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Nitrates can also be found in other medicines such as isosorbide dinitrate or isosorbide mononitrate.

Medication Class	Interaction Effect	Recommended Action
Nitrates	Risk of severe hypotension	Avoid concomitant use
Alpha-blockers	May cause hypotension	Use with caution
CYP3A4 Inhibitors	Increased Vardenafil levels	Reduce dose or avoid
Other PDE5 inhibitors	Increased side effects	Do not combine

Some recreational drugs called “poppers” also contain nitrates, such levitra now online as amyl nitrate and butyl nitrate. Do not use LEVITRA if you are using these drugs. Ask your doctor or pharmacist if you are not sure if any of your medicines are nitrates.

World Federation of Neurology

LEVITRA has been shown to be effective in men over the age of 18 years who have erectile dysfunction, including men with diabetes or who have undergone prostatectomy. Take any medicines called “nitrates” (See “What important information should you know about LEVITRA?”). Nitrates are commonly used to treat angina. Angina is a symptom of heart disease and can cause pain in your chest, jaw, or down your arm. Medicines called nitrates include nitroglycerin that is found in tablets, sprays, ointments, pastes, or patches. Take riociguat, a guanylate cyclase stimulator, a medicine that treats pulmonary arterial hypertension and chronic-throembolic pulmonary hypertension. Have been told by your healthcare provider to not have sexual activity because of health problems. Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease. WHAT SHOULD YOU DISCUSS WITH YOUR DOCTOR BEFORE TAKING LEVITRA?

• The medication is manufactured by Bayer or authorized pharmaceutical companies.
• It is designed to be more potent and faster acting than generic versions.
• Do not share your medication with others to avoid misuse.

Before taking LEVITRA, tell your doctor about all your medical problems, including if you: Have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack. Ask your doctor if it is safe for you to have sexual activity.

• Levitra Professional 20mg offers an option for men with specific ED needs.
• The medication does not increase libido but enhances erectile response.
• It should be used as part of a comprehensive treatment plan.

Have low blood pressure or have high blood pressure that is not controlled. Or any family members have a rare heart condition known as prolongation of the QT interval (long QT syndrome). Have retinitis pigmentosa, a rare genetic (runs in families) eye disease Have ever had severe vision loss, or if you have an eye condition called non-arteritic anterior ischemic optic neuropathy (NAION).

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Have a deformed penis shape or Peyronie’s disease. Have had an erection that lasted more than 4 hours.

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Physicians should also discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye. Physicians should also discuss with patients 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, including LEVITRA, for this uncommon condition [see Warnings and Precautions (5.4) and[Adverse Reactions (6.1)]. Advise patients to stop taking PDE5 inhibitors, including LEVITRA, 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 LEVITRA. It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors [see Adverse Reactions (6)].

8.5 Geriatric Use

Inform patients that LEVITRA offers no protection against sexually transmitted diseases. Counsel patients that protective measures necessary to guard against sexually transmitted diseases, including the Human Immunodeficiency Virus (HIV), should be considered. Inform patients that the recommended starting dose of LEVITRA is 10 mg. The dose may be increased to a maximum recommended dose of 20 mg or decreased to 5 mg based on efficacy and tolerability. LEVITRA® (Luh-VEE-Trah) (vardenafil HCl) Tablets Read the Patient Information about LEVITRA before you start taking it and again each time you get a refill. Have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia. Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. LEVITRA and other medicines may affect each other. Always check with your doctor before starting or stopping any medicines. Especially tell your doctor if you take any of the following: Medicines called nitrates (see “What important information should you know about LEVITRA?”).

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

When to Seek Medical Attention

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 LEVITRA 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 LEVITRA and this class of compounds. Advise patients to contact the prescribing physician if new medications that may interact with LEVITRA are prescribed by another healthcare provider. Inform patients to stop use of all PDE5 inhibitors, including LEVITRA, and seek medical attention in the event of sudden loss of vision in one or both eyes. 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. Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure.

• Effectiveness depends on individual health conditions and medications.
• Levitra Professional 20mg is sometimes used off-label for other off-label purposes.
• Proper hydration and lifestyle choices can improve overall results.

In some patients the use of PDE5 inhibitor drugs, including LEVITRA, with alpha-blockers can lower blood pressure significantly leading to fainting. You should contact the prescribing physician if alpha-blockers or other drugs that lower blood pressure are prescribed by another healthcare provider. Take LEVITRA exactly as your doctor prescribes. Doses should be taken at least 24 hours apart. Some men can only take a low dose of LEVITRA because of medical conditions or medicines they take.

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If you need emergency medical care for a heart problem, it will be important for your healthcare provider to know when you last took LEVITRA. LEVITRA is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men. ED is a condition where the penis does not harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his doctor for help if the condition bothers him. LEVITRA may help a man with ED get and keep an erection when he is sexually excited.

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Protect a man or his partner from sexually transmitted diseases, including HIV. Speak to your doctor about ways to guard against sexually transmitted diseases. Serve as a male form of birth control. LEVITRA is only for men with ED. LEVITRA is not for women or children. Your doctor will prescribe the dose that is right for you. If you are older than 65 or have liver problems, your doctor may start you on a lower dose of LEVITRA. If you have prostate problems or high blood pressure, for which you take medicines called alpha-blockers, your doctor may start you on a lower dose of LEVITRA.

Condition	Description	Recommended Dose
Erectile Dysfunction (ED)	Helps achieve and sustain erections	20mg as needed
Pulmonary Hypertension	Off-label use in pulmonary hypertension	Consult doctor
Duration of Action	Lasts for approximately 4-6 hours	-
Onset of Action	Effects within 30-60 minutes	-

If you are taking certain other medicines your doctor may prescribe a lower starting dose and limit you to one dose of LEVITRA in a 72-hour (3 days) period. Take 1 LEVITRA tablet about 1 hour (60 minutes) before sexual activity. Some form of sexual stimulation is needed for an erection to happen with LEVITRA.

Trial summary

You may also find it helpful to share this information with your partner. This leaflet does not take the place of talking with your doctor. You and your doctor should talk about LEVITRA when you start taking it and at regular checkups. If you do not understand the information, or have questions, talk with your doctor or pharmacist. WHAT IMPORTANT INFORMATION SHOULD YOU KNOW ABOUT LEVITRA?

7.1 Potential for Pharmacodynamic Interactions with LEVITRA

LEVITRA can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. With a sudden drop in blood pressure, you could get dizzy, faint, or have a heart attack or stroke. Take any medicines called “nitrates” (often used to control chest pain, also known as angina). Use recreational drugs called “poppers” like amyl nitrate and butyl nitrate. Tell all your healthcare providers that you take LEVITRA. LEVITRA may be taken with or without meals.

• Levitra Professional 20mg may interact with other medications like nitrates.
• Inform your healthcare provider about all medicines you are taking.
• Misuse can lead to serious health complications or decreased effectiveness.

Do not change your dose of LEVITRA without talking to your doctor. Your doctor may lower your dose or raise your dose, depending on how your body reacts to LEVITRA. Call your doctor or emergency room immediately if you accidentally took more LEVITRA than prescribed. WHAT ARE THE POSSIBLE SIDE EFFECTS OF LEVITRA? The most common side effects with LEVITRA are headache, flushing, stuffy or runny nose, indigestion, upset stomach, dizziness or back pain.

Contraindication	Explanation
Nitrate Medications	Risk of severe hypotension
Severe Heart Conditions	Increased risk during cardiovascular events
Allergies to Vardenafil	Potential allergic reactions
Liver or Kidney Disease	Dose adjustment may be required

These side effects usually go away after a few hours. Call your doctor if you get a side effect that bothers you or one that will not go away.

Overdose/Missed Dose

LEVITRA must be used only under a doctor’s care. When a man is sexually stimulated, his body’s normal physical response is to increase blood flow to his penis. LEVITRA helps increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Once a man has completed sexual activity, blood flow to his penis decreases, and his erection goes away. Talk to your doctor to decide if LEVITRA is right for you. An erection that won’t go away (priapism). If you get an erection that lasts more than 4 hours, get medical help right away. Priapism must be treated as soon as possible or lasting damage can happen to your penis including the inability to have erections. Color vision changes, such as seeing a blue tinge to objects or having difficulty telling the difference between the colors blue and green.