How to get a boner from the NHS
NHS prescriptions for:
sildenafil, tadalafil and vardenafil; apomorphine; alprostadil
are only given if:
You have a long term health condition:
Diabetes, MS, Parkinson’s, Polio, Prostate Ca, Severe pelvic injury, single gene neuro-disease, spina bifida, spinal cord injury
You are receiving dialysis
You have had pelvic or urological surgery
You have received such medications since 14/9/98
You are caused severe distress by the condition
Significant disruption to normal social/occupational activities, mood, behaviour
Contraindications to Sildenafil (Viagra)
Patients taking Nitrates, or similar vasodilating drugs such as Nicorandil
Viagra is a PDE (Phosphodiesterase) type V inhibitor, with preference for penile vasculature
Phosphodiesterases come in various forms, the most clinically significant of which break down cyclic AMP and cyclic GMP
One of the effects of cGMP is to promote smooth muscle relaxation, which in blood vessels --> vasodilation and decreased BP
If PDE breaks cGMP down, but we inhibit the PDE, the concentration of cGMP remains higher.
So concurrent use of Viagra and other nitrates risks profound hypotension
Hypotension with BP < 90/50
Recent stroke or MI
Unstable cardiac dysrhythmias
Poorly compensated heart failure
Severe hepatic impairment - metabolised by the liver
(Know retinal degeration - eg Retinitis Pigmentosa - some PDE sensitivity in these pts - rare)
NB - Most men with coronary heart disease can safely resume sexual intercourse, with the exception of those listed above
Side effects
(=vasodilatory effects)
visual disturbances e.g. blue discolouration, non-arteritic anterior ischaemic neuropathy
nasal congestion
flushing
gastrointestinal side-effects
headache








