkue to work — it does not cause an erection on its own.

The active ingredient and how it works in the body are the same. The difference lies in how the medicine is delivered. Hezkue is a metered-dose oral spray rather than a tablet, which some patients prefer if they have difficulty swallowing pills or want flexibility in adjusting their dose pump-by-pump. The SmPC notes that onset of activity may be delayed if Hezkue is taken with food, which is also the case for sildenafil tablets. Whether Hezkue or a tablet is the better option for you is a clinical decision best made with your prescriber.

The recommended starting dose is 4 pumps (2ml, equivalent to 50mg of sildenafil), taken approximately one hour before sexual activity. Based on how well it works and how well it is tolerated, your prescriber may adjust this to 2 pumps (25mg) or up to 8 pumps (100mg). The maximum dose is 100mg per day, and Hezkue should not be taken more than once in any 24-hour period.

Hezkue should be taken around one hour before sexual activity. Sildenafil can remain active in the body for up to 4–5 hours, though the duration and strength of effect vary between individuals. Taking Hezkue with a heavy or fatty meal may delay how quickly it starts working.

Shake the bottle for around 20 seconds, remove the child-resistant cap, and attach the metering pump. Before first use, prime the pump by spraying three times into a tissue and discarding. When ready, spray the prescribed number of pumps into your mouth and swallow straight away. After use, close the nozzle, remove the pump, wash it with water, let it dry, and replace the child-proof cap. Detailed instructions are provided in the patient information leaflet supplied with your prescription.

Hezkue is not suitable for everyone. You should not take Hezkue if you:

• Are taking any form of nitrates (e.g. GTN spray or tablets) or nitric oxide donors such as amyl nitrite ("poppers")
• Are taking riociguat or other guanylate cyclase stimulators
• Have been advised to avoid sexual activity for cardiovascular reasons
• Have severe liver impairment, recent stroke or heart attack, or low blood pressure
• Have certain inherited eye conditions such as retinitis pigmentosa
• Are allergic to sildenafil or any of the excipients

Our clinicians will review your medical history in full before prescribing.

Some medicines interact with sildenafil. Co-administration with ritonavir is not advised. Caution is needed if you take alpha-blockers (for blood pressure or prostate conditions), other CYP3A4 inhibitors, or other ED treatments. Always disclose your full medication list during your consultation.