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Second-line treatments for men who do not respond to or cannot tolerate PDE5 inhibitors include: Intracavernosal injections (alprostadil) Intraurethral alprostadil Topical alprostadil cream Vacuum erection devices Penile prosthesis surgery (for refractory cases) When to seek urgent medical attention: Men should contact their GP promptly if ED develops suddenly, particularly if accompanied by chest pain, breathlessness, or other cardiovascular symptoms, as ED may indicate previously undiagnosed heart disease

This ensures coordinated, safe prescribing and appropriate monitoring of your treatment response and any emerging side effects

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