Precautions and Contraindications for Levitra

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The effect of vardenafil on the QT interval should be considered when prescribing the drug. Clofazimine: (Moderate) Concomitant use of clofazimine and vardenafil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Clozapine: (Moderate) Concomitant use of vardenafil and clozapine may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Cobicistat: (Major) Do not use vardenafil orally disintegrating tablets with cobicistat due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets. Codeine; Phenylephrine; Promethazine: (Moderate) Concomitant use of promethazine and vardenafil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Codeine; Promethazine: (Moderate) Concomitant use of promethazine and vardenafil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Conivaptan: (Major) Do not use vardenafil orally disintegrating tablets with conivaptan due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Vardenafil is primarily metabolized by CYP3A; conivaptan is a moderate CYP3A inhibitor.

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Cyclosporine: (Major) Do not use vardenafil orally disintegrating tablets with cyclosporine due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Vardenafil is primarily metabolized by CYP3A4/5; cyclosporine is a moderate CYP3A4 inhibitor. Danazol: (Major) Do not use vardenafil orally disintegrating tablets with danazol due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Vardenafil is primarily metabolized by CYP3A4/5; danazol is a moderate CYP3A4 inhibitor. Darunavir: (Major) Do not use vardenafil orally disintegrating tablets with darunavir due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets.

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Vardenafil is primarily metabolized by CYP3A4/5; darunavir is a strong CYP3A4 inhibitor. Coadministration with other strong CYP3A4 inhibitors increased the AUC of vardenafil by 10- to 16-fold. Darunavir; Cobicistat: (Major) Do not use vardenafil orally disintegrating tablets with cobicistat due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets. (Major) Do not use vardenafil orally disintegrating tablets with darunavir due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets. Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: (Major) Do not use vardenafil orally disintegrating tablets with cobicistat due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets.

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Dasatinib: (Moderate) Concomitant use of vardenafil and dasatinib may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Degarelix: (Moderate) Concomitant use of vardenafil and androgen deprivation therapy (i.e., degarelix) may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Delavirdine: (Major) Do not use vardenafil orally disintegrating tablets with delavirdine due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 24-hour period of vardenafil oral tablets. Vardenafil is primarily metabolized by CYP3A4/5; delavirdine is a strong CYP3A4 inhibitor. Deutetrabenazine: (Moderate) Consider the potential for additive QT effects if vardenafil is administered with deutetrabenazine. Crizotinib: (Major) Do not use vardenafil orally disintegrating tablets with crizotinib due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Vardenafil is primarily metabolized by CYP3A4/5; crizotinib is a moderate CYP3A4 inhibitor. In addition, vardenafil is associated with QT prolongation. Both therapeutic and supratherapeutic doses of vardenafil may produce an increase in QTc interval. Crizotinib has also been associated with concentration-dependent QT prolongation. Monitor ECGs and electrolytes if crizotinib and vardenafil oral tablets are used together. Cyclosporine: (Major) Do not use vardenafil orally disintegrating tablets with cyclosporine due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Vardenafil is primarily metabolized by CYP3A4/5; cyclosporine is a moderate CYP3A4 inhibitor. Danazol: (Major) Do not use vardenafil orally disintegrating tablets with danazol due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Vardenafil is primarily metabolized by CYP3A4/5; danazol is a moderate CYP3A4 inhibitor. Darunavir: (Major) Do not use vardenafil orally disintegrating tablets with darunavir due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets. Vardenafil is primarily metabolized by CYP3A4/5; darunavir is a strong CYP3A4 inhibitor. Coadministration with other strong CYP3A4 inhibitors increased the AUC of vardenafil by 10- to 16-fold. Darunavir; Cobicistat: (Major) Do not use vardenafil orally disintegrating tablets with cobicistat due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets. (Major) Do not use vardenafil orally disintegrating tablets with darunavir due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets.

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Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: (Major) Do not use vardenafil orally disintegrating tablets with cobicistat due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets. Dasatinib: (Moderate) Concomitant use of vardenafil and dasatinib may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients.

Medication Class Potential Interaction Effect
Nitrates Dangerous hypotension Should not be combined
Alpha-blockers Lower blood pressure May cause orthostatic hypotension
CYP3A4 inhibitors Increased Levitra levels Risk of side effects
Antifungal agents (e.g., ketoconazole) Increased drug levels Potential toxicity

Degarelix: (Moderate) Concomitant use of vardenafil and androgen deprivation therapy (i.e., degarelix) may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Delavirdine: (Major) Do not use vardenafil orally disintegrating tablets with delavirdine due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 24-hour period of vardenafil oral tablets.

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Vardenafil is primarily metabolized by CYP3A4/5; delavirdine is a strong CYP3A4 inhibitor. Deutetrabenazine: (Moderate) Consider the potential for additive QT effects if vardenafil is administered with deutetrabenazine. Deutetrabenazine may prolong the QT interval, but the degree of QT prolongation is not clinically significant when deutetrabenazine is administered within the recommended dosage range. Dexmedetomidine: (Moderate) Concomitant use of dexmedetomidine and vardenafil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Dextromethorphan; Diphenhydramine; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Dextromethorphan; Guaifenesin; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors.

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Dextromethorphan; Quinidine: (Major) levitra professional 20mg Vardenafil should be avoided in patients taking Class IA antiarrhythmics (disopyramide, procainamide, and quinidine). Diltiazem: (Major) Do not use vardenafil orally disintegrating tablets with diltiazem due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Additive effects on blood pressure are also possible. Vardenafil is primarily metabolized by CYP3A and diltiazem is a moderate CYP3A inhibitor. Diphenhydramine; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Disopyramide: (Major) Vardenafil should be avoided in patients taking Class IA antiarrhythmics (disopyramide, procainamide, and quinidine). Dofetilide: (Major) Concomitant use of vardenafil and dofetilide increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Dolasetron: (Moderate) Concomitant use of vardenafil and dolasetron may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients.

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Dolutegravir; Rilpivirine: (Moderate) Concomitant use of vardenafil and rilpivirine may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients.

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Donepezil: (Moderate) Concomitant use of vardenafil and donepezil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Donepezil; Memantine: (Moderate) Concomitant use of vardenafil and donepezil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Doxazosin: (Moderate) Due to the potential for symptomatic hypotension, patients should be stable on alpha-blocker therapy before initiating therapy with the lowest dose of vardenafil. Dronedarone: (Contraindicated) Use of dronedarone with vardenafil is contraindicated due to an increased risk for QT prolongation and torsade de pointes. Increased vardenafil exposure may occur due to dronedarone inhibition of CYP3A4.

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Doxazosin: (Moderate) Due to the potential for symptomatic hypotension, patients should be stable on alpha-blocker therapy before initiating therapy with the lowest dose of vardenafil. Dronedarone: (Contraindicated) Use of dronedarone with vardenafil is contraindicated due to an increased risk for QT prolongation and torsade de pointes. Increased vardenafil exposure may occur due to dronedarone inhibition of CYP3A4. An increase in vardenafil-related adverse effects, such as prolonged erection, hypotension, or QT prolongation, is possible. Dronedarone is associated with a dose-related increase in the QTc interval.

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Coadministration of other drugs that also prolong the QT interval may result in additive QT prolongation. Therapeutic and supratherapeutic doses of vardenafil can produce an increase in QTc interval. Dronedarone is a moderate inhibitor of CYP3A4, the primary isoenzyme responsible for the metabolism of vardenafil. Droperidol: (Major) Concomitant use of vardenafil and droperidol increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Dutasteride; Tamsulosin: (Moderate) Due to the potential for symptomatic hypotension, patients should be stable on tamsulosin therapy before initiating therapy with the lowest dose of vardenafil.

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Conversely, patients already receiving an optimized dose of vardenafil should be started on the lowest dose of tamsulosin; increases in the alpha-blocker dose should be done in a stepwise fashion. Other variables, such as intravascular volume depletion, concurrent antihypertensive therapy, or evidence of hemodynamic instability with alpha-blocker monotherapy, may affect the safety of concomitant use of vardenafil and tamsulosin. Duvelisib: (Major) Do not use vardenafil orally disintegrating tablets with duvelisib due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Vardenafil is primarily metabolized by CYP3A4/5; duvelisib is a moderate CYP3A4 inhibitor. Efavirenz: (Moderate) Concomitant use of vardenafil and efavirenz may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. An increase in vardenafil-related adverse effects, such as prolonged erection, hypotension, or QT prolongation, is possible. Dronedarone is associated with a dose-related increase in the QTc interval. Coadministration of other drugs that also prolong the QT interval may result in additive QT prolongation. Therapeutic and supratherapeutic doses of vardenafil can produce an increase in QTc interval. Dronedarone is a moderate inhibitor of CYP3A4, the primary isoenzyme responsible for the metabolism of vardenafil. Droperidol: (Major) Concomitant use of vardenafil and droperidol increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Dutasteride; Tamsulosin: (Moderate) Due to the potential for symptomatic hypotension, patients should be stable on tamsulosin therapy before initiating therapy with the lowest dose of vardenafil. Conversely, patients already receiving an optimized dose of vardenafil should be started on the lowest dose of tamsulosin; increases in the alpha-blocker dose should be done in a stepwise fashion. Other variables, such as intravascular volume depletion, concurrent antihypertensive therapy, or evidence of hemodynamic instability with alpha-blocker monotherapy, may affect the safety of concomitant use of vardenafil and tamsulosin. Duvelisib: (Major) Do not use vardenafil orally disintegrating tablets with duvelisib due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Vardenafil is primarily metabolized by CYP3A4/5; duvelisib is a moderate CYP3A4 inhibitor. Efavirenz: (Moderate) Concomitant use of vardenafil and efavirenz may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients.

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The effect of vardenafil on the QT interval should be considered when prescribing the drug. Clofazimine: (Moderate) Concomitant use of clofazimine and vardenafil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Clozapine: (Moderate) Concomitant use of vardenafil and clozapine may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Cobicistat: (Major) Do not use vardenafil orally disintegrating tablets with cobicistat due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets. Codeine; Phenylephrine; Promethazine: (Moderate) Concomitant use of promethazine and vardenafil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients.

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(Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Codeine; Promethazine: (Moderate) Concomitant use of promethazine and vardenafil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Conivaptan: (Major) Do not use vardenafil orally disintegrating tablets with conivaptan due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Vardenafil is primarily metabolized by CYP3A; conivaptan is a moderate CYP3A inhibitor. Crizotinib: (Major) Do not use vardenafil orally disintegrating tablets with crizotinib due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets.

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Vardenafil is primarily metabolized by CYP3A4/5; crizotinib is a moderate CYP3A4 inhibitor. In addition, vardenafil is associated with QT prolongation. Both therapeutic and supratherapeutic doses of vardenafil may produce an increase in QTc interval. Crizotinib has also been associated with concentration-dependent QT prolongation. Monitor ECGs and electrolytes if crizotinib and vardenafil oral tablets are used together. Efavirenz; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Concomitant use of vardenafil and efavirenz may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Eliglustat: (Moderate) Concomitant use of vardenafil and eliglustat may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Major) Do not use vardenafil orally disintegrating tablets with cobicistat due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets.

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Efavirenz; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Concomitant use of vardenafil and efavirenz may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Eliglustat: (Moderate) Concomitant use of vardenafil and eliglustat may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Major) Do not use vardenafil orally disintegrating tablets with cobicistat due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Major) Do not use vardenafil orally disintegrating tablets with cobicistat due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets. Emtricitabine; Rilpivirine; Tenofovir alafenamide: (Moderate) Concomitant use of vardenafil and rilpivirine may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Major) Do not use vardenafil orally disintegrating tablets with cobicistat due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 72-hour period of vardenafil oral tablets.

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Deutetrabenazine may prolong the QT interval, but the degree of QT prolongation is not clinically significant when deutetrabenazine is administered within the recommended dosage range. Dexmedetomidine: (Moderate) Concomitant use of dexmedetomidine and vardenafil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Dextromethorphan; Diphenhydramine; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Dextromethorphan; Guaifenesin; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Dextromethorphan; Quinidine: (Major) levitra professional 20mg Vardenafil should be avoided in patients taking Class IA antiarrhythmics (disopyramide, procainamide, and quinidine).

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Diltiazem: (Major) Do not use vardenafil orally disintegrating tablets with diltiazem due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Additive effects on blood pressure are also possible. Vardenafil is primarily metabolized by CYP3A and diltiazem is a moderate CYP3A inhibitor. Diphenhydramine; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Disopyramide: (Major) Vardenafil should be avoided in patients taking Class IA antiarrhythmics (disopyramide, procainamide, and quinidine).

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Dofetilide: (Major) Concomitant use of vardenafil and dofetilide increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Dolasetron: (Moderate) Concomitant use of vardenafil and dolasetron may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Dolutegravir; Rilpivirine: (Moderate) Concomitant use of vardenafil and rilpivirine may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Donepezil: (Moderate) Concomitant use of vardenafil and donepezil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Donepezil; Memantine: (Moderate) Concomitant use of vardenafil and donepezil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Emtricitabine; Rilpivirine; Tenofovir alafenamide: (Moderate) Concomitant use of vardenafil and rilpivirine may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients.