Therapeutic AreaFormulary ChoicesCost 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
• Poliomyelitis
• 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-lineSildenafil25mg tablets: £0.83 (4)
50mg tablets: £0.88 (4)
100mg tablets: £0.95 (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:Vardenafil5mg tablets: £7.56 (4)
10mg tablets: £14.08 (4)
20mg tablets: £23.48 (4)
Avanafil50mg tablets: £10.94 (4)
£19.70 (8)
100mg tablets: £14.08 (4)
£26.26 (8)
200mg tablets: £21.90 (4)
£39.40 (8)
Third line:Tadalafil10mg tablets: £28.88 (4)
20mg tablets: £28.88 (4)
Tadalafil is offered as a third line option for patients who are intolerant or unresponsive to Sildenafil and Vardenafil. It should not be used in patients taking nitrates.
Cialis® Once Daily is non-formulary
Non oral therapyAlprostadil
as Vitaros® cream
4 doses: £40An alternative to oral medication