Erectile dysfunction
NICE CKS: Erectile dysfunction BAUS: Erectile dysfunction
Initially 50mg approx. 1 hour before sexual activity, subsequent doses adjusted according to response to 25-100mg as a single dose as needed. Max. 1 dose in 24 hours (max. single dose 100mg).
Initially 50mg approx. 1 hour before sexual activity, subsequent doses adjusted according to response to 25-100mg as a single dose as needed. Max. 1 dose in 24 hours (max. single dose 100mg).
Initially 50mg approx. 1 hour before sexual activity, subsequent doses adjusted according to response to 25-100mg as a single dose as needed. Max. 1 dose in 24 hours (max. single dose 100mg).
Tadalafil (10mg or 20mg tablets) may be a suitable alternative for patients who develop visual disturbances with sildenafil or for whom a longer duration of action is required. On demand tadalafil is suitable for individuals who anticipate sexual activity up to twice weekly.
Initially 10mg (max. per dose 20mg), to be taken at least 30 minutes before sexual activity, subsequent doses adjusted according to response, the effect of intermittent dosing may persist for longer than 24 hours, continuous daily use not recommended; maximum 1 dose per day.
Initially 10mg (max. per dose 20mg), to be taken at least 30 minutes before sexual activity, subsequent doses adjusted according to response, the effect of intermittent dosing may persist for longer than 24 hours, continuous daily use not recommended; maximum 1 dose per day.
Tadalafil (2.5mg or 5mg tablets) for patients who anticipate sexual activity at least three times weekly. Consider referral to specialist erectile dysfunction clinic.
5mg once daily, reduced to 2.5mg once daily, adjusted according to response.
5mg once daily, reduced to 2.5mg once daily, adjusted according to response.
Alprostadil cream is approved for use where treatment with oral PDE5 inhibitors are contraindicated or not tolerated.
Apply 300micrograms to the tip of the penis 5-30 minutes before sexual activity; maximum 1 dose in 24 hours and not more than 2-3 times per week.
Prescribing Notes:
- The National Health Service (General Medical Services Contracts) (Scotland) Regulations 2018 limit the use of NHS prescriptions by GPs for treatment of erectile dysfunction.
- For the treatment of erectile dysfunction (ED) for patients with distress, all patients eligible for treatment will be able to receive treatment on NHS prescription from their GP. Refer to Scottish Drug Tariff part 12 ‘Drugs to be prescribed in certain circumstances under the NHS Pharmaceutical services’ for items that must be endorsed ‘SLS’. Generic sildenafil is no longer included in the list of items that 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.
- Examination of the patient is important to check for anatomical abnormalities and Peyronie’s disease which may need referral to Urology. Diabetes needs to be excluded and cardiovascular risk factors addressed because they are commonly present.
- Once daily tadalafil (2.5mg or 5mg) is approved for use in patients responding to an on-demand regimen who anticipate frequent use (at least three times weekly).
- It should be noted that the maximum dose for daily tadalafil is 5mg once daily.
- Sildenafil and tadalafil are contra-indicated in men receiving nitrates in any form, and nicorandil. Consider discontinuing nitrates if no longer needed.
- Prescribers are advised to prescribe one treatment per week (4 tablets per month) for most patients. The prescriber, in exercising their clinical judgement, may prescribe a larger quantity (8 tablets per month) where they feel it is appropriate.
- Patients should have tried maximum tolerated doses of two different oral treatments for a minimum of 8 doses each, before referring them to Urology for consideration of other non-oral therapies.
- In patients co-prescribed alpha-blockers, tadalafil should be avoided due to an enhanced hypotensive effect. There should be at least a 4 hour gap between taking sildenafil and the alpha-blocker and at least a 6 hour gap for vardenafil.
History Notes
25/11/2024
Updated prescribing information, ERWG Nov 2024.
18/05/2022
East Region Formulary content agreed.
Alprostadil, or a vacuum pump recommended following specialist clinic assessment.
As per specialist.
As per specialist.
As per specialist.
As per specialist.
As per specialist.
As per specialist.
Vardenafil is approved for restricted use, in patients where sildenafil has been ineffective and the patient is being co-prescribed an alpha-blocker.
As per specialist.
As per specialist.
As per specialist.
As per specialist.
Prescribing Notes:
- The National Health Service (General Medical Services Contracts) (Scotland) Regulations 2018 limit the use of NHS prescriptions by GPs for treatment of erectile dysfunction.
- For the treatment of erectile dysfunction (ED) for patients with distress, all patients eligible for treatment will be able to receive treatment on NHS prescription from their GP. Refer to Scottish Drug Tariff part 12 ‘Drugs to be prescribed in certain circumstances under the NHS Pharmaceutical services’ for items that must be endorsed ‘SLS’. Generic sildenafil is no longer included in the list of items that 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.
- Examination of the patient is important to check for anatomical abnormalities and Peyronie’s disease which may need referral to Urology. Diabetes needs to be excluded and cardiovascular risk factors addressed because they are commonly present.
- Once daily tadalafil (2.5mg or 5mg) is approved for use in patients responding to an on-demand regimen who anticipate frequent use (at least three times weekly).
- It should be noted that the maximum dose for daily tadalafil is 5mg once daily.
- Sildenafil and tadalafil are contra-indicated in men receiving nitrates in any form, and nicorandil. Consider discontinuing nitrates if no longer needed.
- Prescribers are advised to prescribe one treatment per week (4 tablets per month) for most patients. The prescriber, in exercising their clinical judgement, may prescribe a larger quantity (8 tablets per month) where they feel it is appropriate.
- Patients should have tried maximum tolerated doses of two different oral treatments for a minimum of 8 doses each, before referring them to Urology for consideration of other non-oral therapies.
- In patients co-prescribed alpha-blockers, tadalafil should be avoided due to an enhanced hypotensive effect. There should be at least a 4 hour gap between taking sildenafil and the alpha-blocker and at least a 6 hour gap for vardenafil.
- Vardenafil (Levtira) is approved for restricted use only. In patients where sildenafil has been ineffective and the patient is being co-prescribed an alpha-blocker.
- Alprostadil can be administered as an alternative to oral treatments. For doses up to 20mcg the preferred formulation is Caverject Dual Chamber. For higher does the recommended formulation is Viridal Duo.
History Notes
25/11/2024
Updated prescribing information, ERWG Nov 2024.
11/05/2023
Viridal Duo Continuation Packs removed as discontinued.
18/05/2022
East Region Formulary content agreed.