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PDE5 Inhibitor — Erectile Dysfunction Pregnancy: Not applicable — male indication

Vardenafil

Brand names: Levitra, Vivanza

Adult dose

Dose: 10 mg taken 25-60 minutes before sexual activity
Route: Oral
Frequency: As needed (maximum once daily)
Max: 20 mg per dose
Start at 10 mg; reduce to 5 mg if tolerated poorly; increase to 20 mg if needed. Orodispersible tablet (Vivanza 10 mg) available for patients with swallowing difficulties — do not use with liquids

Paediatric dose

Dose: Not applicable N/A/kg
Route: Oral
Frequency: Not applicable
Max: Not applicable
Not applicable

Dose adjustments

Renal

No dose adjustment required

Hepatic

Reduce to 5 mg starting dose in moderate hepatic impairment; avoid in severe

Paediatric weight-based calculator

Not applicable

Clinical pearls

  • More potent than sildenafil on a milligram basis — 10 mg vardenafil is approximately equivalent to 50 mg sildenafil
  • QT prolongation concern is greater with vardenafil than other PDE5 inhibitors — avoid in patients on class IA or III antiarrhythmics or with QT prolongation
  • Orodispersible formulation (Vivanza): useful for patients who dislike tablets or have swallowing difficulties; however, food interaction is the same as standard tablet
  • NICE recommends offering ED treatment on NHS: one tablet per week for men who have ED — regardless of cause; not rationed to specific diagnostic groups
  • Onset: 25-60 minutes; duration: 4-5 hours — shorter than tadalafil but similar to sildenafil

Contraindications

  • Concurrent nitrates (absolute — severe hypotension risk)
  • Concurrent guanylate cyclase stimulators (riociguat)
  • Recent stroke or MI (within 6 months)
  • Severe cardiac failure
  • Uncontrolled hypotension (BP under 90/50)

Side effects

  • Headache (most common)
  • Flushing
  • Nasal congestion
  • Dyspepsia
  • Visual disturbances (blue tinge, blurred vision)
  • Hypotension
  • QT prolongation (more than sildenafil or tadalafil — caution with QT-prolonging drugs)

Interactions

  • Nitrates (absolute contraindication — severe potentially fatal hypotension)
  • Alpha-blockers (additive hypotension — allow 6-hour gap)
  • Strong CYP3A4 inhibitors (ketoconazole, ritonavir — reduce vardenafil dose to 5 mg)
  • Antiarrhythmics (QT prolongation — class IA and III — avoid)

Monitoring

  • Blood pressure
  • Cardiovascular assessment before initiating
  • Response to treatment

Reference: BNFc; BNF 90; NICE NG44 (Erectile Dysfunction); EAU Sexual Dysfunction Guidelines 2024. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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