vardenafil
Vardenafil is a first-choice medication for erectile dysfunction (ED). It's no longer sold under the brand name Levitra, but it's available as generic tablets and orally disintegrating tablets (ODTs). Common side effects of vardenafil include headache, flushing, and stuffy nose. Interactions between vardenafil and other medications generally involve those that lower blood pressure.
What is Vardenafil?
What is Vardenafil used for?
Erectile dysfunction
How Vardenafil works
Vardenafil is a phosphodiesterase-5 enzyme (PDE-5) inhibitor. It works by blocking PDE-5, a protein in your body that normally prevents an erection from happening. When it blocks PDE-5, vardenafil helps an erection occur by allowing certain muscles in the penis to relax and the penis to fill with blood.
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What are the side effects of Vardenafil?
Common Side Effects
- Headache (up to 15%)
- Flushing (up to 11%)
- Stuffy nose (up to 9%)
- Indigestion (up to 4%)
Other Side Effects
- Dizziness
- Back pain
- Nausea
- Sinus inflammation
- Flu-like symptoms
Serious Side Effects
- Dangerously low blood pressure: feeling faint or weak, dizziness, blurry vision, feeling confused
- Erection lasting for more than 4 hours
- Vision loss
Source: DailyMed
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The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Hearing loss, ringing in ears
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
- Prolonged or painful erection
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Sudden vision loss in one or both eyes
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Dizziness
- Facial flushing, redness
- Headache
- Muscle pain
- Runny or stuffy nose
- Upset stomach
Pros and cons of Vardenafil
Pros
Might work slightly faster than sildenafil (Viagra) and tadalafil (Cialis)
Improves how long an erection lasts
Can take with or without food
Available as orally disintegrating tablets (ODTs) for people who have trouble swallowing
Available as a lower-cost generic
Cons
Should take about 1 hour before sex, so you might need to plan ahead
Not recommended if you've had a heart attack or stroke in the past 6 months
Can't use if you've recently taken nitrates like isosorbide mononitrate (Monoket) or nitroglycerin (Nitrostat)
Not recommended if you have severe liver or kidney problems
Doesn't prevent sexually transmitted infections (STIs)
Pharmacist tips for Vardenafil
Vardenafil works best if it's taken about an hour before sexual activity.
You can take vardenafil with or without food, though the medication might work faster if it's taken on an empty stomach.
Vardenafil doesn't stop the spread of sexually transmitted infections (STIs), like herpes or human immunodeficiency virus (HIV). Be sure to practice safe sex.
Some vardenafil tablets contain FD&C Yellow No. 5 (tartrazine). Let your provider know if you've had an allergic reaction to this dye before.
If you have an erection lasting for more than 4 hours, go to the emergency department or call your provider right away as this can lead to damage to the penis.
Additional tips for the orally disintegrating tablets (ODTs):
Don't remove vardenafil from the packaging until you're ready to take your dose. Otherwise, any moisture can damage the medication, and it could melt in your hand.
Place vardenafil on your tongue, let it dissolve, and then swallow like normally.
Vardenafil ODTs work best when it's taken without water or any other liquid.
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Frequently asked questions about Vardenafil
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What are the risks and warnings for Vardenafil?
Vardenafil can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Heart problems
Risk factors: Heart condition | Recent heart attack or stroke in the past 6 months | High or low blood pressure | Currently taking other medications that can cause QT prolongation
Tell your provider if you have any heart conditions before starting vardenafil. If you have certain heart-related conditions, such as very serious heart failure, it's not recommended that you participate in sexual activity and take vardenafil because of risks to your heart health. Vardenafil hasn't been studied in people who have certain conditions, such as recent heart attacks or strokes. It's not known how well the medication works or how safe it is in this group of people.
Additionally, it's shown that vardenafil can make the QT interval (the time it takes for your heart to reset) longer. This can lead to irregular heart rhythm. If you have a heart condition, take any medications for abnormal heart rhythm, or take other medications that might cause QT prolongation, discuss with your provider about whether vardenafil is safe for you.
Low blood pressure
Risk factors: Taking alpha blockers | Taking medications for high blood pressure or chest pain (angina)
When you take vardenafil with other medications that can lower blood pressure, your blood pressure can drop to very low levels. Be careful using vardenafil if you're also taking alpha blockers or blood pressure medications. Your provider might ask you to check your blood pressure regularly if you're taking these other medications. Slowly get up from a sitting or lying down position to lower the risk of feeling dizzy and falling. You should never take vardenafil if you're taking nitrate medications for chest pain (angina) or medications like Adempas (riociguat). These combinations can cause your blood pressure to suddenly drop to unsafe levels.
Prolonged erection
Risk factors: Medical conditions that affect the penis | Sickle cell anemia | Multiple myeloma | Leukemia
Rarely, some people who took vardenafil reported having an erection that lasted for more than 4 hours (priapism). If not treated in time, this can lead to permanent damage to your penis. You might be at risk for this side effect if you have other conditions affecting your penis, sickle cell anemia, multiple myeloma, or leukemia. Get medical attention right away if you have an erection that lasts longer than 4 hours or if you feel pain during an erection.
Vision changes
Risk factors: "Crowded" optic disc
If you suddenly notice changes in your vision in one or both eyes, go to the emergency room or call your provider right away. Although rare, some people have experienced eye damage that could be permanent when they took medications like vardenafil. It's not clear whether vardenafil can raise the risk of this eye damage. But it's known that if your provider has told you that you have a "crowded" optic disc, you might be at higher risk for vision changes. Tell your provider about your full medical history before taking vardenafil.
Hearing loss
Some people who took vardenafil reported experiencing hearing loss. This could happen along with ringing in the ears (tinnitus) and dizziness. Stop using vardenafil and call your provider right away if you notice changes in your hearing in one or both ears.
Interactions with other medications
Risk factors: Taking nitrate medications | Taking blood pressure medications | Taking alpha blockers | Taking certain antifungals or antivirals
Vardenafil can have serious interactions with certain medications. It's important that you tell your provider about all the medications you're taking before you start vardenafil. For example, you shouldn't take vardenafil with nitrate medications because this combination can cause your blood pressure to become dangerously low. If you're taking other blood pressure medications, your provider might not recommend vardenafil until your blood pressure is under control. Taking vardenafil with medications, like oral azole antifungals and ritonavir (Norvir), can put you at higher risk for side effects, such as headaches, flushing, and vision changes.
Vardenafil dosage forms
Typical dosing for Vardenafil
The typical starting dose is 10 mg by mouth about 1 hour before sexual activity. Your provider will adjust your dose based on your response. The maximum dose is 20 mg.
Vardenafil shouldn't be taken more than once a day at any dose.
Your dose might differ if you have liver problems, are 65 years of age or older, or take certain medications that can interact with vardenafil.
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How much does Vardenafil cost?
Vardenafil contraindications
Taking a nitrate medication for chest pain (angina)
Taking guanylate cyclase (GC) stimulators, such as Adempas (riociguat)
What are alternatives to Vardenafil?
Erectile dysfunction
Benign prostatic hyperplasia (BPH)
What is the latest news about Vardenafil?
Vardenafil images
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References
Best studies we foundAlembic Pharmaceuticals Inc. (2023). VARDENAFIL HYDROCHLORIDE tablet, film coated [package insert]. DailyMed.
Bourin, M. (2018). Clinical Pharmacology of Phosphodiesterase 5 Inhibitors in Erectile Dysfunction. SOA Archives of Pharmacy & Pharmacology.
Burnett, A. L., et al. (2018). Erectile Dysfunction: AUA Guideline. The Journal of Urology.
Centers for Disease Control and Prevention. (2023). How You Can Prevent Sexually Transmitted Diseases.
Evans, J. D., et al. (2015). A comparison of the available phosphodiesterase-5 inhibitors in the treatment of erectile dysfunction: a focus on avanafil. Patient Preference and Adherence.
Farzam, K., et al. (2023). QT Prolonging Drugs. StatPearls.
Freund, P., et al. (2023). Pseudopapilledema.
Huang, S. A., et al. (2013). Phosphodiesterase-5 (PDE5) Inhibitors In the Management of Erectile Dysfunction. P&T: A Peer-Reviewed Journal for Formulary Management.
Levine, G. N., et al. (2012). Sexual Activity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation.
Macleods Pharmaceuticals Limited. (2023). VARDENAFIL tablet [package insert]. DailyMed.
Morales, A. M., et al. (2009). Vardenafil for the treatment of erectile dysfunction: an overview of the clinical evidence. Clinical Interventions in Aging.
Porst, H., et al. (2006). Extended duration of efficacy of vardenafil when taken 8 hours before intercourse: a randomized, double-blind, placebo-controlled study. European Urology.
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