netFormulary South East London Joint Medicines Formulary NHS
Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
Notes:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

 Details...
07.04.05  Expand sub section  Drugs for erectile dysfunction
 note 

For managing erectile dysfunction associated with prostate cancer treatment, refer to NICE Guideline NG131

Aviptadil / phentolamine 25 micrograms / 2mg solution for intracavernosal injection (Invicorp®)
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Third Choice
Amber 2

Alternative treatment option after intracavernosal alprostadil 

Refer to South East London guidance for managing erectile dysfunction (ED) in primary and secondary care for more detailed prescribing guidance (see link below)

 
Link  SE London IMOC Recommendation: Invicorp™ (aviptadil / phentolamine 25 micrograms / 2mg solution for intracavernosal injection) for the management of erectile dysfunction in adult males
   
07.04.05  Expand sub section  Alprostadil
Alprostadil intracavernosal injection (Viridal®, Caverject®)
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Second Choice
Amber 2

Second line option for erectile dysfunction after failure of PDE-5 inhibitors.

Refer to SE London erectile dysfunction pathway (link above)

 
   
Alprostadil transurethral application (MUSE® urethral sticks)
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Second Choice
Amber 2

Second line option for erectile dysfunction after failure of PDE-5 inhibitors.

Refer to SE London erectile dysfunction pathway (link above)

 
   
Alprostadil topical cream (Vitaros® topical cream)
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Formulary
Amber 2

Second line option for erectile dysfunction after failure of PDE-5 inhibitors.

Refer to SE London erectile dysfunction pathway (link above) and SE London IMOC recommendation (link below)

 
Link  SE London IMOC Recommendation: Alprostadil 3mg/g cream (Vitaros™) for the management of erectile dysfunction in adult males
   
07.04.05  Expand sub section  Phosphodiesterase type 5 inhibitors
Sildenafil tabs
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First Choice First-line PDE5 inhibitor for the treatment of erectile dysfunction 
Tadalafil 10 mg, 20mg tabs (when required dosing)
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Formulary

For patients who have not tolerated or failed treatment on the maximum dose of prn sildenafil (100 mg)

Once daily regular dosing for erectile dysfunction (except for use in penile rehabilitation post radical prostatectomy) is non-formulary.  See entries below.

 
   
Tadalafil tabs (daily dosing post robotic nerve-sparing radical prostatectomy - off-label)
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Restricted Drug Restricted
Red

Approved off-label indication: 

Penile rehabilitation post robotic nerve sparing radical prostatectomy

Dose = 5 mg daily for 3 months only(full 3 month course to be supplied by the hospital)

 
   
Epinephrine (adrenaline) injection 1 mg/ml
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Formulary

Approved off-label indication:

Drug-induced priapism once physical measures to direct blood from penis and aspiration have failed

USE UNDER SPECIALIST SUPERVISION ONLY Use with caution – risk of hypertensive crisis. Continual monitoring of blood pressure and pulse is essential.

  • Dose: 10-20 micrograms (0.5-1 mL diluted solution as below) injected into corpus cavernosum after aspiration of blood has failed to produce a response.
  • Dilution: 1 mg in 1 mL epinephrine is diluted to 50 mL with sodium chloride 0.9% (49 mL) to give 20 micrograms/mL solution
 
   
Metaraminol injection 10mg/mL
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Formulary

Approved off-label indication:

Drug-induced priapism once physical measures to direct blood from penis and aspiration have failed.

USE UNDER SPECIALIST SUPERVISION ONLY Use with caution – risk of hypertensive crisis. Continual monitoring of blood pressure and pulse is essential.

  • Dose: 1 mg (1mL diluted solution) metaraminol injected into corpus cavernosum after aspiration of blood has failed to produce a response. Repeat if no response.
  • Dilution: 10 mg in 1mL metaraminol is diluted to 10 mL with sodium chloride 0.9% 9 mL to give 1 mg/mL solution
 
   
Phenylephrine injection 10 mg/mL
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Formulary

Approved off-label indication:

Drug-induced priapism once physical measures to direct blood from penis and aspiration have failed.

USE UNDER SPECIALIST SUPERVISION ONLY Use with caution – risk of hypertensive crisis. Continual monitoring of blood pressure and pulse is essential.

  • Dose: 100-200 micrograms (0.5-1 mL diluted solution as below) injected into corpus cavernosum after aspiration of blood has failed to produce a response.
  • Repeat every 5 – 10 minutes as necessary up to a total dose of 1 mg.
  • Dilution: 10 mg in 1 mL phenylephrine is diluted to 50 mL with sodium chloride 0.9% (49mL) to give 200 micrograms/mL solution
 
   
Etilefrine immediate release tabs
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Unlicensed Drug Unlicensed
Red

USE UNDER SPECIALIST SUPERVISION ONLY

Priapism in sickle cell crisis

Dose = 5 mg -10 mg at night with an alarm dose of 5 mg - 10 mg four hours later, increasing if required. Max of 30 mg/day.

At GSTT refer to the "Sickle Cell Disease Adult Guidelines" for dosing and monitoring

 
   
 ....
 Non Formulary Items
Dapoxetine hydrochloride  (premature ejaculation)

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Non Formulary
Grey
Link  SE APC Recommendation: Dapoxetine hydrochloride tablets for premature ejaculation (grey - not recommended)
 
Tadalafil - once daily dosing for erectile dysfunction

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Non Formulary
Grey

Daily dosing is not for prescribing except in the instance of penile rehabilitation post nerve-sparing radical prostatectomy (see entry above)

Link  SE London APC Patient Information Leaflet: Changes to once-daily tadalafil prescribing
 
  
Key
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
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   

Amber 1

Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

Amber 2

Specialist initiation followed by maintenance prescribing in primary care  

Amber 3

Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  

Green

Specialist and non-specialist initiation  

Grey

Not recommended for prescribing  

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