Some drug treatments for erectile dysfunction (ED) may only be prescribed on the NHS under certain circumstances, with NHS prescriptions requiring the “SLS endorsement”. For details please see the criteria listed in Part XVIIB of the .
Generically written prescriptions for sildenafil, tadalafil and vardenafil no longer require the "SLS" endorsement, and they can be prescribed on the NHS for any person with ED, regardless of cause. The SLS endorsement requirements continue to apply to the brandedversions (Viagra®, Cialis®, Levitra®) and they can only be prescribed on NHS prescriptions for ED in restricted circumstances if patients meet the criteria.
NHS prescriptions (endorsed "SLS") can be issued for Viagra®, Cialis®, Levitra®, alprostadil, avanafil and certain vacuum tumescence devices to men suffering from ED who have certain medical conditions: diabetes, multiple sclerosis, Parkinson's disease, poliomyelitis, prostate cancer or following prostatectomy, radical pelvic surgery or severe pelvic injury, single gene neurological disease, spina bifida, spinal cord injury, renal failure requiring dialysis or following transplant, plus men who were receiving specific treatment as listed in the Drug Tariff for ED at the expense of the NHS before 14th September 1998. For the full list of “SLS” products and prescribing criteria please see the Drug Tariff (link above).
GPs can issue private prescriptions for the above drugs and devices for patients on their NHS list who do not meet these criteria but they cannot charge patients for issuing a private prescription.
The DoH has recommended that treatment should also be available from specialist services when the condition is causing severe distress and the following criteria should be assessed:
- significant disruption to normal social and occupational activities
- a marked effect on mood, behaviour, social and environmental awareness
- a marked effect on interpersonal relationships
Phosphodiesterase 5 (PDE5) inhibitors increase arterial blood flow, which leads to smooth muscle relaxation, vasodilation and penile erection. Three potent selective PDE5 inhibitors - sildenafil (Viagra®), tadalafil (Cialis®) and vardenafil (Levitra®) are available. These medications have proven efficacy and safety both in non-selected populations of men with ED and in specific sub-groups of patients, (for example, men with diabetes and those who have had a prostatectomy). The major difference in these drugs is that sildenafil and vardenafil are relatively short-acting drugs, having a half-life of approximately 4 hours, whereas tadalafil has a significantly longer half-life of 17.5 hours.
November 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
