On October 20, 2026, SSP Co. (エスエス製薬), the Japanese OTC arm of Opella, began selling Cialis (tadalafil 10 mg) on Amazon.co.jp. It is the first erectile-dysfunction drug in Japan available without a prescription. The pill is a "requires-guidance" medicine (要指導医薬品), so buying it online still involves a pharmacist. The buyer fills in a health and medication checklist, then has a video call with a pharmacist who decides whether the drug is safe for them and gives usage guidance. Only then does the order ship. Each order is limited to one box of four tablets, at a suggested retail price of ¥5,808 including tax. Buyers must be men aged 18 or over.

Why It Matters

Japan has a large male population with a well-documented reluctance to see a doctor about ED. It has now gone from prescription-only to pharmacist-gated e-commerce in under three months. For the global market, this is the most significant ED switch since the UK moved sildenafil to the pharmacy shelf with Viagra Connect in 2018. The format is also notable: an Amazon listing with a mandatory pharmacist video call. That is effectively the telehealth model, run by a pharmacist rather than a prescriber, on the world's largest retail platform. Expect other markets to point to it, starting with the UK, where [Aspargo is seeking OTC status for liquid sildenafil](/stories/aspargo-liquid-sildenafil-uk-otc), and the OTC-topical race led by [Futura's Eroxon](/stories/futura-eroxon-h1-2026-us-partner). For DTC telehealth operators eyeing Asia (Hims has [named Japan](/stories/hims-eucalyptus-convertible-notes-350m) among its expansion markets), the opportunity looks smaller. When a branded, pharmacist-checked tablet ships from Amazon, a subscription ED app has less convenience to sell and has to compete on price, privacy and bundled care. The one-box-per-order cap and the video-call requirement are the safeguards regulators will watch. If they hold, the Japanese model becomes a precedent for others to copy. If they turn into box-ticking, it will be used as a warning.

The online launch follows a staged retail rollout. SSP started selling the drug on July 31 through selected AEON-group, Tsuruha and Welcia stores that employed pharmacists trained and tested on the product. On August 31 it expanded to qualifying pharmacies and drugstores nationwide. On October 22 the Mainichi reported that, according to SSP, sales have "far exceeded expectations." The paper quoted Dr. Koichi Nakajima, vice president of the Japanese Society for Sexual Medicine, who stressed that the drug "is not an aphrodisiac" and that nitrates and some antiarrhythmics remain contraindicated. He also suggested that retail access could prompt men to pay attention to underlying conditions such as hypertension and diabetes.

SSP's own figures set out the commercial case. Its 2026 "ED White Paper" survey estimates that about one in two Japanese men may have ED, defined as an Erection Hardness Score of 3 or below. Only about 20% have ever talked to anyone about it. Just 15.7% have consulted a medical institution and 19.3% have taken medication. The Japanese Society for Sexual Medicine's 2024 estimate, cited by Mainichi, is about 14 million men with ED. SSP's main argument for selling online is to reduce counterfeits. It cites a Japanese health-ministry-funded study from fiscal 2014 that found about 70% of personally imported "Cialis" was fake.

Sources

Update — 2026-10-22

Initial entry — story first created.