Vardenafil Tablets
Vardenafil hydrochloride orally disintegrating tablets can be used in patients with mild hepatic impairment.
Vardenafil contraindications
The cGMP in turn triggers smooth muscle relaxation, allowing increased blood flow into the penis, resulting in erection. The tissue concentration of cGMP is regulated by both the rates of synthesis and degradation via phosphodiesterases (PDEs). The most abundant PDE in the human corpus cavernosum is the cGMP-specific PDE5; therefore, the inhibition of PDE5 enhances erectile function by increasing the amount of cGMP. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 has no effect in the absence of sexual stimulation.In vitro studies have shown that vardenafil is a selective inhibitor of PDE5. The inhibitory effect of vardenafil is more selective on PDE5 than for other known phosphodiesterases (>15-fold relative to PDE6, >130-fold relative to PDE1, >300-fold relative to PDE11, and >1,000-fold relative to PDE2, 3, 4, 7, 8, 9, and 10).12.2 PharmacodynamicsThe pharmacodynamic studies described below were conducted using vardenafil film-coated tablets.Effects on Blood PressureIn a clinical pharmacology study of patients with erectile dysfunction, single doses of vardenafil 20 mg film-coated tablets caused a mean maximum decrease in supine blood pressure of 7 mmHg systolic and 8 mmHg diastolic (compared to placebo), accompanied by a mean maximum increase of heart rate of 4 beats per minute.
Does vardenafil interact with other medicines (drug interactions)?
Vardenafil may add to the blood pressure lowering effects of antihypertensive agents [see Drug Interactions (7)].Effects on Blood Pressure and Heart Rate when Vardenafil is Combined with NitratesA study was conducted in which the blood pressure and heart rate response to 0.4 mg nitroglycerin (NTG) sublingually was evaluated in 18 healthy subjects following pretreatment with vardenafil 20 mg film-coated tablets at various times before NTG administration. Vardenafil 20 mg caused an additional time-related reduction in blood pressure and increase in heart rate in association with NTG administration. In volunteers with moderate hepatic impairment (Child-Pugh B), the Cmax and AUC following a 10 mg vardenafil (film-coated tablets) dose were increased by 130% and 160%, respectively, compared to healthy control subjects. Vardenafil has not been evaluated in patients with severe (Child-Pugh C) hepatic impairment. Do not use vardenafil hydrochloride orally disintegrating tablets in patients with moderate to severe hepatic impairment [see Warnings and Precautions (5.8) and Dosage and Administration (2). ]8.7 Renal ImpairmentDo not use vardenafil hydrochloride orally disintegrating tablets in patients on renal dialysis.In volunteers with mild renal impairment (CLcr = 50 to 80 mL/min), the pharmacokinetics of vardenafil 20 mg film-coated tablets were similar to those observed in a control group with normal renal function. In the moderate (CLcr = 30 to 50 mL/min) or severe (CLcr <30 mL/min) renal impairment groups, the AUC of vardenafil was 20 to 30% higher compared to that observed in a control group with normal renal function (CLcr >80 mL/min).
- Vardenafil is available by prescription only.
- Common side effects include headache and flushing.
- It should be taken on an empty stomach for best results.
- Do not combine vardenafil with nitrates.
Vardenafil hydrochloride orally disintegrating tablets can be used in patients with mild, moderate or severe renal impairment. Do not use vardenafil hydrochloride orally disintegrating tablets in patients on renal dialysis as vardenafil has not been evaluated in such patients [see Dosage and Administration (2.3) and Warnings and Precautions (5.9)]. Vardenafil hydrochloride orally disintegrating tablets are not indicated for use in females. There are no data with the use of vardenafil hydrochloride orally disintegrating tablets in pregnant women to inform any drug-associated risks. In animal reproduction studies conducted in pregnant rats and rabbits, no adverse developmental outcomes were observed with oral administration of vardenafil during organogenesis at exposures for unbound vardenafil and its major metabolite at approximately 100 and 29 times, respectively, the maximum recommended human dose (MRHD) of 20 mg based on AUC(see Data).
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| Kamagra Oral Jelly | 100mg | 110 + 9 Sachets | 334.87€ 318.92€ | |
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| Cialis Soft Tabs | 20mg | 10 Pills | 39.03€ 37.17€ | |
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| Viagra Professional | 100mg | 20 Pills | 71.14€ 67.75€ | |
| Priligy Generic Dapoxetine | 60mg | 90 + 10 Pills | 265.64€ 252.99€ | |
| Levitra Professional | 20mg | 60 + 2 Pills | 223.11€ 212.49€ | |
| Kamagra Soft Tabs | 100 mg | 84 + 4 Pills | 233.05€ 221.95€ | |
| Viagra Generic | 100mg | 10 Pills | 28.91€ 27.53€ | |
| Levitra Generic | 20mg | 90 + 8 Pills | 180.78€ 172.17€ | |
| Viagra Super Active | 100mg | 30 + 6 Pills | 64.09€ 61.04€ | |
| Kamagra | 100mg | 120 + 6 Pills | 330.74€ 314.99€ | |
| Levitra Generic | 40mg | 90 + 6 Pills | 234.73€ 223.55€ | |
| Levitra Soft Tabs | 20mg | 120 + 8 Pills | 288.52€ 274.78€ | |
| Cialis Black | 80mg | 20 Pills | 71.83€ 68.41€ | |
| Kamagra 100 mg | 100 mg | 360 + 6 Pills | 839.95€ 799.95€ |
No evidence of specific potential for teratogenicity, embryotoxicity or fetotoxicity was observed in rats and rabbits that received vardenafil at up to 18 mg/kg/day during organogenesis. This dose is approximately 100 fold (rat) and 29 fold (rabbit) greater than the AUC values for unbound vardenafil and its major metabolite in humans given the maximum recommended human dose (MRHD) of 20 mg. In the rat pre-and postnatal development study, the NOAEL (no observed adverse effect level) for maternal toxicity was 8 mg/kg/day. Based on plasma exposures in the rat developmental toxicity study, 1 mg/kg/day in the pregnant rat is estimated to produce total AUC values for unbound vardenafil and its major metabolite comparable to the human AUC at the MRHD of 20 mg. There is no information on the presence of vardenafil and its major metabolite vigora 200 mg in human milk, the effects on the breastfed infant, or the effects on milk production. Vardenafil is present in rat milk of lactating rats (see Data). Vardenafil was secreted into the milk of lactating rats at concentrations approximately 10-fold greater than found in the plasma.
Understanding Erectile Dysfunction (ED)
Renal dialysis is not expected to accelerate clearance because vardenafil is highly bound to plasma proteins and is not significantly eliminated in the urine. The maximum dose of vardenafil for which human data are available is a single 120 mg dose of the film–coated tablets administered to healthy male volunteers. The majority of these subjects experienced reversible back pain/myalgia and/or “abnormal vision.” Single doses up to 80 mg vardenafil and multiple doses up to 40 mg vardenafil administered once daily over 4 weeks were tolerated without producing serious adverse side effects. When 40 mg of vardenafil was administered twice daily, cases of severe back pain were observed. No muscle or neurological toxicity was identified.
Dosage for people with kidney disease
In cases of overdose, standard supportive measures should be taken as required. 11 DESCRIPTION Vardenafil hydrochloride orally disintegrating tablets, USP are an oral therapy for the treatment of erectile dysfunction. This monohydrochloride salt of vardenafil is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific PDE5.Vardenafil HCl, USP is designated chemically as piperazine, 1-[[3-(1,4-dihydro-5-methyl-4-oxo-7-propylimidazo[5,1-f][1,2,4]triazin-2-yl)-4-ethoxyphenyl]sulfonyl]-4-ethyl-, monohydrochloride and has the following structural formula:Vardenafil HCl, USP is a white or slightly brown or yellow powder with a molecular weight of 579.1. It is slightly soluble in water, freely soluble in anhydrous Ethanol. Practically insoluble in heptane.Vardenafil hydrochloride orally disintegrating tablets, USP are formulated as white to off white, round, orally disintegrating tablets.
Less common
Vardenafil hydrochloride orally disintegrating tablets, USP are an oral therapy for the treatment of erectile dysfunction. Vardenafil HCl, USP is designated chemically as piperazine, 1-[[3-(1,4-dihydro-5-methyl-4-oxo-7-propylimidazo[5,1-f][1,2,4]triazin-2-yl)-4-ethoxyphenyl]sulfonyl]-4-ethyl-, monohydrochloride and has the following structural formula: Vardenafil hydrochloride orally disintegrating tablets, USP are formulated as white to off white, round, orally disintegrating tablets. 12 CLINICAL PHARMACOLOGY 12.1 Mechanism of ActionPenile erection is a hemodynamic process initiated by the relaxation of smooth muscle in the corpus cavernosum and its associated arterioles. During sexual stimulation, nitric oxide is released from nerve endings and endothelial cells in the corpus cavernosum. Nitric oxide activates the enzyme guanylate cyclase resulting in increased synthesis of cyclic guanosine 20 mg vardenafil monophosphate (cGMP) in the smooth muscle cells of the corpus cavernosum. Following a single oral dose of 3 mg/kg, 3.3% of the administered dose was excreted into the milk within 24 hours. Vardenafil hydrochloride orally disintegrating tablets are not indicated for use in pediatric patients. Safety and efficacy in children has not been established. Vardenafil AUC and Cmax in elderly males 65 years or older taking vardenafil hydrochloride orally disintegrating tablets were increased by 39% and 21%, respectively, in comparison to patients aged 45 years and below. No overall differences in safety or effectiveness were observed between patients ≥65 years old and those < 65 years old in placebo-controlled clinical trials [see Clinical Pharmacology (12.3)].
2.1 General
There is no information on the presence of vardenafil and its major metabolite vigora 200 mg in human milk, the effects on the breastfed infant, or the effects on milk production. Vardenafil is present in rat milk of lactating rats (see Data). Vardenafil was secreted into the milk of lactating rats at concentrations approximately 10-fold greater than found in the plasma. Following a single oral dose of 3 mg/kg, 3.3% of the administered dose was excreted into the milk within 24 hours. Vardenafil hydrochloride orally disintegrating tablets are not indicated for use in pediatric patients.
Usual Adult Dose for:
Safety and efficacy in children has not been established. Vardenafil AUC and Cmax in elderly males 65 years or older taking vardenafil hydrochloride orally disintegrating tablets were increased by 39% and 21%, respectively, in comparison to patients aged 45 years and below. No overall differences in safety or effectiveness were observed between patients ≥65 years old and those < 65 years old in placebo-controlled clinical trials [see Clinical Pharmacology (12.3)]. Do not use vardenafil hydrochloride orally disintegrating tablets in patients with moderate or severe hepatic impairment. In volunteers with mild hepatic impairment (Child-Pugh A), the Cmax and AUC following a 10 mg vardenafil (film-coated tablets) dose were increased by 22% and 17%, respectively, compared to healthy control subjects.
Dosage for people with liver disease
Do not use vardenafil hydrochloride orally disintegrating tablets in patients with moderate to severe hepatic impairment [see Warnings and Precautions (5.8) and Dosage and Administration (2).] Do not use vardenafil hydrochloride orally disintegrating tablets in patients on renal dialysis. In volunteers with mild renal impairment (CLcr = 50 to 80 mL/min), the pharmacokinetics of vardenafil 20 mg film-coated tablets were similar to those observed in a control group with normal renal function. 10 OVERDOSAGE The maximum dose of vardenafil for which human data are available is a single 120 mg dose of the film–coated tablets administered to healthy male volunteers. The majority of these subjects experienced reversible back pain/myalgia and/or “abnormal vision.” Single doses up to 80 mg vardenafil and multiple doses up to 40 mg vardenafil administered once daily over 4 weeks were tolerated without producing serious adverse side effects.When 40 mg of vardenafil was administered twice daily, cases of severe back pain were observed. No muscle or libido for women neurological toxicity was identified.In cases of overdose, standard supportive measures should be taken as required. Do not use vardenafil hydrochloride orally disintegrating tablets in patients with moderate or severe hepatic impairment. In volunteers with mild hepatic impairment (Child-Pugh A), the Cmax and AUC following a 10 mg vardenafil (film-coated tablets) dose were increased by 22% and 17%, respectively, compared to healthy control subjects. Do not use vardenafil hydrochloride orally disintegrating tablets in patients with moderate to severe hepatic impairment [see Warnings and Precautions (5.8) and Dosage and Administration (2).] Do not use vardenafil hydrochloride orally disintegrating tablets in patients on renal dialysis. In volunteers with mild renal impairment (CLcr = 50 to 80 mL/min), the pharmacokinetics of vardenafil 20 mg film-coated tablets were similar to those observed in a control group with normal renal function. 10 OVERDOSAGE The maximum dose of vardenafil for which human data are available is a single 120 mg dose of the film–coated tablets administered to healthy male volunteers.
- The recommended dose varies but often is 10 mg.
- Vardenafil should not be used more than once daily.
- Alcohol consumption may reduce its effectiveness.
- Consult a doctor before starting vardenafil.
The majority of these subjects experienced reversible back pain/myalgia and/or “abnormal vision.” Single doses up to 80 mg vardenafil and multiple doses up to 40 mg vardenafil administered once daily over 4 weeks were tolerated without producing serious adverse side effects.When 40 mg of vardenafil was administered twice daily, cases of severe back pain were observed. No muscle or libido for women neurological toxicity was identified.In cases of overdose, standard supportive measures should be taken as required. Renal dialysis is not expected to accelerate clearance because vardenafil is highly bound to plasma proteins and is not significantly eliminated in the urine. The maximum dose of vardenafil for which human data are available is a single 120 mg dose of the film–coated tablets administered to healthy male volunteers. The majority of these subjects experienced reversible back pain/myalgia and/or “abnormal vision.” Single doses up to 80 mg vardenafil and multiple doses up to 40 mg vardenafil administered once daily over 4 weeks were tolerated without producing serious adverse side effects. When 40 mg of vardenafil was administered twice daily, cases of severe back pain were observed. No muscle or neurological toxicity was identified. In cases of overdose, standard supportive measures should be taken as required. 11 DESCRIPTION Vardenafil hydrochloride orally disintegrating tablets, USP are an oral therapy for the treatment of erectile dysfunction. This monohydrochloride salt of vardenafil is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific PDE5.Vardenafil HCl, USP is designated chemically as piperazine, 1-[[3-(1,4-dihydro-5-methyl-4-oxo-7-propylimidazo[5,1-f][1,2,4]triazin-2-yl)-4-ethoxyphenyl]sulfonyl]-4-ethyl-, monohydrochloride and has the following structural formula:Vardenafil HCl, USP is a white or slightly brown or yellow powder with a molecular weight of 579.1. It is slightly soluble in water, freely soluble in anhydrous Ethanol. Practically insoluble in heptane.Vardenafil hydrochloride orally disintegrating tablets, USP are formulated as white to off white, round, orally disintegrating tablets. Vardenafil hydrochloride orally disintegrating tablets, USP are an oral therapy for the treatment of erectile dysfunction.
| Parameter | Value | Notes |
|---|---|---|
| Absorption Time | 30-60 minutes | Peak plasma concentration reached during this time |
| Half-life | 4-5 hours | Duration of drug activity |
| Bioavailability | Approximately 15% | Oral absorption efficiency |
| Metabolism | Via CYP3A4 enzyme | Liver processing of drug |
Vardenafil HCl, USP is designated chemically as piperazine, 1-[[3-(1,4-dihydro-5-methyl-4-oxo-7-propylimidazo[5,1-f][1,2,4]triazin-2-yl)-4-ethoxyphenyl]sulfonyl]-4-ethyl-, monohydrochloride and has the following structural formula: Vardenafil hydrochloride orally disintegrating tablets, USP are formulated as white to off white, round, orally disintegrating tablets. 12 CLINICAL PHARMACOLOGY 12.1 Mechanism of ActionPenile erection is a hemodynamic process initiated by the relaxation of smooth muscle in the corpus cavernosum and its associated arterioles.
| Study/Source | Sample Size | Success Rate | Notes |
|---|---|---|---|
| Clinical Trial A | 150 men | 80% | Significant improvement in erectile function |
| Clinical Trial B | 200 men | 75% | Better outcomes with 10 mg dose compared to placebo |
| Real-world Reports | 300 patients | 78% | Effective in various age groups and conditions |
During sexual stimulation, nitric oxide is released from nerve endings and endothelial cells in the corpus cavernosum.
The bottom line
Vardenafil hydrochloride orally disintegrating tablets can be used in patients with mild hepatic impairment. In volunteers with moderate hepatic impairment (Child-Pugh B), the Cmax and AUC following a 10 mg vardenafil (film-coated tablets) dose were increased by 130% and 160%, respectively, compared to healthy control subjects. Vardenafil has not been evaluated in patients with severe (Child-Pugh C) hepatic impairment. Do not use vardenafil hydrochloride orally disintegrating tablets in patients with moderate to severe hepatic impairment [see Warnings and Precautions (5.8) and Dosage and Administration (2). ]8.7 Renal ImpairmentDo not use vardenafil hydrochloride orally disintegrating tablets in patients on renal dialysis.In volunteers with mild renal impairment (CLcr = 50 to 80 mL/min), the pharmacokinetics of vardenafil 20 mg film-coated tablets were similar to those observed in a control group with normal renal function.
Electroanalytical application of carbon based electrodes to the pharmaceuticals
In the moderate (CLcr = 30 to 50 mL/min) or severe (CLcr <30 mL/min) renal impairment groups, the AUC of vardenafil was 20 to 30% higher compared to that observed in a control group with normal renal function (CLcr >80 mL/min). Vardenafil hydrochloride orally disintegrating tablets can be used in patients with mild, moderate or severe renal impairment. Do not use vardenafil hydrochloride orally disintegrating tablets in patients on renal dialysis as vardenafil has not been evaluated in such patients [see Dosage and Administration (2.3) and Warnings and Precautions (5.9)]. Vardenafil hydrochloride orally disintegrating tablets are not indicated for use in females. There are no data with the use of vardenafil hydrochloride orally disintegrating tablets in pregnant women to inform any drug-associated risks.
Incidence not known
In animal reproduction studies conducted in pregnant rats and rabbits, no adverse developmental outcomes were observed with oral administration of vardenafil during organogenesis at exposures for unbound vardenafil and its major metabolite at approximately 100 and 29 times, respectively, the maximum recommended human dose (MRHD) of 20 mg based on AUC(see Data). No evidence of specific potential for teratogenicity, embryotoxicity or fetotoxicity was observed in rats and rabbits that received vardenafil at up to 18 mg/kg/day during organogenesis. This dose is approximately 100 fold (rat) and 29 fold (rabbit) greater than the AUC values for unbound vardenafil and its major metabolite in humans given the maximum recommended human dose (MRHD) of 20 mg. In the rat pre-and postnatal development study, the NOAEL (no observed adverse effect level) for maternal toxicity was 8 mg/kg/day. Based on plasma exposures in the rat developmental toxicity study, 1 mg/kg/day in the pregnant rat is estimated to produce total AUC values for unbound vardenafil and its major metabolite comparable to the human AUC at the MRHD of 20 mg. Nitric oxide activates the enzyme guanylate cyclase resulting in increased synthesis of cyclic guanosine 20 mg vardenafil monophosphate (cGMP) in the smooth muscle cells of the corpus cavernosum. The cGMP in turn triggers smooth muscle relaxation, allowing increased blood flow into the penis, resulting in erection. The tissue concentration of cGMP is regulated by both the rates of synthesis and degradation via phosphodiesterases (PDEs). The most abundant PDE in the human corpus cavernosum is the cGMP-specific PDE5; therefore, the inhibition of PDE5 enhances erectile function by increasing the amount of cGMP. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 has no effect in the absence of sexual stimulation.In vitro studies have shown that vardenafil is a selective inhibitor of PDE5. The inhibitory effect of vardenafil is more selective on PDE5 than for other known phosphodiesterases (>15-fold relative to PDE6, >130-fold relative to PDE1, >300-fold relative to PDE11, and >1,000-fold relative to PDE2, 3, 4, 7, 8, 9, and 10).12.2 PharmacodynamicsThe pharmacodynamic studies described below were conducted using vardenafil film-coated tablets.Effects on Blood PressureIn a clinical pharmacology study of patients with erectile dysfunction, single doses of vardenafil 20 mg film-coated tablets caused a mean maximum decrease in supine blood pressure of 7 mmHg systolic and 8 mmHg diastolic (compared to placebo), accompanied by a mean maximum increase of heart rate of 4 beats per minute. Vardenafil may add to the blood pressure lowering effects of antihypertensive agents [see Drug Interactions (7)].Effects on Blood Pressure and Heart Rate when Vardenafil is Combined with NitratesA study was conducted in which the blood pressure and heart rate response to 0.4 mg nitroglycerin (NTG) sublingually was evaluated in 18 healthy subjects following pretreatment with vardenafil 20 mg film-coated tablets at various times before NTG administration. Vardenafil 20 mg caused an additional time-related reduction in blood pressure and increase in heart rate in association with NTG administration.
| Side Effect | Frequency | Severity | Recommended Action |
|---|---|---|---|
| Headache | Common | Mild | Take analgesics, hydration |
| Flushing | Common | Mild | Cool environment, hydrate |
| Nasal Congestion | Moderate | Mild | Use decongestants if needed |
| Dizziness | Less common | Mild | Sit or lie down immediately |
| Muscle Pain | Rare | Mild | Consult doctor if persists |
