Levitra FAQ

Erectile Dysfunction: Oral Therapy Treatment Options
What is erectile dysfunction?
Cialis (Tadalafil)
Medical uses

Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision, including permanent loss of vision, that has been reported rarely post-marketing in temporal association with the use of all PDE5 inhibitors. It is not possible to determine whether these events were related directly to the use of PDE5 inhibitors or to other factors.

Erectile Dysfunction: Oral Therapy Treatment Options

placebo: 354±137 and 347±143 seconds, respectively). The total time to 1 mm or greater ST-segment depression was similar to placebo in both the 10 mg and the 20 mg vardenafil groups (10 mg LEVITRA vs. placebo: 380±108 and 334±108 seconds; 20 mg vardenafil vs. placebo: 364±101 and 366±105 seconds, respectively). Single oral doses of phosphodiesterase inhibitors have demonstrated transient dose- related impairment of color discrimination (blue/green) using the Farnsworth-Munsell 100-hue test and reductions in electroretinogram (ERG) b-wave amplitudes, with peak effects near the time of peak plasma levels.

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These findings are consistent with the inhibition of PDE6 in rods and cones, which is involved in phototransduction in the retina. The findings were most evident one hour after administration, diminishing but still present 6 hours after administration. In a single dose study in 25 normal males, vardenafil 40 mg, twice the maximum daily recommended dose, did not alter visual acuity, intraocular pressure, fundoscopic and slit lamp findings. In another double blind, placebo controlled clinical trial, at least 15 doses of 20 mg vardenafil were administered over 8 weeks versus placebo to 52 males. Thirty-two (32) males (62%) of the patients completed the trial.

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Retinal function was measured by ERG and FM-100 test 2, 6 and 24 hours after dosing. The trial was designed to detect changes in retinal function that might occur in more than 10% of patients. Vardenafil did not produce clinically significant ERG or FM-100 effects in healthy men compared to placebo. Two patients on vardenafil in the trial reported episodes of transient cyanopsia (objects appear blue). There was no effect on sperm motility or morphology after single 20 mg oral doses of vardenafil in healthy volunteers. Inform patients of the increased risk of NAION in individuals who have already experienced NAION in one eye and discuss the increased risk of NAION among the general population in patients with a "crowded" optic disc, although evidence is insufficient to support screening of prospective users of PDE5 inhibitor, generic levitra pills canada including vardenafil, for this uncommon condition.

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Advise patients to stop treatment and seek prompt medical attention in the event of sudden decrease or loss of hearing. These events, which may be accompanied by tinnitus and dizziness, have been reported in temporal association to the intake of PDE5 inhibitors, including vardenafil. It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors. The use of vardenafil offers no protection against sexually transmitted diseases. Counseling of patients about protective measure necessary to guard against sexually transmitted diseases, including the Human Immunodeficiency Virus (HIV), should be considered. Advise patients that the disintegrating tablet (Staxyn) is not interchangeable with the film-coated tablet (Levitra). General Notes: May be taken with or without food.

What is erectile dysfunction?

The pharmacokinetics of vardenafil are approximately dose proportional over the recommended dose range. Absorption: 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 levitra price list high-fat meals caused a reduction in Cmax by 18%-50%. Distribution: The mean steady-state volume of distribution (Vss) for vardenafil is 208 L, indicating extensive tissue distribution.

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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. Metabolism: Vardenafil is metabolized predominantly by the hepatic enzyme CYP3A4, with contribution from the CYP3A5 and CYP2C isoforms. The major circulating metabolite, M1, results from desethylation at the piperazine moiety of vardenafil.

What is tadalafil (Cialis®)?

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. Therefore, M1 accounts for approximately 7% of total pharmacologic activity. Elimination: 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). (Tablet) Place on tongue to disintegrate; take without liquid and immediately upon removal from blister.

Levitra has been shown to enhance erectile function in clinical studies.
It is not classified as a controlled substance but still requires caution.
Side effects usually diminish after the body adjusts to the medication.
Patients should inform their doctor of all health issues before starting Levitra.
In some cases, Levitra may be used temporarily or as needed.
Regular blood pressure monitoring is recommended when using Levitra.
Levitra should be stored safely away from children and pets.
Discuss all medication options with a healthcare provider to find the best treatment.

Approval Status: Approved for marketing by the U.S.

Levitra can be part of a comprehensive approach to managing erectile dysfunction.
Dietary supplements claiming to be similar to Levitra are not FDA-approved.
If an erection lasts longer than 4 hours, seek emergency medical care.
Levitra may be less effective in men with severe diabetes or cardiovascular disease.
Patients should avoid grapefruit or grapefruit juice while on Levitra.
Precautions include avoiding driving or operating machinery after taking Levitra.
Individuals with hereditary eye diseases should consult a doctor before use.
Levitra may cause a drop in blood pressure, especially when combined with other meds.

FDA on August 19, 2003. Chemical/Biological Nature: LEVITRA is a small molecule chemical compound, with a molecular weight of 579.1 daltons. Administration: LEVITRA is taken orally 60 minutes before sexual activity.

Cialis (Tadalafil)

Patients should be advised to contact the prescribing physician if other anti-hypertensive drugs or new medications that may interact with vardenafil are prescribed by another healthcare provider. Discuss with patients the appropriate use of vardenafil and its anticipated benefits. It should be explained that sexual stimulation is required for an erection to occur after taking vardenafil. It should be taken approximately 60 minutes before sexual activity. Patients should be counseled regarding the dosing of vardenafil especially regarding the maximum daily dose.

Are Levitra and Viagra the same?

Patients should be advised to contact their healthcare provider for dose modification if they are not satisfied with the quality of their sexual performance with vardenafil or in the case of an unwanted effect. Inform patients that there have been rare reports of prolonged erections greater than 4 hours and priapism (painful erections greater than 6 hours in duration) for vardenafil and this class of compounds. In the event that an erection persists longer than 4 hours, the patient should seek immediate medical assistance. If priapism is not treated immediately, penile tissue damage and permanent loss of potency may result. Advise patients to stop treatment and seek medical attention in the event of sudden loss of vision in one or both eyes. For most patients, the recommended starting dose is 10 mg. Depending on an individual’s response, the dose may be adjusted higher to 20 mg or lower to 5 mg. The recommended maximum dosing frequency is no more than once daily. Mechanism of Disease: Penile erection is a hemodynamic event. There are many abnormalities that could lead to erectile dysfunction.

Condition	Risk/Reason	Notes
Nitrate medication use	Severe hypotension	Contraindicated
Heart disease	Increased risk of adverse events	Consult doctor
Liver impairment	Altered drug metabolism	Dose adjustment may be needed
Retinitis pigmentosa	Potential for exacerbation	Use with caution

Normally, the signal transduction events mediated by cyclic guanosine monophosphate (cGMP) lead to the relaxation of the smooth muscle of blood vessels that supply blood to the penis when there is sexual stimulation. The lack of, or insufficient sustained levels of, cGMP result in erectile dysfunction.

Medical uses

Pediatrics: Vardenafil is not indicated for use in pediatric patients. Vardenafil trials were not conducted in the pediatric population. Geriatric: 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. Hepatic Impairment: 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. 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.

What is Levitra?

Vardenafil has not been evaluated in patients with severe (Child-Pugh C) hepatic impairment. Renal Impairment: In male volunteers with ClCr= 50-80 mL/min, the pharmacokinetics of vardenafil were similar to those observed in a control group with ClCr >80 mL/min. In male volunteers with ClCr = 30-50 mL/min or ClCr <30 mL/min renal impairment groups, the AUC of vardenafil was 20-30% higher compared to that observed in a control group with ClCr >80 mL/min). Vardenafil pharmacokinetics have not been evaluated in patients requiring renal dialysis. Advise patients of the contraindication of vardenafil with regular and/or intermittent use of organic nitrates.