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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 7 - Obstetrics, Gynaecology, and urinary-tract disorders 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
07.04.05 Drugs for erectile dysfunction

Lifestyle changes should be discussed and tried before pharmacological treatments are considered for erectile dysfunction.

Sildenafil 50mg tablets (Viagra Connect®) can be purchased from a Community Pharmacist, and is first line treatment where the patient is willing and able to self-care.

Where drug treatment on prescription is indicated, generic sildenafil (at the minimum effective dose) is the first line choice of drug to be used in the treatment of erectile dysfunction.

Tadalafil on demand (10mg or 20mg tablets) is second line formulary choice and should only be prescribed at NHS expense for men who meet the medical conditions and circumstances specified by the Department of Health.

  • Have diabetes, multiple sclerosis, Parkinson’s disease, poliomyelitis, prostate cancer, severe pelvic injury, single gene neurological disease, spina bifida, or spinal cord injury
  • Are receiving dialysis for renal failure
  • Have had radical pelvic surgery, prostatectomy, or kidney transplant
  • Were receiving Caverject©, Erecnos©, MUSE©, Viagra or Virdal© for ED, at the expense of the NHS on 14th September 1998

Where generic sildenafil is ineffective or contra-indicated and the patient does not meet the NHS criteria for drugs other than generic sildenafil, a private prescription can be provided in Primary Care.

07.04.05 Alprostadil

Alprostadil
(Intra-cavernosal Injection)

Amber SPA
Restricted Drug Restricted

Only prescribable on the NHS for erectile dysfunction if fulfil NHS SLS criteria (listed in part XVIIIB of the Drug Tariff).

For second-line use after failure of oral PDE5-inhibitors.

Entry reviewed June 2025

BNF BNFc SPC

Aviptadil / phentolamine 25mcg / 2mg (Invicorp®)
(Intra-cavernosal Injection)

Amber SPA
Restricted Drug Restricted

Only prescribable on the NHS for erectile dysfunction if fulfil NHS SLS criteria (listed in part XVIIIB of the Drug Tariff).

For second-line use after failure of oral PDE5-inhibitors.

BNF BNFc SPC
07.04.05 Phosphodiesterase type 5 inhibitors
07.04.05 Papaverine and phentolamine
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.