The "Vascular Warning"
- CV Risk: ED is often a precursor to symptomatic CVD. Screen QRISK, Glucose, and Lipids in all new presentations.
- Blood Tests: Early morning (9am) Total Testosterone. If <12 nmol/L, repeat with SHBG/LH/FSH/Prolactin.
Prescribing Strategy
- 1st Line: PDE5 Inhibitors. Tadalafil 5mg od (low dose daily) or 10mg/20mg "on demand." Tadalafil is preferred for its longer half-life.
- Contraindications: Absolute contraindication with Nitrates (e.g., GTN spray/Isosorbide Mononitrate) due to fatal hypotension risk.
- Failure: Ensure the patient has tried the maximum dose at least 8 times with adequate sexual stimulation before declaring failure.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.