Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
Drugs for erectile dysfunction
The Northern (NHS) Treatment Advisory Group recommends that on the basis of evidence available there was no evidence to recommend the use of daily dosing over on-demand dosing of PDE5 inhibitors, and there was no evidence that tadalafil was superior to sildenafil. On this basis NTAG recommends on-demand dosing using the PDE5 inhibitor with the lowest acquisition cost, currently this is generic sildenafil.
Approved only for second line use after intolerance to, or failure of sildenafil
Alprostadil (Vitaros® & Muse® )
Vitaros® 3mg/g cream
Muse® 250microgram, 500microgram, and 1mg.
Aviptadil 25microgram/phentolamine 2mg solution for injection (Invicorp®)
Approved as first choice intracavernosal injection option.
Aviptadil 25microgram/phentolamine 2mg solution for injection.
Alprostadil (Caverject® & Viridal Duo®)
Approved as the second choice intracavernosal injection option.
Caverject® 10, 20 & 40 microgram injections (Caverject® dual chamber injections are easier to use and less expensive than the vials).
Viridal Duo® 10, 20 and 40 microg starter pack and dual chamber injection (approved for use whilst supply issues surrounding Caverject® are ongoing).
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First Choice item
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Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment.
In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.
Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement.
The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber.
If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.
Drugs normally recommended or initiated by hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development.
Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed.