
Vardenafil is eliminated predominantly by hepatic metabolism, mainly by CYP3A4 and to a minor extent, CYP2C isoforms. Concomitant use with potent CYP3A4 inhibitors such as ritonavir, indinavir, ketoconazole, as well as moderate CYP3A inhibitors such as erythromycin results in significant increases of plasma levels of vardenafil (see PRECAUTIONS, WARNINGS and DOSAGE AND ADMINISTRATION).
Mean vardenafil plasma concentrations measured after the administration of a single oral dose of 20 mg to healthy male levitra no prescription online volunteers are depicted in Figure 1. Figure 1: Plasma Vardenafil Concentration (Mean ± SD) Curve for a Single 20 mg LEVITRA Dose Vardenafil is rapidly absorbed with absolute bioavailability of approximately 15%. Maximum observed plasma concentrations after a single 20 mg dose in healthy volunteers are usually reached between 30 minutes and 2 hours (median 60 minutes) after oral dosing in the fasted state. Two food-effect studies were conducted which showed that high-fat meals caused a reduction in Cmax by 18%-50%. The mean steady-state volume of distribution (Vss) for vardenafil is 208 L, indicating extensive tissue distribution. Vardenafil and its major circulating metabolite, M1, are highly bound to plasma proteins (about 95% for parent drug and M1). This protein binding is reversible and independent of total drug concentrations.
Following a single oral dose of 20 mg vardenafil in healthy volunteers, a mean of 0.00018% of the administered dose was obtained in semen 1.5 hours after dosing.
Tell your doctor about all other medications you use for erectile dysfunction. This list is not complete and many Other drugs may interact with vardenafil. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Levitra only for the for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. LEVITRA- vardenafil hydrochloride tablet, film coated APHENA PHARMA SOLUTIONS - TENNESSEE, INC. LEVITRA® is an oral therapy for the treatment of erectile dysfunction. Vardenafil HCl 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 is a nearly colorless, solid substance with a molecular weight of 579.1 g/mol and a solubility of 0.11 mg/mL in water. LEVITRA is formulated as orange, round, film-coated tablets with “BAYER” cross debossed on one side and “2.5”, “5”, “10”, and “20” on the other side corresponding to 2.5 mg, 5 mg, 10 mg, and 20 mg of vardenafil, respectively. Vardenafil is metabolized predominantly by the hepatic enzyme CYP3A4, with contribution from the CYP3A5 and CYP2C isoforms.
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The major circulating metabolite, M1, results from desethylation at the piperazine moiety of vardenafil. The plasma concentration of M1 is approximately 26% that of the parent compound. This metabolite shows a phosphodiesterase selectivity profile similar to that of vardenafil and an in vitro inhibitory potency for PDE5 28% of that of vardenafil.
Penile 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 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 phosphodiesterase type 5 (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). The pharmacokinetics of vardenafil are approximately dose proportional over the recommended dose range. Therefore, M1 accounts for approximately 7% of total pharmacologic activity. The total body clearance of vardenafil is 56 L/h, and the terminal half-life of vardenafil and its primary metabolite (M1) is approximately 4-5 hours.
After oral administration, vardenafil is excreted as metabolites predominantly in the feces (approximately 91-95% of administered oral dose) and to a lesser extent in the urine (approximately 2-6% of administered oral dose).
| Storage Condition | Description | Note |
|---|---|---|
| Temperature | Keep at room temperature (15-30°C) | Protect from heat and moisture |
| Light | Store in a dark place | Avoid direct sunlight |
| Children | Keep out of reach | Safety precaution |
| Expiry Date | Check before use | Discard after expiry |
Pediatrics: Vardenafil trials were not conducted in the pediatric population. Geriatrics: In a healthy volunteer study of elderly males (≥65 years) and younger males (18–45 years), mean Cmax and AUC were 34% and 52% higher, respectively, in the elderly males (see PRECAUTIONS, Geriatric Use and DOSAGE AND ADMINISTRATION). Consequently, a lower starting dose of LEVITRA (5 mg) in patients ≥65 years of age should be considered. Renal Insufficiency: In volunteers with mild renal impairment (CLcr = 50-80 ml/min), the pharmacokinetics of vardenafil were similar to those observed in a control group with normal renal function. In the moderate (CLcr = 30-50 ml/min) or severe (CLcr<30 ml/min) renal impairment groups, the AUC of vardenafil was 20–30% higher compared to that observed in a control group with normal renal function (CLcr>80 ml/min). Vardenafil pharmacokinetics have not been evaluated in patients requiring renal dialysis (see PRECAUTIONS, Renal Insufficiency, and DOSAGE AND ADMINISTRATION). Hepatic Insufficiency: In volunteers with mild hepatic impairment (Child-Pugh A), the Cmax and AUC following a 10 mg vardenafil dose were increased by 22% and 17%, respectively, compared to healthy control subjects.
Avoid consuming grapefruit products and orange marmalades. Drinking alcohol can increase certain side effects of Levitra. Do not use any other medicine to treat impotence unless your doctor tells you to. Get emergency medical help if you have signs of an allergic reaction to Levitra: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using Levitra and get emergency medical help if you have: heart attack symptoms - chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating; heart attack symptoms - chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating; vision changes or sudden vision loss; or vision changes or sudden vision loss; or erection is painful or lasts longer than 4 hours (prolonged erection can damage the penis).
erection is painful or lasts longer than 4 hours (prolonged erection can damage the penis). Stop using Levitra and call your doctor at once if you have: ringing in your ears, or sudden hearing loss; ringing in your ears, or sudden hearing loss; swelling in your hands, ankles, or feet; swelling in your hands, ankles, or feet; a light-headed feeling, like you might pass out; or a light-headed feeling, like you might pass out; or flushing (sudden warmth, redness, or tingly feeling); flushing (sudden warmth, redness, or tingly feeling); This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Do not use Levitra with similar medications such as avanafil (Stendra), sildenafil (Viagra), or tadalafil (Cialis). In volunteers with moderate hepatic impairment (Child-Pugh B), the Cmax and AUC following a 10 mg vardenafil dose were increased by 130% and 160%, respectively, compared to healthy control subjects. Consequently, a starting dose of 5 mg is recommended for patients with moderate hepatic impairment, and the maximum dose should not exceed 10 mg (see PRECAUTIONS and DOSAGE AND ADMINISTRATION).
| Use Case | Description | Precaution |
|---|---|---|
| Erectile Dysfunction | Improves blood flow to the penis for erection | Do not combine with nitrates |
| Off-label Uses | Pulmonary hypertension (less common) | Under medical supervision |
| Duration of Effect | Usually lasts around 4-6 hours | Avoid excessive alcohol intake |
Vardenafil has not been evaluated in patients with severe (Child-Pugh C) hepatic impairment.
| Attribute | Description | Notes |
|---|---|---|
| Active Ingredient | Vardenafil | PDE5 inhibitor |
| Dosage Form | Tablet | 5mg dosage |
| Manufacturer | Bayer Pharmaceuticals | Approved by FDA |
| Use Duration | Typically effective within 30-60 minutes | Onset of action |
| Typical Course | Taken as needed, not regularly | Consult doctor for guidance |
In a clinical pharmacology study of patients with erectile dysfunction, single doses of vardenafil 20 mg 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.
-Initial dose: 10 mg orally once a day, as needed, approximately 60 minutes before sexual activity. Increase to 20 mg or decrease to 5 mg based on efficacy and tolerability. -Maximum dose: 20 mg once a day Patients on stable alpha blocker therapy: -Initial dose: 5 mg orally once a day Comments: -Sexual stimulation is required for a response to treatment. -A time interval between dosing should be considered when administering this drug concomitantly with alpha-blockers. 65 years or older: -Initial dose: 5 mg orally once a day, as needed, approximately 60 minutes before sexual activity Comments: Sexual stimulation is required for a response to treatment.
Since Levitra is used as needed, you are not likely to be on a dosing schedule. Do not take Levitra more than once a day. Allow 24 hours to pass between doses. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Grapefruit and Seville oranges may interact with vardenafil and cause side effects. The maximum decrease in blood pressure occurred between 1 and 4 hours after dosing.
Following multiple dosing for 31 days, similar blood pressure responses were observed on Day 31 as on Day 1.