Vardenafil

LEVITRA

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Pronunciation: var-DEN-a-fil (le-VEE-tra)

Vardenafil ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Vardenafil ballicule

Vardenafil LEVITRA mascot mnemonic cartoon — Visual mnemonic: Vardenafil mascot
**“Levi’s Garden to fill”**

What it isPDE5 inhibitor; erectile dysfunction.

Why this oneSimilar efficacy to sildenafil with an orally disintegrating form.

What limits itFatal hypotension with nitrates. More QT effect than the other PDE5 inhibitors; CYP3A4-dependent.

Vardenafil molecular structure (skeletal formula) — Molecular structure: Vardenafil

FDA-approved for

erectile dysfunction (2003)

FDA label

Read the full label on DailyMed ↗

FDA dosing	Population	Start	Target	Max
Erectile dysfunction	Adults	10 mg PRN ~60 min before sexual activity (range 5–20 mg)	10 mg PRN	20 mg; max one dose/day
Erectile dysfunction	Geriatric ≥65 y	5 mg PRN	5 mg PRN	one dose/day

Renal Not for use in patients on renal dialysis.

Hepatic Moderate impairment (Child-Pugh B): start 5 mg, max 10 mg. Severe (Child-Pugh C): do not use.

Maximum one dose per day.

Instructions

With or without food; take ~60 min before sexual activity
Maximum once per day
On stable alpha-blocker therapy: start 5 mg
CYP3A4 inhibitors: limit dose (e.g., ritonavir/cobicistat ≤2.5 mg/72 h; ketoconazole/itraconazole 400 mg, clarithromycin ≤2.5 mg/24 h; erythromycin ≤5 mg/24 h)

Available strengths

tab 2.5, 5, 10, 20 mg
ODT 10 mg

Contraindications

Concomitant nitrates or nitric oxide donors
Guanylate cyclase stimulators (e.g., riociguat)

Cautions

Cardiovascular status — avoid if sexual activity is inadvisable
Priapism (>4 h: seek immediate care)
NAION (sudden vision loss)
Sudden hearing loss
Symptomatic hypotension with alpha-blockers
QT prolongation (avoid with class IA/III antiarrhythmics or congenital long QT)

Adverse reactions

Headache
Flushing
Nasal congestion/rhinitis
Dyspepsia
Sinusitis
Flu syndrome
Dizziness
Increased creatine kinase
Nausea
Back pain

Pregnancy Not indicated for use in females.

Lactation Not indicated for use in females.

Cost

Vardenafil (LEVITRA)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/unit	CostPlus
2.5 mg	tab	per unit		offered
5 mg	tab	per unit	$7.10/ea	offered
10 mg	tab	per unit	$2.87/ea	offered
20 mg	tab	per unit	$2.79/ea	offered

Generic entry2012

NO BOXED WARNINGS

Principal riskFatal hypotension with nitrates; more QT than the others

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades1 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryUnknown / historical label unavailable

Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.

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Memory aids: interaction avatars

CYP3A4 substrate

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