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Probe · vardenafil · 3 min read

Can Levitra start with an alpha-blocker on the chart?

Only after the alpha-blocker is stable. PDE5 inhibitors should then start at the lowest recommended dose. On that row Levitra starts at 5 mg, or 2.5 mg when certain CYP3A4 inhibitors are also used. A time interval between dosing should be considered. Simultaneous terazosin 10 mg and vardenafil 5 mg produced symptomatic hypotension in one man (standing 80/60 mmHg). That drop was not seen when the same pair was separated by 6 hours. Twenty milligrams is not the combined first night.

Medically reviewed by Dr. Mateo Ruiz, MD - Clinical pharmacology, Barcelona

Last reviewed

Updated

01What milligram starts next to a stable alpha-blocker?

Forest-green still life: hour gap between two bottles, amber tablet waiting

Levitra should be initiated at 5 mg in men stable on an alpha-blocker. Use 2.5 mg when certain CYP3A4 inhibitors are also on the chart. This vault's 20 mg lock is not that start.

Tamsulosin 0.4 or 0.8 mg daily was studied with vardenafil 10 mg and 20 mg given at the same time in 23 men. Three men reported dizziness after vardenafil 20 mg. There were no cases of syncope in that cohort.

02Is tamsulosin safer to stack at the same hour?

Tamsulosin 0.4 mg with simultaneous vardenafil 5 mg still produced standing systolic values under 85 mmHg in two men. A 6-hour separation did not erase every outlier on that cohort.

Do not treat tamsulosin as a free pass to start 20 mg at the same swallow as the alpha-blocker. Stabilize first. Start 5 mg. Consider a gap.

03What did a 6-hour gap change with terazosin?

In 21 men on terazosin 5 or 10 mg, vardenafil 5 mg given at the same time left five men with a standing systolic drop greater than 30 mmHg (two on placebo). One man had symptomatic hypotension at 80/60 mmHg one hour after the simultaneous pair.

Hypotension was not observed when vardenafil 5 mg and terazosin were given 6 hours apart. That is why the insert says a time interval should be considered.

04Can a late bottle sit on that first combined night?

Alcohol is a third vasodilator. The alcohol probe holds the 0.5 g/kg study. Do not add it to the first night of 5 mg plus an alpha-blocker.

Volume depletion and other antihypertensives also change the safety of the pair. Bring the full list to the visit.

05What happened when terazosin was forced up in volunteers?

Healthy men had terazosin forced to 10 mg daily over 14 days (n=29) or tamsulosin 0.4 mg for five days (n=24). Standing systolic values under 85 mmHg when vardenafil and terazosin were timed to hit peak together led to early termination of that arm.

Most of those low readings were not paired with symptoms (7 of 8). The early stop is still the reason this page will not recommend a same-hour 20 mg start on terazosin.

06What has to be true before the first Levitra swallow?

Patients should be stable on alpha-blocker therapy before a PDE5 inhibitor starts. Men who are already wobbly on the alpha-blocker alone are at higher risk of symptomatic hypotension when vardenafil is added.

If the man is already on an optimized PDE5 dose, the alpha-blocker should start at its lowest dose. Stepwise increases in the alpha-blocker can drop pressure further.

Sources

  1. DailyMed LEVITRA (vardenafil)
  2. LEVITRA 2.4 / 5.6 / 12.2 Study 1: terazosin 6-hour separation; tamsulosin simultaneous outliers.

Checked against the current label and reviewed by Dr. Mateo Ruiz. See Probe, Assay, Glow-check, Seal.

Vault consult

Answers follow the U.S. Levitra label.

Willa F. Tamsulosin every night. Start 20 mg the same hour?

Vault reply

Keep the alpha-blocker stable, then start Levitra at 5 mg. A time interval should be considered. Twenty milligrams is not the combined start.

Orhan B. Why do people talk about 6 hours?

Vault reply

When vardenafil 5 mg and terazosin were given 6 hours apart, the symptomatic hypotension seen with simultaneous dosing was not observed. The insert asks clinicians to consider a time interval.

Tess G. I am on terazosin and ritonavir. Five or 20?

Vault reply

Ritonavir forces 2.5 mg in 72 hours. The alpha-blocker row already starts at 5 mg, or 2.5 mg with certain CYP3A4 inhibitors. Twenty milligrams is off both rows.

Before you start, stop, or change any medicine, speak with your prescriber or pharmacist - they hold your chart, this vault card does not. Open the vault disclaimer.