7.4 Erectile and ejaculatory conditions

Page content

Page breadcrumb

Print this page

7.4 Erectile and ejaculatory conditions

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

Traffic light status (TLS) explained:

Green: Routine prescribing within licensed indication
Amber 1: specialist recommendation followed by GP initiation and continuation
Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
Amber 3: specialist initiation and stabilisation followed by GP continuation
Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
Red: Hospital or specialist prescribing only
Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

Sildenafil

Tablets 25mg, 50mg, 100mg

Notes:

Drug Safety Update. Sildenafil (Revatio and Viagra): reports of persistent pulmonary hypertension of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction (Nov 2018)
It is currently recommended that patients should receive eight doses of a PDE5 inhibitor with sexual stimulation at maximum dose before classifying a patient as a non-responder. Full guidance from the British Society for Sexual Medicine.
Prescribers should ensure that generic sildenafil tablets 25, 50 and 100mg tablets are always considered first line for the treatment of erectile dysfunction.
Only patients that meet Selected List criteria can be considered for alternative treatments on the NHS (see below).
Doctors within secondary care are asked not to ask GPs to prescribe drugs outside of the controls imposed by Selected List Scheme.
Alternative erectile dysfunction treatments (including branded Viagra) can continue to be provided privately subject to patient preference.
Prescribers should review their NHS prescribing of treatments for ED to ensure that patients who do meet Selected List criteria are prescribed generic sildenafil 25, 50 and 100mg tablets.
Quantities: guidance remains in force with a recommended dosage frequency of one dose per week; higher quantities can be prescribed at the discretion of the prescriber.
All other formulations of sildenafil or brands remain under the control of Part XVIIIB of the Drug Tariff and can only be prescribed within that context

Selected List criteria are as follows:

any man suffering from diabetes, multiple sclerosis, Parkinson’s disease, poliomyelitis, prostate cancer, severe pelvic injury, single gene neurological disease, spina bifida or spinal cord injury
any man receiving treatment for renal failure by dialysis
any man who has had a prostatectomy or radical pelvic surgery or renal failure treated by transplant
any man who has been diagnosed as suffering severe distress resulting from erectile dysfunction where the assessment has been made by a specialist service or GP under arrangements made with a local Health Board to provide such assessments

Tadalafil (Amber 2)

Tablets 10mg, 20mg

Note:

Place in therapy: second line after Sildenafil
The daily dosing of Tadalafil for erectile dysfunction remains non-formulary

Once-daily Tadalafil Commissioning Statement

Prescribers should not initiate once daily tadalafil for any new patient.

Once daily tadalafil should be discontinued from primary care prescribing (deprescribed), with support from specialist services if necessary.

It should be noted that once daily tadalafil is not on the Joint Trusts formulary and as such should not have been prescribed.

Patient Information Leaflet can be found on the formulary website at: https://www.formularymk.nhs.uk/includes/documents/Patient-information-Changes-to-once-daily-tadalafil-prescribing.pdf

Alprostadil SLS

Caverject^®intracavernosal injection 10 microgram, 20 microgram, 40 microgram

Full information is in the Drug Tariff Part XVIIIB Prescriptions must be endorsed SLS. A prescription not containing this endorsement will not be reimbursed by the Prescription Pricing Division and so should not be dispensed.
HSC 1999/177 recommends that treatment for impotence should be available from specialist services when impotence is causing severe distress. Patients who are prescribed treatment for impotence on the NHS following the guidance in this circular need to continue to receive their treatment through specialist services. GPs cannot issue an FP10, endorsed SLS, where treatment has been started by a specialist for a patient suffering severe distress unless they also meet one of the above criteria.
Patients who are not eligible for an NHS prescription can be issued a private prescription.
HSC 1999/148 advises doctors that one treatment a week will be appropriate for most patients treated for erectile dysfunction. If a GP exercising his clinical judgement considers that more than one treatment a week is appropriate he should prescribe that amount on the NHS.
The treatment of priapism following alprostadil should not be delayed more than 6 hours. The BNF contains full information.

Vacuum Pumps

Vacuum pumps are designated as low priority and should not normally be prescribed.

If in exceptional circumstances, a specialist wishes to prescribe one for a patient who meets the NHS erectile dysfunction SLS criteria then the supply must be made by the specialist service / hospital.

GPs should not be asked to prescribe vacuum pumps.

Traffic light status (TLS) explained:

Green: Routine prescribing within licensed indication
Amber 1: specialist recommendation followed by GP initiation and continuation
Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
Amber 3: specialist initiation and stabilisation followed by GP continuation
Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
Red: Hospital or specialist prescribing only
Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.