Erectile dysfunction (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Note: Drug treatments for erectile dysfunction

  • May only be prescribed on the NHS under certain circumstances and the prescription must be endorsed SLS; refer to the BNF for further details.
  • Most patients are not eligible under current NHS rules for NHS treatment. Where private prescriptions are issued, GPs may wish to advise patients that sildenafil is now very low cost and may be the preferable option.
  • Sildenafil and tadalafil are contra-indicated in patients receiving nitrates and nicorandil.
  • Use with caution in patients on alpha-blockers, eg doxazosin, tamsulosin.  
  • If prescribing after myocardial infarction/acute coronary syndrome, advise re-introduction at 1 month after cardiac event if patient is pain-free and does not require nitrates or nicorandil.
  • Sildenafil has a duration of action of around 6 hours and its onset of effect may be delayed if taken with food. Tadalafil has a longer duration of action (up to 30 hours) and may be preferred for patients for whom this represents a significant advantage.  Its onset of action is unaffected by food.
  • Serum testosterone should be measured on an early morning sample to exclude hypogonadism.
  • Both tadalafil and sildenafil should be tried at their maximum doses on several occasions before referring the patient to Urology for consideration of other therapies, eg transurethral or intra-cavernosal alprostadil or vacuum devices.  Psychosexual counselling should also be considered.
  • Vacuum pumps are available and prescribable in primary care following assessment and recommendation at a urology clinic

For further information see erectile dysfunction guidance.

SILDENAFIL - (First line)

Therapy notes


Risk minimisation materials

  • off-label indication for Raynaud’s phenomenon.

Formulation and dosage details

Formulation:

Tablets 25mg, 50mg, 100mg

Dosage:

Initially 50mg (older people, 25mg) approximately 1 hour before sexual activity, subsequent doses adjusted according to response to 25 to 100mg as a single dose as needed; maximum 1 dose in 24 hours (maximum single dose 100mg).

Notes:

Note: Sildenafil for pulmonary hypertensionThe initiation, prescribing and supply is from the National Specialist Service for pulmonary arterial hypertension (Scottish Pulmonary Vascular Unit or similar specialists) only. 
For further information see NHS inform

TADALAFIL

Therapy notes

Formulation and dosage details

Formulation:

Tablets 2·5mg, 5mg

Dosage:

For daily dosing.

Formulation and dosage details

Formulation:

Tablets 10mg, 20mg

Dosage:

For on demand dosing.

Initially 10mg approximately 30 minutes to 12 hours before sexual activity, subsequent doses adjusted according to response to 20mg as a single dose; maximum 1 dose in 24 hours. 

ALPROSTADIL

Therapy notes

Formulation and dosage details

Formulation:

Intracavernosal injection 5 micrograms, 10 micrograms, 20 micrograms, 40 micrograms (specialist initiation only)

Dosage:

  • Urology Clinic: First dose supervised and patient education and training given.
  • Prescribing instructions sent to patient's GP for onward management. 

Formulation and dosage details

Formulation:

Double chamber cartridge 10 micrograms, 20 micrograms (specialist initiation only)

Dosage:

  • Urology Clinic: First dose supervised and patient education and training given.
  • Prescribing instructions sent to patient's GP for onward management. 

Formulation and dosage details

Formulation:

Urethral stick 500 microgram, 1000 microgram (Muse®) (specialist initiation only)

Dosage:

  • Urology Clinic: First dose supervised and patient education and training given.
  • Prescribing instructions sent to patient's GP for onward management. 

DAPOXETINE

Therapy notes

Formulation and dosage details

Formulation:

Tablets 30mg, 60mg (specialist initiation only)

Dosage:

As per SMC 987/14: treatment of premature ejaculation (PE) in adult men aged 18 to 64 years. NB - SMC not recommended advice considered to be non-extant by NHS Highland.

For premature ejaculation in men who meet all the following criteria: poor control over ejaculation, a history of premature ejaculation over the past 6 months, marked distress or interpersonal difficulty as a consequence of premature ejaculation, and an intravaginal ejaculatory latency time of less than two minutes.

AVIPTADIL WITH PHENTOLAMINE MESILATE

Therapy notes

Formulation and dosage details

Formulation:

Solution for injection 25 micrograms/2mg in 0.35ml (Restricted: specialist initiation only)

Dosage:

As per SMC 1284/17: For the symptomatic treatment of erectile dysfunction in adult males due
to neurogenic, vasculogenic, psychogenic, or mixed aetiology.

SMC restriction: for use in those who have failed on oral therapies (oral phosphodiesterase type-5 inhibitors) and other non-injectable formulations of erectile dysfunction medications.

  • Urology Clinic: First dose supervised and patient education and training given.
  • Prescribing instructions sent to patient's GP for onward management. 

Editorial Information

Last reviewed: 04/03/2021

Version: 1.1

Document Id: F246