With the exception of generic sildenafil, the following formulary drugs for the treatment of erectile dysfunction, may only be prescribed on the NHS under certain circumstances:

Alprostadil, Tadalafil, Vardenafil, Viagra, vacuum devices

The drug treatments listed above for erectile dysfunction should not be prescribed on the NHS except in men who:

• 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, Cialis, Erecnos, MUSE, Uprima, 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).

NHS prescriptions for erectile dysfunction meeting the criteria above, must be endorsed with the reference 'SLS'. A prescription not containing this endorsement will not be reimbursed by the Prescription Pricing Division and so should not be dispensed.

Although Invicorp (aviptadil with phentolamine) is not subject to these prescribing restrictions at a national level, the NHS Devon Commissioning Policy indicates that it is only routinely commissioned in patients who meet these criteria (see section 7.4.5 Drugs for erectile dysfunction).

Patients who are not eligible for an NHS prescription, and those for whom generic sildenafil is unsuitable, can be issued with a private prescription by their GP.

Full information is available in the Drug Tariff Part XVIIIB or BNF.

HSC 1999/177 recommends that treatment for impotence should be available from specialist services when impotence is causing severe distress. Patients who are prescribed treatment for impotence on the NHS following the guidance in this circular need to continue to receive their treatment through specialist services. GPs cannot issue an FP10, endorsed SLS, where treatment has been started by a specialist for a patient suffering severe distress unless they also meet one of the above criteria.