|Therapeutic Area||Formulary Choices||Cost for 28|
(unless otherwise stated)
|Rationale for decision / comments|
|7.4.5 Drugs for erectile dysfunction|
|The drugs for the treatment of erectile dysfunction in men listed below are considered appropriate for initiation in general practice, where patients meet the following criteria for NHS prescribing and are endorsed as “SLS”:
• Diabetes mellitus
• Multiple sclerosis
• Parkinson's disease
• Prostate Cancer
• Severe pelvic injury
• Single gene neurological disease
• Spina Bifida
• Spinal cord injury
• Dialysis for renal failure
• Radical pelvic surgery, prostatectomy or kidney transplant
• Were receiving Caverject®, Erecnos®, MUSE®, Viagra® or Viridal® for ED at NHS expense on 14-09-1998
Prescriptions need to be annotated “SLS” with the exception of sildenafil from August 1st 2014
|First-line||Sildenafil||25mg tablets: £1.01 (4)|
50mg tablets: £1.22 (4)
100mg tablets: £1.36 (4)
|All PDE5 inhibitors are contra-indicated in patients taking nitrates.
Prophylactic use after prostate surgery to improve recovery. Not licenced for this indication, therefore treat as RED if recommended by a relevant specialist for this indication.
NICE CG66 states that all PDE5’s are effective and the evidence is not sufficient to distinguish between them.
|Second-line:||Vardenafil||5mg tablets: £6.42 (4)|
10mg tablets: £11.86(4)
20mg tablets: £6.62 (4)
|Avanafil||50mg tablets: £10.94 (4)|
100mg tablets: £14.08 (4)
200mg tablets: £21.90 (4)
|Expensive alternative. Use if other treatment fails. SLS only|
|Tadalafil||10mg tablets: £1.34 (4)|
20mg tablets: £1.72 (4)
|Tadalafil should not be used in patients taking nitrates.
Cialis® Once Daily is non-formulary
Tadalafil 5mg daily is now approved for treatment of BPH and LUTS in men.
|Non oral therapy||Alprostadil|
as Vitaros® cream
|4 doses: £40||An alternative to oral medication|