Brand Name(s):Caverject, MUSE, Virudal
Indication:Erectile dysfunction (including aid to diagnosis)
Sildenafil should be prescribed first line. It is effective in 75% of patients and has a proven safety record. It is most effective if taken on an empty stomach. Tadalafil is effective for a longer period (24 to 36 hours as opposed to 4 to 6 hours) and its absorption is less affected by food. But it is a new black triangle drug. Vardenafil may be more effective in some patients. Its absorption is less affected by food. But it too is a new black triangle drug. None of these preparations should be prescribed to patients taking nitrates.
All these medications, except generic sildenafil, are Schedule 11 category medications and if prescribed in primary care must be endorsed SLS
The practical effect of this categorization is that GPs are limited in their use of this treatment for men who in their clinical judgement are suffering from erectile dysfunction and have any of the following medical conditions: Diabetes, Multiple Sclerosis, Parkinson’s Disease, Poliomyelitis, Prostate Cancer, Severe Pelvic Injury. Single Gene Neurological Disease, Spina bifida, Spinal Cord Injury
Or a man with erectile dysfunction who on 14th September 1998 was receiving a course of treatment under the NHSS; or a man who is receiving treatment for renal failure by dialysis; or a man who has had the following surgery: Prostatectomy, Radical pelvic surgery, Renal failure treated by transplant
The Department of Health recommends that treatment should also be available, but only from specialist services, when the condition is causing severe distress. Where a GP is satisfied that the man is suffering from impotence and that this impotence is causing him severe distress, a referral should be made. In determining whether a patient is suffering from severe distress it is recommended that the following criteria should be taken into account:
Significant disruption to normal social and occupational activity
Marked effect on mood, behaviour, social and environmental awareness
Marked effect on interpersonal relationships.
The specialist provider undertakes all prescribing in these circumstances.
Please see HSC 1999/148 and HSC 1999/177 for further information (available on the DoH website: www.doh.gov.uk/coin) DD&TC March 2003