REMEDY : BNSSG referral pathways & Joint Formulary
Covid -19 Specific information
Decision Support Tools Patient Information & Safety-netting Bone & Soft Tissue - USC (2WW) Brain & CNS - USC (2WW) Breast - USC (2WW) Cancer of Unknown Primary - USC (2WW) Children & Young People – USC (2WW) Family History of Cancer Gynaecology - USC (2WW) Haematology - USC (2WW) Head & Neck incl Thyroid - USC (2WW) Lower GI - USC (2WW) Lung - USC (2WW) Non-Specific Symptoms - USC (2WW) Pancreas - USC (2WW) Skin - USC (2WW) Upper GI - USC (2WW) Urology - USC (2WW)
Advice & Guidance for GPs
Advice & Guidance Services Advice and Guidance Best Practice Triage Service (RAS) on e-Referral
Biochemistry
Alkaline Phosophatase Clinical Biochemistry in Primary Care Creatinine Kinase Hyperkalaemia Hyperlipidaemia Hypomagnesaemia Lipid Advice & Guidance Service
Breast
Advice & Guidance Service Axillary masses Breast Implants (non-cancer) Breast Pain Breast Surgery Breastfeeding Family History of Breast Cancer Male Breast Symptoms Mastitis and Breast Abscess Nipple conditions
Cancer Screening
Bowel Cancer Screening Breast Cancer Screening Cervical Cancer Screening Pancreatic Cancer Surveillance Programme Targeted Lung Health Check (TLHC) program
Cancer Support
Advice & Guidance Service Cancer and Severe Mental Illness (SMI) LD & Cancer Living with and beyond cancer (LWBC) Nutrition in cancer Physio for NBT Cancer patients Post cancer - Digital Remote Monitoring and Personalised Stratified Follow Up Rehab / prehab Toxicity Risk Assessment Tool
Cardiology
Advice & Guidance Service Angina Arrhythmia Atrial Fibrillation and Flutter Cardiac Rehabilitation Cardiac Rhythm Analysis Coronary Artery Calcification ECG - Open Access ECHO - requesting Heart Failure Hypertension Inherited Cardiac Conditions NT Pro BNP Testing Pacemakers Postural Orthostatic Tachycardia Syndrome (PoTS) Rapid Access Chest Pain Clinics Syncope and TLOC (non-traumatic) Thoracic Aorta Disease
Care of the Elderly
Active Ageing - South Glos Advice and guidance - Care of the Elderly Assistive Technology Service Falls & Balance Fracture Liaison Service Frailty Hearing Services Live Longer Better Movement Disorders NHS@home - Frailty pathway Rapid Assessment Clinic For Older People
Community Therapy
Community Therapy
COVID-19
Acute Assessment COVID Medicine Delivery Unit (CMDU) COVID Oximetry @ Home Virtual Ward COVID Testing Long COVID TeamNet and Latest updates
Dementia
Dementia - Assessment & referral Dementia Prescribing Mental Capacity & Best Interest Decisions
Dermatology
Acne vulgaris Actinic Keratosis Advice & Guidance and guidelines Alopecia Basal Cell Carcinoma Benign Skin Lesions Bowens Disease Community Dermatology Service Cosmetic skin treatments Eczema Hidradenitis Suppurativa Hyperhidrosis Leg Ulcer Mole Mapping/Surveillance Pityriasis Rosea Pityriasis Versicolor Polymorphic Light Eruption Pruritis Psoriasis Rosacea Scabies Seborrhoeic Dermatitis Skin Camouflage Tinea Tissue Viability/Wound Care Service Unusual Appearance - Outlook Urticaria Vulval Skin Care Warts and Verrucas
Diabetes
Community Diabetes Specialist Service Diabetes & Nutrition Diabetes Advice and Guidance Diabetes Foot Care Diabetes Mellitus - Guidelines Diabetes self-management Diabetes Structured Education Diabetic Eye Screening Monogenic Diabetes Neuropathic Pain (Diabetic) Non-diabetic Hyperglycaemia and the National Diabetes Prevention Program Pregnancy and diabetes Rapid Access Diabetes Clinic Type 2 diabetes management Type 2 Path to Remission Programme
Dietetics & Nutrition
Advice & Guidance Service Local Services Malnutrition & Oral Nutritional Supplements Vitamin D Deficiency Weight management
Drug and Alcohol Misuse
Alcohol Misuse Opiate Dependence Non-opiate drug dependence Bristol Drug and Alcohol Service North Somerset Drug & Alcohol Service South Gloucestershire Drug & Alcohol Service Bristol Shared Care Breaking Free (Bristol & South Glos)
DVT and PE
DVT and SVT Pathway Pulmonary Embolus (suspected) Secondary Care DVT Services Unprovoked DVT
Enablement
Bristol Centre for Enablement Wheelchair Services
End of Life Care and Hospice
Bereavement support Death Certification and Medical Examiner End of Life Care End of life care - community support ReSPECT Plus SR1 Form (formerly DS1500) St Peters Hospice Weston Hospice
Endocrinology
Adrenal incidentaloma Adrenal insufficiency Advice and Guidance (Endocrinology) Endocrinology Services - UHBW and NBT Gynaecomastia Hirsutism Hyperprolactinaemia Hyperthyroidism Hyponatraemia Hypothyroidism Male hypogonadism Polyuria Primary hyperparathyroidism (PHPTH) Secondary hypertension Sub Clinical hyperthyroidism Sub Clinical hypothyroidism Thyroid Disease and pregnancy Thyroid eye disease
ENT
Advice & Guidance Service Anosmia Audiology (adult) Dizziness and Vertigo Ear wax and microsuction ENT HOT Clinic Epistaxis Hearing Problems Middle ear problems Moulded Ear Plugs Nasal Treatment Neck Lumps (including Goitre) Otitis Externa Rhinosinusitis & Nasal Polyps Snoring Speech & Language Tinnitus Tonsils Uvula
Fertility
Advice & Guidance Service Infertility Semen Analysis
Gastroenterology and Colorectal Surgery
Advice & Guidance Services Anaemia (Gastroenterology) Anal FIssure Barrett's oesophagus Coeliac Disease Colon Polyps Community Gastroenterology Clinic - InHealth Constipation in Adults Dyspepsia and Reflux Endoscopy Eosinophilic Oesophagitis Faecal Calprotectin FIT (Faecal Immunochemical Test) Gallstones (and polyps) Haemorrhoids and anal lesions Hiccups Inflammatory Bowel Disease (Confirmed) Inflammatory Bowel Disease (suspected) Irritable Bowel Syndrome Microscopic Colitis Pancreatitis (Acute) Pancreatitis (Chronic) and PEI Rectal Bleeding Stoma care Upper GI Bleed Urgent Gastroenterology Services
Gender Identity Genetics
Alpha 1 Antitrypsin Deficiency (AATD) Family History of Breast/Ovarian Cancer Family History of Colorectal Cancer Genetic Haemochromatosis Genetics - general Monogenic Diabetes
Gynaecology
Advice & Guidance Service Abnormal vaginal bleeding Cervical Conditions Dyspareunia Early Pregnancy Assessment Clinic Emergency Gynaecology Endometriosis Female Cosmetic Surgery Female Genital Mutilation Female Genitalia Surgery Female Urinary Incontinence Fibroids Hyperemesis Gravidarum Menopause Menstrual Disorders Mesh Complications Open Access Gynae Imaging Ovarian Conditions PCOS Pelvic Inflammatory Disease Pelvic Organ Prolapse Persistent Pelvic Pain (women) Premature Ovarian Insufficiency Recurrent Miscarriage Termination of Pregnancy Vaginal Discharge Vulval Skin Conditions
Haematology
Advice & Guidance Service Anaemia Blood Transfusions & Iron infusions Genetic Haemochromatosis Guidelines for Primary Care Leucocytosis (including neutrophilia and lymphocytosis) Lymphadenopathy (adults) Macrocytosis Polycythaemia Sickle Cell & Thalassaemia Vitamin B12 Warfarin monitoring
Hepatology
Advice & Guidance Hepatology Service Genetic Haemochromatosis Liver disease Viral Hepatitis Urgent Hepatology Service
Homeless and Migrant Healthcare
Asylum Seeker and Refugee Health Homelessness Support
Imaging - see Radiology
Immunology
Immunology & Allergy Advice & Guidance Services Immunology & Allergy Guidelines
Infectious Diseases and Microbiology
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Investigations
Biochemistry Advice Chronic Disease Monitoring Community Diagnostic Centres Community phlebotomy Inflammatory Marker Testing Medical Calculators Pathology Services Transport and storage of samples
Learning Disabilities
Adult Learning Disability Health Service Constipation and Learning Disability Dyslexia Dyspraxia / DCD in adults LD & Autism Hospital Liaison LD & Cancer Screening LD and COVID-19 LeDeR - learning disability mortality reviews Mental Capacity & Best Interest Decisions Resources for Learning Disability Annual Health Checks and Health Action Plans Stop over medication (STOMP)
Lifestyle advice
Lifestyle advice
Max Fax and Dental
Advice & Guidance Service Cleft Lip and/or Palate (adult) Dental Care Reconstructive Prosthetics Services Salivary Gland Problems Temporomandibular Joint Disorders Trigeminal Neuralgia
Menopause
Alternatives and Adjuncts to HRT Cardiovascular conditions and HRT Contraception and Menopause Diagnosing menopause Early menopause - under 45 Genitourinary symptoms Gynaecology conditions and HRT Hormone Replacement Therapy (HRT) HRT and breast conditions HRT and Migraines HRT in over 60s Hormone sensitive cancers Premature Ovarian Insufficiency (Menopause <40y) Referral - Menopause Side effects and risks of HRT Testosterone for low libido VTE and HRT Resources for patients
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24/7 Mental Health Support ADHD (adult) Autism-Spectrum Depression (adults) Eating Disorders Gambling Addiction HOPE programme ICU Follow-up NBT Insomnia Mental health and wellbeing Integrated Network Team (MINT) Mental Health - Social Prescribing Mental Health Support - Which Service Neuropsychiatry Perinatal Mental Health Primary Care Liaison Service - AWP Psychosis: Schizophrenia Safe Haven Mental Health Support Sanctuary (Bristol) Mental Health Support Second Step Wellbeing Services Self Harm Self-help Leaflets for Mental Health Sexual Assault / Abuse Support SMI (Severe Mental Illness) Physical Health Improvement Suicidal Thoughts Talking Therapies (IAPT) Unusual Appearance Veterans Mental Health
Nephrology
Advice & Guidance Service Acute Kidney Injury Chronic Kidney Disease Renal referrals (including urgent referrals)
Neurology
Advice & Guidance - Neurology/HOT Clinic Advice and Guidance - Neurovascular/Stroke Bell's Palsy Cognitive Disorders Concussion / mild traumatic brain injury First Seizure Clinic Head Injury Therapy Unit Headache (adults) Huntington's Disease Multiple Sclerosis Neuromuscular Neurophysiology Neuropsychiatry Parkinson's Disease Peripheral Neuropathy Restless Leg Syndrome Spasticity service Specialist Community Neurology Stroke Transient Ischaemic Attack Tremor Trigeminal Neuralgia
Neurosurgery
Advice & Guidance (Neurosurgery) Cauda Equina Syndrome Neurosurgery Spinal Surgery Trigeminal Neuralgia
Nursing
Community Nursing - Bristol Community Nursing -North Somerset Community Nursing - South Glos Lymphoedema
Obstetrics
Advice & Guidance Service Cholestasis of Pregnancy Diabetes in Pregnancy Early Pregnancy Assessment Clinic Family Nurse Partnership Folic acid and Vitamin B12 in pregnancy Group B Strep in Pregnancy Hyperemesis Gravidarum Hypertension in pregnancy Maternity Services Perinatal Mental Health Post Natal Care Termination of pregnancy Thyroid Disease and Pregnancy Vaccination in Pregnancy
Oncology
Advice & Guidance Service BHOC Acute Care Cancer Support Oncology Referrals
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Orthopaedics
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Physiotherapy
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Podiatry
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Prescribing
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Radiology imaging
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Surgery
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Urgent Care
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Weight Management
Digital Weight Management Introduction and Tier 1 Weight Management Low Calorie Diet Pilot Non-diabetic Hyperglycaemia and the National Diabetes Prevention Program (NDPP) Tier 2 Weight Management Services Tier 3 & 4 Weight Management Service - BNSSG Post Bariatric Surgery Monitoring
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Advice & Guidance
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End of life care - children When a child dies
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ENT
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Chronic Abdominal Pain and IBD Coeliac disease (children) Constipation Diarrhoea and vomiting Faltering Growth Milk Related Problems Neonatal milk & vitamin guideline Reflux Disease
Gender Identity
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FGM in children (<18) Gynaecology (paediatric and adolescent) The Star Clinic Vulvovaginitis
Haematology
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Immunisation
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Infectious Diseases
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Mental Health
Asylum & Refugee Clinic (ARC) Mental Health Resources for Children and Young People CAMHS mental health 24/7 emergency line CAMHS Referral information Happymaps Self-harm in Children and Young People
Milk Related Problems
Milk Related Problems
Neonatal
Hep B vaccine for at risk infants Jaundice Neonatal milk & vitamin requirements Sacral dimples and pits Umbilical Granuloma
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Orthopaedics
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Paediatric Chapters
1. Gastro-intestinal System 2. Cardiovascular system 3. Respiratory System 4. Nervous system 5. Infections 6. Endocrine system 7. Obstetrics, gynaecology, and urinary-tract disorders 8. Malignant Disease and Immunosuppression 9. Nutrition and Blood 10. Musculoskeletal and joint diseases 11. Eye 12. Ear, Nose and Oropharynx 13. Skin 14. Immunological products and vaccines 15. Anaesthesia 16. Palliative Care 17. Miscellaneous Preparations
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Home > Formulary : Adult > Chapters > 7. Obstetrics, Gynaecology and Urinary-tract Disorders >

BNSSG Adult Joint Formulary

7.4 Erectile and ejaculatory conditions

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Last edited: 01-02-2024

7.4.1 Erectile dysfunction

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

  • Please see BNSSG Erectile Dysfunction Primary Care Prescribing Guidelines
  • Prescriptions for generic sildenafil no longer need to be endorsed SLS
  • Other drug treatments (including branded sildenafil – Viagra®) for erectile dysfunction may only be prescribed by a GP at NHS expense under certain criteria set by the Department of Health. These drugs are therefore only GREEN when used in accordance with these criteria (and endorsed 'SLS'). Note that the DH require that prescribing in cases of severe distress should only take place in specialist centres, and in these circumstances the drugs are RED.
  • Sildenafil and tadalafil are RED when used for pulmonary arterial hypertension

 

Sildenafil (TLS Green)

Tadalafil tablets (weekly) (TLS Blue)

Tadalafil 5mg tablets (once daily) (TLS Amber Specialist Initiated)

Treatment of erectile dysfunction in adult males post robotic laparoscopic prostatectomy (penile rehabilitation) only - for up to a 12 month duration

Alternatives:

Vardenafil (TLS Amber Specialist Recommended)

Alprostadil intracavernosal injection (Caverject®, Viridal® Duo) (TLS Amber Specialist Recommended)

  • The lowest acquisition cost should be prescribed and brands should not be changed without appropriate patient counselling

Alprostadil urethral application (Muse®) (TLS Amber Specialist Recommended)

Alprostadil urethral cream (Vitaros®) (TLS Amber Specialist Recommended)

Aviptadil / Phentolamine (Invicorp®) (TLS Amber Specialist Recommended)

 

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