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7.4.5 Drugs for erectile dysfunction

General Notes

  • Drug treatments for erectile dysfunction may only be prescribed on HSC prescription under certain circumstances. These are:
    • men who have diabetes, multiple sclerosis, Parkinson’s disease, poliomyelitis, prostate cancer, severe pelvic injury, single gene neurological disease, spina bifida, or spinal cord injury
    • men who are receiving dialysis for renal failure
    • men who have had radical pelvic surgery, prostatectomy (including transurethral resection of the prostate) or kidney transplant
    • men who were receiving Caverject®, Erecnos®, MUSE®, Viagra® or Viridal® for erectile dysfunction, at the expense of the NHS, on 14th Sept 1998
  • The prescription must be endorsed “SLS”.
  • GPs can issue private prescriptions for patients on their list, that don’t meet SLS criteria, but cannot charge patients for issuing a private prescription.
  • Men suffering from severe distress as a result of impotence should be referred for assessment by specialist in secondary care. In Northern Ireland, treatments for impotence leading to severe distress are classified as red drugs; supply is via hospital pharmacies. For full details on the red/amber list, visit http://www.ipnsm.hscni.net/red-amber/.

Drugs for erectile dysfunction

ChoiceDrug
1st choiceSildenafil tablets 50mg, 100mg
2nd choiceTadalafil 10mg, 20mg tablets

Prescribing Notes

  • Refer to NICE CKS: Erectile dysfunction for further information on management. Note NHS prescription criteria in Northern Ireland differ – refer to general notes above.
  • Presentation with erectile dysfunction should prompt assessment and screening for cardiovascular disease.
  • There is not enough evidence to routinely recommend tadalafil ‘once daily’ (2.5mg, 5mg) preparations for erectile dysfunction.
  • It may take time to work, 6 attempts with a particular drug, at a maximal dose with optimum timing and stimulation is recommended before considering treatment failure; if continued failure try switching to an alternative PDE5i.
  • Sildenafil and tadalafil are now available to purchase from pharmacies for suitable patients.