netFormulary NHS
Milton Keynes Formulary
Milton Keynes University Hospital NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes Clinical Commissioning Group
Milton Keynes Community Health Services
 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
07.04.05  Expand sub section  Drugs for erectile dysfunction
07.04.05  Expand sub section  Alprostadil
07.04.05  Expand sub section  Phosphodiesterase type 5 inhibitors
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Tablets 25mg, 50mg, 100mg

It is currently recommended that patients should receive eight doses of a PDE5

inhibitor with sexual stimulation at maximum dose before classifying a patient
as a non-responder. Full guidance from the British Society for Sexual Medicine.

Prescribers should ensure that generic sildenafil tablets 25, 50 and 100mg
tablets are always considered first line for the treatment of erectile dysfunction.

Only patients that meet Selected List criteria can be considered for alternative
treatments on the NHS (see below).

Doctors within secondary care are asked not to ask GPs to prescribe drugs
outside of the controls imposed by Selected List Scheme.

Alternative erectile dysfunction treatments (including branded Viagra) can
continue to be provided privately subject to patient preference.

Prescribers should review their NHS prescribing of treatments for ED to ensure
that patients who do meet Selected List criteria are prescribed generic sildenafil
25, 50 and 100mg tablets.

Quantities: guidance remains in force with a recommended dosage frequency of
one dose per week; higher quantities can be prescribed at the discretion of the

All other formulations of sildenafil or brands remain under the control of Part
XVIIIB of the Drug Tariff and can only be prescribed within that context

Selected List criteria are as follows:
any man suffering from diabetes, multiple sclerosis, Parkinson’s disease,
poliomyelitis, prostate cancer, severe pelvic injury, single gene neurological
disease, spina bifida or spinal cord injury
any man receiving treatment for renal failure by dialysis
any man who has had a prostatectomy or radical pelvic surgery or renal failure
treated by transplant
any man who has been diagnosed as suffering severe distress resulting from
erectile dysfunction where the assessment has been made by a specialist
service or GP under arrangements made with a local Health Board to provide
such assessments

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Amber 2

Tablets 10mg, 20mg

The Adcirca® and Talmanco® brands are not to be used as not licensed for use in erectile dysfunction.

Second line after Sildenafil

NB: Daily dosing is non-formulary. Use of tadalafil for indications other than erectile dysfunction is also non-formulary.


Once-daily Tadalafil Commissioning Statement:

  • Prescribers should not initiate once daily tadalafil for any new patient. Once daily tadalafil should be discontinued from primary care prescribing (de-prescribed), with support from specialist services if necessary.
  • It should be noted that once daily tadalafil is not on the Joint Trusts formulary and as such should not have been prescribed.
  • Patient Information Leaflet can be found here:
Link  NICE: Hyperplasia (benign prostatic) - tadalafil (terminated appraisal) (TA273)
07.04.05  Expand sub section  Papaverine and phentolamine
 Non Formulary Items

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Non Formulary
Sildenafil chewable tablets  (Nipatra®)

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Non Formulary
Tadalafil once daily

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Non Formulary

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Non Formulary
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
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Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
Controlled Drug
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Cancer Drugs Fund
NHS England

Traffic Light Status Information

Status Description


Routine prescribing within licensed indication  

Amber 1

Specialist recommendation followed by GP initiation and continuation  

Amber 2

Specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation   

Amber 3

Specialist initiation and stabilisation followed by GP continuation  

Amber SCG

Specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline  


Hospital or specialist prescribing only  

Red Red

These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.