Use of Phosphodiesterase type 5 (PDE-5) Inhibitors in Penile Rehabilitation

Phosphodiesterase type 5 (PDE-5) Inhibitors include Sildenafil, Tadalafil and Vardenafil

GPs should NOT prescribe PDE-5 inhibitors for penile rehabilitation since this does not meet ‘SLS’ criteria for prescribing on FP10s and should refer all patients back to the consultant recommending treatment for ongoing management.

Erectile dysfunction is a known potential complication for men undergoing radical retro pubic prostatectomy (RRP) for prostate cancer. Many men can expect to recover erectile function however, despite using nerve sparing prostatectomy techniques, spontaneous recovery is slow, requiring up to two years. A relatively new strategy in clinical management has arisen from the idea that early induced sexual stimulation and blood flow in the penis may facilitate the return of natural erectile function and resumption of medically unassisted sexual activity. Evidence for the use of PDE-5 inhibitors in this way is however limited.

Tadalafil is approved for hospital use only in North East Essex.

Tadalafil 5mg daily is approved for hospital use only in men with moderate to severe LUTS with associated erectile dysfunction and for post prostatectomy erectile dysfunction. The patients post RRP will be reviewed after 6-8 weeks and treatment will continue if effective for a total of 6 months and then consideration for switching to sildenafil. All tadalafil prescriptions for the above indications will be issued by the hospital.

Please bear in mind drug treatments for erectile dysfunction except generic sildenafil can only be prescribed on the NHS to patients fulfilling the following criteria;

·  have diabetes, multiple sclerosis, Parkinson’s disease, poliomyelitis, prostate cancer, severe pelvic injury, single gene neurological disease, spina bifida, or spinal cord injury;

·  are receiving dialysis for renal failure;

·  have had radical pelvic surgery, prostatectomy (including transurethral resection of the prostate), or kidney transplant;

·  were receiving Caverject®, Erecnos®, MUSE®, Viagra®, or Viridal® for erectile dysfunction, at the expense of the NHS, on 14 September 1998;

·  are suffering severe distress as a result of impotence (prescribed in specialist centres only).

The prescription must be endorsed ‘SLS’.

N.B. daily tadalafil ‘Cialis’ is hospital only within North East Essex locality and should not be prescribed within primary care.

Also, prescribing of PDE 5 inhibitors for pulmonary hypertension is restricted to secondary/tertiary care only. Any patient who is prescribed quantities sufficient for daily treatment should be reviewed and any with pulmonary hypertension referred back to their specialist

Updated by: North East Essex Medicines Management Team June 2017

Approved by: North East Essex Medicines Management Committee Review: September 2018