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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
07.04.05 Phosphodiesterase type 5 inhibitors

Sildenafil 25mg, 50mg, 100mg tablets
(For erectile dysfunction)

GREEN
First Choice

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.

  • Viagra® brand is still subject to SLS criteria - see above for eligibility criteria. 

Entry reviewed: May 2024

 

BNF BNFc SPC
MHRA DSU Nov 2018: Sildenafil (Revatio and Viagra): reports of persistent pulmonary hypertension of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction

Tadalafil 10mg, 20mg tablets (on demand use)
(Tablets)

 
Restricted Drug Restricted

Green For erectile dysfunction - Only prescribe on the NHS if patient fulfils NHS SLS criteria (listed in part XVIIIB of the Drug Tariff). Approved for use by the Urology consultants.

Tadalafil 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 (NHS SLS criteria.) - See above for eligibility criteria.

Cialis Together 10mg tablets are also available over the counter (link below for community pharmacy materials) 

Cialis Together 10mg tablets - Risk Management Materials for community pharmacies



Amber SPA Approved for 2nd-line use for the treatment of severe Raynaud's disease when prescribed by a Consultant Rheumatologist. This indication is off-label.

 

Entry reviewed: May 2024

BNF BNFc SPC
NICE TA273: Hyperplasia (benign prostatic) - tadalafil (terminated appraisal) (TA273)

Tadalafil 5mg, 2.5mg tablets (once daily dose)
(Erectile dysfunction)

GREEN
Restricted Drug Restricted

Tadalafil is second line formulary choice as an option where sexual activity is anticipated two or more times a week / on a spontaneous basis.

Should only be prescribed at NHS expense for men who meet the medical conditions and circumstances specified by the Department of Health (NHS SLS criteria.) - See above for eligibility criteria.

Usual starting dose is 5mg once daily, reduced to 2.5mg if not tolerated.

 

 

Entry reviewed: May 2024

BNF BNFc SPC
NICE TA273: Hyperplasia (benign prostatic) - tadalafil (terminated appraisal) (TA273)
Non formulary items

Sildenafil oromucosal spray (Hezkue®) (For erectile dysfunction)

DNP
Non Formulary

 

Entry reviewed: November 2025 

BNF BNFc SPC
MHRA DSU Nov 2018: Sildenafil (Revatio and Viagra): reports of persistent pulmonary hypertension of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction
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.