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Vardenafil orally disintegrating tablets provide increased exposure as compared to the regular tablets; therefore, use with potent CYP3A4 inhibitors such as indinavir is not recommended.

Coadministration of indinavir (800 mg every 8 hours) with a single dose of vardenafil (10 mg) altered the pharmacokinetics of vardenafil with buy generic viagra tablets a 16-fold increase in AUC, a 7-fold increase in Cmax, and a 2-fold increase in half-life.

Conversely, vardenafil reduced the AUC and Cmax of indinavir by 30% and 40%, respectively. Inotuzumab Ozogamicin: (Major) Avoid coadministration of inotuzumab ozogamicin with vardenafil due to the potential for additive QT prolongation and risk of torsade de pointes (TdP).

If coadministration is unavoidable, obtain an ECG and serum electrolytes prior to the start of treatment, after treatment initiation, and periodically during treatment. Inotuzumab has been associated with QT interval prolongation. Both therapeutic and supratherapeutic doses of vardenafil produce an increase in QTc interval (e.g., 4 to 6 msec calculated by individual QT correction). Isavuconazonium: (Moderate) Concomitant use of isavuconazonium with vardenafil may result in increased serum concentrations of vardenafil.

Vardenafil is a substrate of the hepatic isoenzyme CYP3A4; isavuconazole, the active moiety of isavuconazonium, is a moderate inhibitor of this enzyme. Caution and close monitoring for adverse events, including hypotension, syncope, visual changes, and prolonged erection, are advised if these drugs are used together.

Isoniazid, INH; Pyrazinamide, PZA; Rifampin: (Minor) Vardenafil is metabolized by cytochrome P450 3A4. It can be expected that concomitant administration of CYP3A4 enzyme-inducers, like the rifamycins, will decrease plasma levels of vardenafil.

Isoniazid, INH; Rifampin: (Minor) Vardenafil is metabolized by cytochrome P450 3A4.

It can be expected that concomitant administration of CYP3A4 enzyme-inducers, like the rifamycins, will decrease plasma levels of vardenafil. Isosorbide Dinitrate, ISDN: (Severe) Coadministration of phosphodiesterase inhibitors with organic nitrates or nitrites in any dosage formulation is contraindicated. Consistent with their known effects on the nitric oxide/cGMP pathway, concomitant use of phosphodiesterase inhibitors and nitrates can cause severe hypotension, syncope, or myocardial infarction. Deaths have been reported in men who were using sildenafil while taking nitrate or nitrite therapy for angina. Isosorbide Mononitrate: (Severe) Coadministration of phosphodiesterase inhibitors with organic nitrates or nitrites in any dosage formulation is contraindicated.

Consistent with their known effects on the nitric oxide/cGMP pathway, concomitant use of phosphodiesterase inhibitors and nitrates can cause severe hypotension, syncope, or myocardial infarction. Deaths have been reported in men who were using sildenafil while taking nitrate or nitrite therapy for angina. Itraconazole: (Major) Avoid use of vardenafil during and for 2 weeks after discontinuation of

itraconazole

therefore

Taking these drugs together increases exposure to vardenafil, and may cause additive effects on the QT interval.

Both itraconazole and vardenafil have been associated with QT prolongation; coadministration may increase this risk.

Ivosidenib: (Major) Avoid coadministration of ivosidenib with vardenafil due to an increased risk of QT prolongation; vardenafil exposure may also decrease.

If concomitant use is unavoidable, monitor ECGs for QTc prolongation and monitor electrolytes; correct any electrolyte abnormalities as clinically appropriate. An interruption of therapy and dose reduction of ivosidenib and/or vandetanib may be necessary if QT prolongation occurs.

Ivosidenib is a CYP3A4 inducer that has been associated with prolongation of the QTc interval and ventricular arrhythmias. Vardenafil is a sensitive CYP3A4 substrate that is associated with QT prolongation.

Both therapeutic and supratherapeutic doses of vardenafil produce an increase in QTc interval. Ketoconazole: (Major) Caution is advised when administering ketoconazole with vardenafil due to the potential for additive effects on the QT interval and increased exposure to vardenafil. Both ketoconazole and vardenafil have been associated with QT prolongation; coadministration may increase this risk. If these drugs must be administered together, a lower dose of vardenafil is required. The vardenafil orally disintegrating tablets (ODTs) provide increased exposure as compared to the regular tablets; therefore, use of the vardenafil ODTs with potent CYP3A4 inhibitors should be avoided. For patients receiving ketoconazole 200 mg daily, the maximum single vardenafil dose is 5 mg every 24 buy discount viagra hours.

For patients receiving ketoconazole 400 mg daily, the maximum single vardenafil dose is 2.5 mg every 24 hours. In one study, health subjects receiving ketoconazole 200 mg PO daily with a single 5 buy discount viagra mg vardenafil dose experienced a 10-fold increase in the AUC and a 4-fold increase in the Cmax of vardenafil.

Lapatinib: (Moderate) Monitor for evidence of QT prolongation if lapatinib is administered with vardenafil.

Vardenafil is associated with QT prolongation at both therapeutic and supratherapeutic doses. Lapatinib has been associated with concentration-dependent QT prolongation; ventricular arrhythmias and torsade de pointes (TdP) buy discount viagra have been reported in postmarketing experience with lapatinib. Lefamulin: (Major) Coadministration of lefamulin tablets is contraindicated with vardenafil due to increased vardenafil exposure which may result in QT prolongation and torsade de pointes (TdP).

If coadministration of lefamulin injection cannot be avoided, ECG monitoring is recommended during treatment. Vardenafil is a sensitive CYP3A4 substrate that is associated with QT prolongation.

Both therapeutic and supratherapeutic doses of vardenafil produce an increase in QTc interval. Lefamulin is a CYP3A4 inhibitor that has a concentration dependent QTc prolongation effect.

The pharmacodynamic interaction potential to prolong the QT interval of the electrocardiogram between lefamulin and other drugs that effect cardiac conduction is unknown.

Lenvatinib: (Major) Avoid coadministration of lenvatinib with vardenafil due to the risk of QT prolongation. Prolongation of the QT interval has been reported with lenvatinib therapy.

Vardenafil is associated with QT prolongation at both therapeutic and supratherapeutic doses.

Lesinurad: (Moderate) Lesinurad may decrease the systemic exposure and therapeutic efficacy of vardenafil; monitor for potential reduction in efficacy. Vardenafil is a CYP3A substrate, and lesinurad is a weak CYP3A inducer.

Lesinurad; Allopurinol: (Moderate) Lesinurad may decrease the systemic exposure and therapeutic efficacy of vardenafil; monitor for potential reduction in efficacy. Vardenafil is a CYP3A substrate, and lesinurad is a weak CYP3A inducer.

Letermovir: (Major) Due to increased vardenafil

exposure

cyclosporine

plasma

In addition, the half-life of vardenafil increased by 2-fold.

Moderate CYP3A4 inhibitors, increased the Cmax and AUC of vardenafil by 3-fold and 4-fold, respectively.

Leuprolide: (Moderate) Consider whether the benefits of androgen deprivation therapy (i.e., leuprolide) outweigh the potential risks of QT prolongation in patients receiving vardenafil as concurrent use may increase the risk of QT prolongation. Both therapeutic and supratherapeutic doses of vardenafil produce an increase in QTc interval.

Androgen deprivation therapy may also prolong the QT/QTc interval.