Position Statement for Prescribing for the treatment of Erectile Dysfunction Following a public consultation, the Department of Health has amended regulations relating to prescribing restrictions for erectile dysfunction (ED), in primary care. The regulations came in to force on 1st August 2014 and do not affect secondary care. SLS indication Generic sildenafil has been removed from the restricted list. GPs and other prescribers are now free to prescribe it without restriction, for the treatment of erectile dysfunction. The ‘SLS’ indication with which a prescriber would have previously endorsed a prescription, now no longer applies. This change only applies to generic sildenafil. The Viagra® brand and the other PDE-5 inhibitors (such as tadalafil) can still only be prescribed at NHS expense if the patient meets the SLS criteria specified in part XVIIIB of the drug tariff. Consequences for private prescribing Changes to the availability of generic sildenafil on the NHS mean that some of those patients who previously received this treatment on a private basis, may now be eligible for NHS prescription. In these cases, GPs should supply treatment on an NHS prescription and not on a private prescription. Quantity of supply However these regulations do not change the position around the quantity of supply. The information provided by the NHS Executive in Health Service Circular 1999/148 issued in June 1999 around the supply of treatments for erectile dysfunction, has yet to be superseded. The Health Circular states that treatment should be considered on a case by case basis but that research evidence indicates that the average frequency of sexual intercourse in the 40- 60 year old age range is once a week. The Department of Health, therefore advised that one treatment per week would be appropriate for most patients treated for erectile dysfunction. However, if in the clinical judgement of a GP, more than one treatment per week is appropriate; this should be prescribed on the NHS. Prescribers are also reminded that excessive prescribing could lead to unlicensed, unauthorised and possibly dangerous use of these treatments. Prescribing once daily treatment is designated as ‘grey’ under Nottinghamshire Area Prescribing Committee’s Traffic Light classification i.e. prescribing is not recommended due to limited clinical and/or cost effective data. Mansfield and Ashfield, Newark and Sherwood, Rushcliffe, Nottingham West and Nottingham North and East CCGs continue to endorse the current position of the Department of Health as laid out in HSC 1999/148 for the frequency of the prescribing of treatment for impotence. Reference DH consultation response: Proposed changes to NHS availability of erectile dysfunction treatments – changing prescribing restrictions for generic sildenafil; Innovation, Growth &Technology/Medicines, Pharmacy & Industry/CCE/17090; June 2014 Produced January 2015 .