Class: Erectile Dysfunction Agent
Dosage Forms. Tablet: 2.5 mg, 5 mg, 10 mg, 20 mg; Tablet, Dispersible: 10 mg
Common FDA Label Indication, Dosing, and Titration.
1. Erectile dysfunction: 10-20 mg po prior to anticipated sexual activity; max frequency is once daily
1. Pulmonary hypertension: 20 mg po daily
MOA. Inhibition of phosphodiesterase type 5 (PDE5) by vardenafil enhances erectile function by increasing the amount of cyclic GMP. Penile erection during sexual stimulation is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cyclic guanosine monophosphate (GMP) in smooth muscle cells. Cyclic GMP causes smooth muscle relaxation and increases blood flow into the corpus cavernosum.
Drug Characteristics: Vardenafil
Medication Safety Issues: Vardenafil
Drug Interactions: Vardenafil
Adverse Reactions: Vardenafil
Efficacy Monitoring Parameters. Improvement in sexual functioning.
Toxicity Monitoring Parameters. Seek medical attention if chest pain, erection lasting more than 4 h, tinnitus, dizziness, shortness of breath.
Key Patient Counseling Points. Take 60 min prior to anticipated sexual activity. Do not take more frequently than once q24h. The orally disintegrating tablet should be placed on tongue immediately upon removal from packaging; the tablet should be taken whole and not crushed or split, do not take with any liquids. Oral tablet can be taken without regard to food. If erection lasts >4 h, seek medical attention.
Clinical Pearls. The choice between tadalafil, sildenafil, or vardenafil is largely one of patient preference; tadalafil would be indicated in those desiring “full-day coverage.” 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.