Vardenafil 20mg

 Phosphodiesterase-5-Inhibitor for Erectile Dysfunction 

CSA NA – FDA Approved – REMS (N) – Can Ship

Vardenafil/Levitra/Staxyn enhances the physiological erectile response following sexual arousal through the potentiation of nitric oxide effects on vascular smooth muscle.  Nitric oxide is released into the corpus cavernosum in response to sexual stimulation.  This stimulates the production of cGMP, leading to smooth muscle relaxation and subsequently vasodilation and erection of the penis.  Vardenafil/Levitra/Staxyn selectively inhibits cGMP for PDE5 which is main enzyme that metabolizes cGMP in the penis, thus enhancing the erectile response of the penis.

Vardenafil, Levitra/Staxyn is indicated for the treatment of erectile dysfunction or organic, psychogenic, or mixed etiology

Use with caution or avoid in persons with increased susceptibility to vasodilators including those with aortic stenosis, cardiomyopathy, and impaired autonomic control of blood pressure.

Use with caution in persons who have suffered a myocardial infarction, stroke, or life-threatening arrhythmia within the last six months.

Use with caution in persons with resting hypotension (blood pressure under 90/50) or hypertension (blood pressure 170/110).

Use with caution in persons with heart failure or coronary artery disease.

Erectile dysfunction – Vardenafil/Levitra/Staxyn

Film coated tablet (Levitra): Take 10mg once daily as needed, can be taken 1 hour before sexual activity.  Reduce the dose down to 5mg if you experience any side effects.  May increase the dose to a maximum daily dose of 20mg if not satisfied with erectile response to sexual stimulation.

Oral disintegrating tablet (Staxyn): Take 10mg once daily as needed, can be taken 1 hour before sexual activity.  The maximum recommended daily dose is 10mg. 

Raynaud’s disease – Vardenafil/Levitra/Staxyn

Take 10mg twice daily. 

How to Take (Vardenafil/Levitra/Staxyn): Do not split the tablet; take the entire tablet and swallow whole on an empty stomach.  When used as needed, take at least 60 minutes prior to sexual activity.  When used as once daily basis, try to take the same time each day regardless of sex. 

You Need to Avoid (Vardenafil/Levitra/Staxyn): Avoid large amounts of grapefruit and its juice (CYP3A4 inhibitor) and alcohol which may enhance the hypotensive effect.  

If You Experience Chest Pain (Vardenafil/Levitra/Staxyn): Seek medical attention immediately.

If You Experience Hearing Loss (Vardenafil/Levitra/Staxyn): If you experience a sudden decrease or loss in hearing.  Seek medical attention.

If Your Penile Erection Does Not Go Down (Vardenafil/Levitra/Staxyn): Painful erections lasting > 6 hours is known as priapism and is rare.  However, if your erection lasts longer than > 4 hours, seek medical condition.  Certain medical conditions such as sickle cell anemia, multiple myeloma and leukemia have been associated with a higher risk of priapism.

If You Experience Vision Loss (Vardenafil/Levitra/Staxyn): Vision loss is rare but may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION).  Please seek medical attention immediately for any sudden loss of vision in one or both eyes.  Risk factors for NAION include coronary artery disease (CAD), diabetes, hypertension, hyperlipidemia, smoking and > 50 years of age.

Pros

Levitra (Vardenafil) significantly improves the achievement and maintenance of an erection during intercourse

Levitra (Vardenafil) Improves overall sexual satisfaction

Levitra (Vardenafil) Improves orgasmic function 

Cons

Mild and transient side effects

Slower onset of action compared to injected or transurethral modes of delivery 

Limited efficacy seen following radical prostatectomy

Contraindicated if you are using organic nitrates in any form due to additive hypotensive effects

Should be used with caution in individuals who have had a myocardial infarction, stroke, or life-threatening arrhythmia within the last six months

Well tolerated, most side effects are transient and mild to moderate in nature.  However, adverse effects such as flushing, diarrhea, myalgia and visual disturbances can increase with doses greater than 100mg every 24 hours.  The most common side effects include:

>10%

Cardiovascular: Flushing (8% to 11%)

Central Nervous System: Headache (14% to 15%)

Gastrointestinal: Dyspepsia (3% to 4%), nausea (2%)

Respiratory: Rhinitis (9%), flu-like symptoms (3%), nasal congestion (3%), sinusitis

Vardenafil, Levitra/Staxyn Usual Dosing

Erectile dysfunction – Vardenafil/Levitra/Staxyn

Film coated tablet (Levitra): Take 10mg once daily as needed, can be taken 1 hour before sexual activity.  Reduce the dose down to 5mg if you experience any side effects.  May increase the dose to a maximum daily dose of 20mg if not satisfied with erectile response to sexual stimulation.

Oral disintegrating tablet (Staxyn): Take 10mg once daily as needed, can be taken 1 hour before sexual activity.  The maximum recommended daily dose is 10mg. 

Raynaud’s disease – Vardenafil/Levitra/Staxyn

Take 10mg twice daily.  

1. Do you take Vardenafil/Levitra/Staxyn with food or on an empty stomach?
   Take Vardenafil/Levitra/Staxyn without food on an empty stomach.
2. Can you drink alcohol when you are on Vardenafil/Levitra/Staxyn?
   You should limit or completely avoid alcohol consumption when taking Vardenafil/Levitra/Staxyn as the alcohol can increase the risk of symptomatic hypotension leading to dizziness and potentially cardiovascular collapse.
3. Can Vardenafil/Levitra/Staxyn cause spontaneous erections?
   No is the short answer.  Vardenafil/Levitra/Staxyn does not directly cause penile erections, but rather affects the penile response to sexual stimulation.  Vardenafil/Levitra/Staxyn inhibits the enzyme phosphodiesterase type 5 (PDE-5) which is responsible for the breakdown of cGMP in the corpus cavernosum of the penis.  During sexual stimulation, there is a local increase in nitric oxide, inhibition of PDE-5 by Levitra (Vardenafil) will lead to increased levels of cGMP and subsequently smooth muscle relaxation around the blood vessels resulting in a significant increase in blood flow into the corpus cavernosum of the penis.
   Bottom line if you are not experiencing sexual stimulation there will be no penile erection.
4. How fast does Vardenafil/Levitra/Staxyn work?
   Levitra (Vardenafil) has an onset of action within 1 hour.   Sublingual vardenafil tablets are more rapid acting and can be taken 30 minutes before sexual intercourse.
5. Can Vardenafil/Levitra/Staxyn cause a painful erection?
   Yes, a condition known as priapism which refers to an erection lasting longer than 6 hours has been reported but only rarely.  Anytime you experience any erection lasting > 4 hours, seek medical attention immediately.
6. Can women use Vardenafil/Levitra/Staxyn for sexual dysfunction?
   There have been a couple of studies investigating the use of phosphodiesterase inhibitors such as Cialis and Viagra in women reporting mixed inconsistent results.  The best available evidence comes from a randomized trial in women suffering from sexual disorders of desire, arousal, orgasm, and dyspareunia treated with Viagra (Sildenafil) for 12 weeks.  They found that Viagra (Sildenafil) was not more effective than placebo in terms of improving any aspect of sexual function.  However, positive effects were reported on sexual arousal and orgasm in premenopausal women with SSRI-associated sexual dysfunction.
7. What works better Cialis, Viagra, or Levitra?
   There is no evidence to suggest which phosphodiesterase-5-inhibitor works best.  There are some special circumstances where one may be preferred over another.  Cialis, Viagra, and Levitra all work the same, however duration of action of Cialis is up to 36 hours compared to 24 hours for Viagra and Levitra.  The adverse effect profile is similar for all drugs with a few exceptions.  Cialis and Levitra have a considerable reduced frequency of visual color distortions compared to Sildenafil.  Cialis and Levitra are not recommended in patients who renal and/or hepatic impairment.