> ## Documentation Index
> Fetch the complete documentation index at: https://docs.hi-doctor.ai/llms.txt
> Use this file to discover all available pages before exploring further.

# Vardenafil 5/10/20mg

> How vardenafil works for erectile dysfunction, the EU efficacy data behind it since 2003, dosing and food timing, and why it must never mix with nitrates.

Vardenafil is a prescription tablet for erectile dysfunction, authorised
across the EU since 2003. It works the same way as sildenafil and
tadalafil — keeping the blood vessels in the penis relaxed so blood can
flow in during sexual arousal — and it must never be taken with nitrate
heart medicines.

<Info>
  Active ingredient: **vardenafil** · Dosages: **5 / 10 / 20 mg**, taken on
  demand · Authorised in the EU since **6 March 2003**
</Info>

## What it is

A PDE5-inhibitor tablet for adult men with erectile dysfunction — either
film-coated or a melt-in-the-mouth (orodispersible) formulation. Sexual
stimulation is still required for it to work.

## How it works

<CardGroup cols={3}>
  <Card title="Arousal releases nitric oxide" icon="bolt">
    Sexual stimulation makes nerves and blood-vessel linings in the penis
    release nitric oxide. This switches on an enzyme called guanylate
    cyclase, which builds up a messenger chemical called cyclic GMP inside
    the smooth muscle of the erectile tissue.
  </Card>

  <Card title="Cyclic GMP opens the blood flow" icon="droplet">
    Cyclic GMP relaxes that smooth muscle, so the arteries widen and blood
    flows into the corpus cavernosum — the two spongy chambers that run
    along the penis. That inflow produces an erection. The body then
    steadily breaks the cyclic GMP down again.
  </Card>

  <Card title="Vardenafil blocks the clean-up enzyme" icon="lock">
    Vardenafil blocks the PDE5 enzyme that normally ends an erection, so
    the blood vessels stay relaxed and fill with blood in response to
    stimulation. Onset is around 25 minutes, and the effect lasts about 5
    hours.
  </Card>
</CardGroup>

## What the studies reported

<Note>
  A single 12-week manufacturer-sponsored trial in a mixed erectile-dysfunction
  population measured IIEF question-level changes — small point movements on
  a 5-point scale, not percentages.
</Note>

The EU marketing authorisation (Levitra EPAR, sections 4.2, 4.8 and 5.1)
reports fixed-dose efficacy on two standard endpoints over three months:

| Endpoint                                    | Vardenafil                | Placebo |
| ------------------------------------------- | ------------------------- | ------- |
| SEP2 (successful penetration)               | 68% / 76% / 80% (by dose) | 49%     |
| SEP3 (successful completion of intercourse) | 53% / 63% / 65% (by dose) | 29%     |

## What has been reported

| Effect                                                    | EU product information            | At-home pivotal trial |
| --------------------------------------------------------- | --------------------------------- | --------------------- |
| Headache                                                  | Very common (>1 in 10)            | 7%–15%                |
| Flushing                                                  | Common                            | 10%–11%               |
| Dyspepsia (indigestion) and rhinitis                      | Common                            | Up to 7%              |
| Dizziness                                                 | Common (1 in 100 to 1 in 10)      | —                     |
| Visual disturbance, ocular hyperaemia, colour distortion  | Uncommon (1 in 1,000 to 1 in 100) | —                     |
| Non-arteritic anterior ischaemic optic neuropathy (NAION) | Not known                         | —                     |

<Warning>
  Vardenafil is contraindicated in men who have already lost vision in one
  eye from NAION, and in men with severe cardiovascular disease. It must
  never be combined with nitrate medicines or nitric-oxide donors — blood
  pressure can fall dangerously.
</Warning>

## How to take it

<CardGroup cols={3}>
  <Card title="Timing" icon="clock">
    The usual starting dose for film-coated tablets is 10 mg, taken 25–60
    minutes before sexual activity; the prescriber may select 5 mg or 20 mg
    based on response and tolerance. At most one dose in 24 hours.
  </Card>

  <Card title="Food" icon="utensils">
    Light meals do not affect it significantly. A very fatty meal can
    delay onset of the film-coated tablet.
  </Card>

  <Card title="Formulation and medicines" icon="triangle-exclamation">
    Film-coated and orodispersible tablets are not interchangeable dose
    for dose. Never combine vardenafil with nitrates, nitric-oxide donors,
    riociguat, or another erectile-dysfunction medicine.
  </Card>
</CardGroup>

Before each dose, check that no new heart, chest-pain, blood-pressure,
rhythm, prostate, antifungal, antibiotic or HIV medicine changes the plan.
Vardenafil can lower blood pressure and carries specific precautions for
QT prolongation and rhythm medicines — seek advice rather than taking
another dose if you faint or have palpitations. Avoid excess alcohol,
because it can worsen dizziness and erectile difficulty. Do not increase
the dose yourself after one unsuccessful attempt — review the pattern with
the prescriber instead.

## Contact your doctor if

* An erection lasting 4 hours or longer, sudden loss of vision or hearing,
  chest pain, collapse, or a severe allergic reaction — seek urgent care
* Marked dizziness, fainting, palpitations, or a headache that is severe
  or persistent
* The prescribed dose is not suitable, or does not give a satisfactory
  response after several correctly timed attempts

## Storage

Keep in the original package, away from moisture and direct heat, and out
of children's reach. Follow the temperature limit on your pack and do not
use it after the expiry date.

## Common questions

<AccordionGroup>
  <Accordion title="How long does vardenafil take to work?">
    Onset is around 25 to 60 minutes for film-coated tablets. The effect lasts about 5 hours. Sexual stimulation is still required for it to work.
  </Accordion>

  <Accordion title="Can I drink alcohol with vardenafil?">
    Avoid excess alcohol because it can worsen dizziness and erectile difficulty. The EU product information advises moderation.
  </Accordion>

  <Accordion title="What is the difference between film-coated and orodispersible tablets?">
    Film-coated and orodispersible tablets are not interchangeable dose for dose. The orodispersible version dissolves on the tongue and does not need water. Check which formulation you have and follow its specific instructions.
  </Accordion>

  <Accordion title="Can vardenafil cause vision problems?">
    Visual disturbance, ocular hyperaemia and colour distortion are listed as uncommon in the EU product information. Non-arteritic anterior ischaemic optic neuropathy (NAION) is reported at a frequency that is not known. Vardenafil is contraindicated in men who have already lost vision in one eye from NAION.
  </Accordion>

  <Accordion title="Can I take vardenafil with heart medicines?">
    Vardenafil can lower blood pressure and carries specific precautions for QT prolongation and rhythm medicines. Before each dose, check that no new heart, chest-pain, blood-pressure, rhythm, prostate, antifungal, antibiotic or HIV medicine changes the plan. Never combine with nitrates.
  </Accordion>

  <Accordion title="Is vardenafil authorised in the EU?">
    Yes. Vardenafil has been authorised across the EU since 6 March 2003 (Levitra EPAR, EMEA/H/C/000475), so a licensed doctor can prescribe it when clinically appropriate.
  </Accordion>
</AccordionGroup>

## How Hi-Doctor handles it

An EU-licensed doctor reviews your case and, if eligible, issues an
electronic prescription valid at any EU pharmacy under Directive
2011/24/EU. See [how a consultation works](/essentials/how-it-works), the
[treatment areas](/essentials/treatments) Hi-Doctor covers, and
[pricing](/essentials/pricing).

## Further reading

The site's own patient guide covers dose scheduling and what to watch for
day to day: [Vardenafil guide](https://hi-doctor.ai/guides/vardenafil).

## Sources

* EMA EPAR — Levitra (vardenafil), EMEA/H/C/000475, marketing
  authorisation issued 06/03/2003
* EMA — Levitra EPAR product information (SmPC sections 4.2, 4.8, 5.1)
* *Int J Impot Res* 2001 — First at-home clinical trial of vardenafil
  (PMID 11494074)
* *J Androl* 2002 — Vardenafil for treatment of men with erectile
  dysfunction: randomised, double-blind, placebo-controlled trial
  (PMID 12399521)

## Start a consultation

<Card title="Sexual health consultation" icon="stethoscope" href="https://hi-doctor.ai/consultation/sexual-health/1">
  Answer the sexual health questionnaire and a registered doctor reviews it.
  They decide whether treatment is appropriate, which one, and at what dose —
  and declining is a normal outcome. See [what it costs](/essentials/pricing)
  and [how the review works](/essentials/how-it-works).
</Card>

<Warning>
  This page is reference information, not medical advice and not a prescription.
  Whether a medicine is appropriate for you is decided by a registered doctor
  after reviewing your consultation.
</Warning>