Vardenafil interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Additive hypotensive effects may occur when phosphodiesterase-5 (PDE5) inhibitors are used with alcohol, as both are mild systemic vasodilators.

  What to do: Patients taking PDE5 inhibitors should avoid consuming large amounts of alcohol, which may increase the potential for orthostatic signs and symptoms including increase in heart rate, decrease in standing blood pressure, dizziness, and headache.

  5 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. "Product Information. Levitra (vardenafil)." Bayer (2003):
  3. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  5. "Product Information. Stendra (avanafil)." Vivus Inc (2012):

• grapefruit juice

  Moderate

  Metabolism

  Grapefruit juice may increase the plasma concentrations of orally administered drugs that are substrates of the CYP450 3A4 isoenzyme. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Because grapefruit juice inhibits primarily intestinal rather than hepatic CYP450 3A4, the magnitude of interaction is greatest for those drugs that undergo significant presystemic metabolism by CYP450 3A4 (i.e., drugs with low oral bioavailability). In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands.

  What to do: Patients who regularly consume grapefruit or grapefruit juice should be monitored for adverse effects and altered plasma concentrations of drugs that undergo significant presystemic metabolism by CYP450 3A4. Grapefruit and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact with these drugs.

  32 sources

  1. Edgar B, Bailey D, Bergstrand R, et al. "Acute effects of drinking grapefruit juice on the pharmacokinetics and dynamics on felodipine and its potential clinical relevance." Eur J Clin Pharmacol 42 (1992): 313-7
  2. Jonkman JH, Sollie FA, Sauter R, Steinijans VW "The influence of caffeine on the steady-state pharmacokinetics of theophylline." Clin Pharmacol Ther 49 (1991): 248-55
  3. Bailey DG, Arnold JM, Munoz C, Spence JD "Grapefruit juice--felodipine interaction: mechanism, predictability, and effect of naringin." Clin Pharmacol Ther 53 (1993): 637-42
  4. Bailey DG, Arnold JMO, Spence JD "Grapefruit juice and drugs - how significant is the interaction." Clin Pharmacokinet 26 (1994): 91-8
  5. Sigusch H, Hippius M, Henschel L, Kaufmann K, Hoffmann A "Influence of grapefruit juice on the pharmacokinetics of a slow release nifedipine formulation." Pharmazie 49 (1994): 522-4
  6. Bailey DG, Arnold JM, Strong HA, Munoz C, Spence JD "Effect of grapefruit juice and naringin on nisoldipine pharmacokinetics." Clin Pharmacol Ther 54 (1993): 589-94
  7. Yamreudeewong W, Henann NE, Fazio A, Lower DL, Cassidy TG "Drug-food interactions in clinical practice." J Fam Pract 40 (1995): 376-84
  8. "Grapefruit juice interactions with drugs." Med Lett Drugs Ther 37 (1995): 73-4

  Show all 32 sourcesShow fewer sources

  9. Hukkinen SK, Varhe A, Olkkola KT, Neuvonen PJ "Plasma concentrations of triazolam are increased by concomitant ingestion of grapefruit juice." Clin Pharmacol Ther 58 (1995): 127-31
  10. Min DI, Ku YM, Geraets DR, Lee HC "Effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of quinidine in healthy volunteers." J Clin Pharmacol 36 (1996): 469-76
  11. Majeed A, Kareem A "Effect of grapefruit juice on cyclosporine pharmacokinetics." Pediatr Nephrol 10 (1996): 395
  12. Clifford CP, Adams DA, Murray S, Taylor GW, Wilkins MR, Boobis AR, Davies DS "Pharmacokinetic and cardiac effects of terfenadine after inhibition of its metabolism by grapefruit juice." Br J Clin Pharmacol 42 (1996): p662
  13. Josefsson M, Zackrisson AL, Ahlner J "Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers." Eur J Clin Pharmacol 51 (1996): 189-93
  14. Kantola T, Kivisto KT, Neuvonen PJ "Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid." Clin Pharmacol Ther 63 (1998): 397-402
  15. Ozdemir M, Aktan Y, Boydag BS, Cingi MI, Musmul A "Interaction between grapefruit juice and diazepam in humans." Eur J Drug Metab Pharmacokinet 23 (1998): 55-9
  16. Bailey DG, Malcolm J, Arnold O, Spence JD "Grapefruit juice-drug interactions." Br J Clin Pharmacol 46 (1998): 101-10
  17. Bailey DG, Kreeft JH, Munoz C, Freeman DJ, Bend JR "Grapefruit juice felodipine interaction: Effect of naringin and 6',7'-dihydroxybergamottin in humans." Clin Pharmacol Ther 64 (1998): 248-56
  18. Garg SK, Kumar N, Bhargava VK, Prabhakar SK "Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy." Clin Pharmacol Ther 64 (1998): 286-8
  19. Lilja JJ, Kivisto KT, Neuvonen PJ "Grapefruit juice-simvastatin interaction: Effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors." Clin Pharmacol Ther 64 (1998): 477-83
  20. Fuhr U, Maier-Bruggemann A, Blume H, et al. "Grapefruit juice increases oral nimodipine bioavailability." Int J Clin Pharmacol Ther 36 (1998): 126-32
  21. Lilja JJ, Kivisto KT, Neuvonen PJ "Grapefruit juice increases serum concentrations of atorvastatin and has no effect on pravastatin." Clin Pharmacol Ther 66 (1999): 118-27
  22. Eagling VA, Profit L, Back DJ "Inhibition of the CYP3A4-mediated metabolism and P-glycoprotein-mediated transport of the HIV-I protease inhibitor saquinavir by grapefruit juice components." Br J Clin Pharmacol 48 (1999): 543-52
  23. Damkier P, Hansen LL, Brosen K "Effect of diclofenac, disulfiram, itraconazole, grapefruit juice and erythromycin on the pharmacokinetics of quinidine." Br J Clin Pharmacol 48 (1999): 829-38
  24. Lee AJ, Chan WK, Harralson AF, Buffum J, Bui BCC "The effects of grapefruit juice on sertraline metabolism: An in vitro and in vivo study." Clin Ther 21 (1999): 1890-9
  25. Dresser GK, Spence JD, Bailey DG "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet 38 (2000): 41-57
  26. Gunston GD, Mehta U "Potentially serious drug interactions with grapefruit juice." S Afr Med J 90 (2000): 41
  27. Takanaga H, Ohnishi A, Maatsuo H, et al. "Pharmacokinetic analysis of felodipine-grapefruit juice interaction based on an irreversible enzyme inhibition model." Br J Clin Pharmacol 49 (2000): 49-58
  28. Libersa CC, Brique SA, Motte KB, et al. "Dramatic inhibition of amiodarone metabolism induced by grapefruit juice." Br J Clin Pharmacol 49 (2000): 373-8
  29. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther 68 (2000): 468-77
  30. Zaidenstein R, Soback S, Gips M, Avni B, Dishi V, Weissgarten Y, Golik A, Scapa E "Effect of grapefruit juice on the pharmacokinetics of losartan and its active metabolite E3174 in healthy volunteers." Ther Drug Monit 23 (2001): 369-73
  31. Sato J, Nakata H, Owada E, Kikuta T, Umetsu M, Ito K "Influence of usual intake of dietary caffeine on single-dose kinetics of theophylline in healthy human subjects." Eur J Clin Pharmacol 44 (1993): 295-8
  32. Flanagan D "Understanding the grapefruit-drug interaction." Gen Dent 53 (2005): 282-5; quiz 286

Conditions

Conditions in which Vardenafil needs care, as documented in this source.

• Cardiovascular Diseases

  Major

  The use of phosphodiesterase-5 (PDE5) inhibitors is not recommended in patients with preexisting cardiovascular disease for whom sexual activity is inadvisable due to the potential cardiac risk. Physicians should also consider the vasodilatory effect of these drugs and whether they may adversely affect patients with underlying cardio- and/or cerebrovascular conditions, in particular those who have suffered a myocardial infarction, stroke, or life-threatening arrhythmia within the last 6 months; those with resting hypotension (BP < 90/50) or hypertension (BP > 170/110); and those with unstable angina associated with cardiac failure or coronary artery disease. There are no controlled clinical data on the safety or efficacy in such patients. Other adverse cardiovascular effects reported include angina pectoris, myocardial infarction, AV block, ventricular arrhythmia, tachycardia, palpitation, hypotension, postural hypotension, syncope, cerebral thrombosis, cerebrovascular hemorrhage, transient ischemic attack, cardiac arrest, heart failure, and hypertension. Many of these events occurred in patients with cardiovascular risk factors and during or shortly after sexual activity.

  19 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. Feenstra J, vanDriePierik RJHM, Lacle CF, Stricker BHC "Acute myocardial infarction associated with sildenafil." Lancet 352 (1998): 957-8
  3. Goldenberg MM "Safety and efficacy of sildenafil citrate in the treatment of male erectile dysfunction." Clin Ther 20 (1998): 1033-48
  4. Zusman RM "Cardiovascular data on sildenafil citrate - Introduction." Am J Cardiol 83 (1999): c1-2
  5. Conti CR, Pepine CJ, Sweeney M "Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease." Am J Cardiol 83 (1999): c29-34
  6. Zusman RM, Morales A, Glasser DB, Osterloh IH "Overall cardiovascular profile of sildenafil citrate." Am J Cardiol 83 (1999): c35-44
  7. Montorsi F, McDermott TED, Morgan R, Olsson A, Schultz A, Kirkeby HJ, Osterloh IH "Efficacy and safety of fixed-dose oral sildenafil in the treatment of erectile dysfunction of various etiologies." Urology 53 (1999): 1011-8
  8. Kloner RA, Zusman RM "Cardiovascular effects of sildenafil citrate and recommendations for its use." Am J Cardiol 84 (1999): n11-7

  Show all 19 sourcesShow fewer sources

  9. Awan GM, Calderon E, Dawood G, Alpert MA "Acute, symptomatic atrial fibrillation after sildenafil citrate therapy in a patient with hypertrophic obstructive cardiomyopathy." Am J Med Sci 320 (2000): 69-71
  10. Kloner RA "Cardiovascular risk and sildenafil." Am J Cardiol 86 (2000): f57-61
  11. Moreira SG, Brannigan RE, Spitz A, Orejuela FJ, Lipshultz LI, Kim ED "Side-effect profile of sildenafil citrate (Viagra) in clinical practice." Urology 56 (2000): 474-6
  12. McMahon CG, Smali R, Johnson H "Efficacy, safety and patient acceptance of sildenafil citrate as treatment for erectile dysfunction." J Urol 164 (2000): 1192-6
  13. Malozowski S, Sahlroot JT "Hemodynamic effects of sildenafil." N Engl J Med 343 (2000): 967-8
  14. Dunn N "Cardiovascular events in users of sildenafil - Paper does not provide any reassurance." Br Med J 323 (2001): 50-1
  15. "Product Information. Levitra (vardenafil)." Bayer (2003):
  16. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  17. Curran M, Keating G "Tadalafil." Drugs 63 (2003): 2203-12; discussion 2213-4
  18. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  19. "Product Information. Stendra (avanafil)." Vivus Inc (2012):

• Kidney Diseases

  Major

  The plasma clearance of phosphodiesterase-5 (PDE5) inhibitors may be decreased in patients with severe renal impairment, resulting in drug accumulation. Therapy with these agents should be avoided in patients with severe renal disease or on renal dialysis. Dose adjustments might be needed based on individual renal assessment and tolerability if used in these patients.

  7 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. "Product Information. Levitra (vardenafil)." Bayer (2003):
  3. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  4. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  5. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  6. "Product Information. Stendra (avanafil)." Vivus Inc (2012):
  7. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Long QT Syndrome

  Major

  Vardenafil prolongs the QT interval. Patients taking Class 1A or Class III antiarrhythmic medications or those with congenital QT prolongation, should avoid using this agent. Caution should be exercised if used in patients with congenital QT syndrome, or using other QT prolonging drugs.

  2 sources

  1. "Product Information. Levitra (vardenafil)." Bayer (2003):
  2. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Alcoholism

  Moderate

  Alcohol consumption may intensify the pressure-lowering effects of mild vasodilators, such as phosphodiesterase 5 (PDE5) inhibitors. Therefore, patients that consume alcohol should be warned to limit alcohol intake while receiving these agents.

  7 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. "Product Information. Levitra (vardenafil)." Bayer (2003):
  3. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  4. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  5. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  6. "Product Information. Stendra (avanafil)." Vivus Inc (2012):
  7. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Epilepsy

  Moderate

  The use of phosphodiesterase 5 (PDE-5) inhibitors has been associated with seizures. Therapy with these agents should be administered cautiously in patients with preexisting seizure disorders.

  7 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. "Product Information. Levitra (vardenafil)." Bayer (2003):
  3. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  4. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  5. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  6. "Product Information. Stendra (avanafil)." Vivus Inc (2012):
  7. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Hearing Loss

  Moderate

  Use of phosphodiesterase-5 (PDE5) inhibitors has been associated with sudden decrease or loss of hearing, which may be accompanied by tinnitus or dizziness. Patients with hearing problems should stop taking these agents and seek prompt medical care.

  7 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. "Product Information. Levitra (vardenafil)." Bayer (2003):
  3. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  4. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  5. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  6. "Product Information. Stendra (avanafil)." Vivus Inc (2012):
  7. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Liver Diseases

  Moderate

  Vardenafil is cleared predominantly by hepatic metabolism. The pharmacokinetic disposition of this agent has not been assessed in patients with severe hepatic impairment. No dosage modification is recommended for patients with mild hepatic impairment, however, therapy with this agent should not be administered to patients with moderate to severe hepatic impairment. In patients with mild hepatic impairment a lower dose of the oral tablet might be used as initial therapy and the maximum dose should not exceed 10 mg.

  2 sources

  1. "Product Information. Levitra (vardenafil)." Bayer (2003):
  2. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Phenylketonurias

  Moderate

  Vardenafil oral disintegrating tablet contains 1.01 mg phenylalanine per tablet. The phenylalanine content should be considered when this product is used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

  1 source

  1. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Priapism

  Moderate

  Prolonged erection greater than 4 hours and priapism (painful erections greater than 6 hours) have been reported during treatment with phosphodiesterase-5 (PDE 5) inhibitors. Priapism may result in penile tissue damage and permanent loss of potency if not treated promptly. These agents should be used cautiously in patients with conditions that may predispose them to priapism such as sickle cell anemia, multiple myeloma, or leukemia, and those with anatomical deformation of the penis (such as angulation, cavernosal fibrosis, or Peyronie's disease). If an erection persists longer than 4 hours, the patient should seek immediate medical assistance.

  8 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. Kassim AA, Fabry ME, Nagel RL "Acute priapism associated with the use of sildenafil in a patient with sickle cell trait." Blood 95 (2000): 1878-9
  3. "Product Information. Levitra (vardenafil)." Bayer (2003):
  4. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  5. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  6. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  7. "Product Information. Stendra (avanafil)." Vivus Inc (2012):
  8. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Retinitis Pigmentosa

  Moderate

  Phosphodiesterase-5 (PDE5) inhibitors have been associated with transient impairment of color discrimination (blue/green) and blue- or color-tinged vision. These agents also inhibit phosphodiesterase-6 (PDE6), to a much lesser extent, which is involved in phototransduction in the retina. There are no controlled clinical data on the safety in patients with retinitis pigmentosa, a minority of whom may have genetic disorders of retinal phosphodiesterases. Therapy with these agents should be avoided in such patients.

  15 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA "Oral sildenafil in the treatment of erectile dysfunction." N Engl J Med 338 (1998): 1397-404
  3. Goldenberg MM "Safety and efficacy of sildenafil citrate in the treatment of male erectile dysfunction." Clin Ther 20 (1998): 1033-48
  4. Zrenner E "No cause for alarm over retinal side-effects of sildenafil." Lancet 353 (1999): 340-1
  5. Vobig MA, Klotz T, Staak M, BartzSchmidt KU, Engelmann U, Walter P "Retinal side-effects of sildenafil." Lancet 353 (1999): 375
  6. Marmor MF "Sildenafil (Viagra) and ophthalmology." Arch Ophthalmol 117 (1999): 518-9
  7. Montorsi F, McDermott TED, Morgan R, Olsson A, Schultz A, Kirkeby HJ, Osterloh IH "Efficacy and safety of fixed-dose oral sildenafil in the treatment of erectile dysfunction of various etiologies." Urology 53 (1999): 1011-8
  8. Vobig MA "Retinal side-effects of sildenafil." Lancet 353 (1999): 1442

  Show all 15 sourcesShow fewer sources

  9. McMahon CG, Smali R, Johnson H "Efficacy, safety and patient acceptance of sildenafil citrate as treatment for erectile dysfunction." J Urol 164 (2000): 1192-6
  10. "Product Information. Levitra (vardenafil)." Bayer (2003):
  11. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  12. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  13. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  14. "Product Information. Stendra (avanafil)." Vivus Inc (2012):
  15. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

Therapeutic duplication

Drug classes that overlap with Vardenafil, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• erectile dysfunction agents

  The recommended maximum number of medicines in the 'erectile dysfunction agents' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'erectile dysfunction agents' category.

  Example product in the source data (US market): Finasteride/tadalafil