Related guidance:
Type 2 diabetes in adults: management NICE guideline (NG28 December 2015, updated June 2022)
- Consider a phosphodiesterase-5 inhibitor to treat problematic erectile dysfunction in men with type 2 diabetes. Initially choose the drug with the lowest acquisition cost and take into account any contraindications.
- After discussion, refer men with type 2 diabetes to a service offering other medical, surgical or psychological management of erectile dysfunction if treatment (including a phosphodiesterase-5 inhibitor, as appropriate) has been unsuccessful.
All Phosphodiesterase type-5 inhibitors are contra-indicated in people taking nitrates.
Prophylactic use after prostate surgery to improve recovery is not a licenced indication and is classified as RED as per Traffic light guidance.
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
| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| Phosphodiesterase type-5 inhibitors | Sildenafil | 25mg tablet: £0.77 (4) 50mg tablet: £0.85 (4) 100mg tablet: £0.91 (4) | Erectile dysfunction, initially 50mg to be taken approximately 1 hour before sexual activity. Maximum per dose 100mg. |
| Vardenafil | 5mg tablet: £6.88 (4) 10mg tablet: £10.68 (4) 20mg tablet: £6.63 (4) | Erectile dysfunction, initially 10mg to be taken approximately 25-60 minutes before sexual activity. Maximum per dose 20mg. People on alpha blocker therapy should take initially 5mg. |
|
| Avanafil | 50mg tablet: £10.94 (4), £19.70 (8) 100mg tablet: £14.08 (4), £26.26 (8) 200mg tablet: £21.90 (4), £39.40 (8) | Erectile dysfunction, intially 100mg to be taken approximately 15-30 minutes before sexual activity. Maximum per dose 200mg. Most expensive option - consider only if other treatment fails. |
|
| Tadalafil | 5mg tablet: £1.95 (28) 10mg tablet: £0.96 (4) 20mg tablet: £1.07 (4) | Erectile dysfunction, initially 10mg to be taken at least 30 minutes before sexual activity. Maximum per dose 20mg. Treatment of benign prostatic hyperplasia 5mg once daily. |
|
| Prostaglandins and analogues | Alprostadil as Vitaros® | 3mg/g cream (single use container): £40 (4) | Apply the contents of the single-dose container (300mcg) to the tip of the penis 5-30 minutes before sexual activity. Maximum 1 dose in 24 hours and not more than 2-3 times a week. |