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Pharmacologic and/or surgical therapy to effectively will happen at the drug in your body after about 4 hours. Its molecular structure is very similar they target: nucleoside reverse transcriptase inhibitors; non-nucleoside reverse.

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Dizziness, fainting spells, heart attack, or stroke may be experienced. If use of a nitrate-containing medication is considered medically necessary, a nitrate may only be taken at least 48 hours after the last dose of vardenafil, and only under close medical supervision. Penis deformation: As with other medications for erectile dysfunction, if you have an anatomical deformation of the penis such as angulation, cavernosal fibrosis, or Peyronie's disease, you should be closely monitored by your doctors if you take this medication.

Prolonged erection: If an erection lasts longer than 4 hours (a rare occurrence), seek immediate medical assistance.

If this condition is not treated quickly, tissue damage and permanent loss of the ability to have an erection could result.

Tell your doctor if you have any of the following conditions as they may increase your risk of a prolonged erection: sickle cell anemia, multiple myeloma, or leukemia. Prostate problems: Tell your doctor if you are taking medications such as sildenafil generic cheap alpha blockers (e.g., doxazosin) to treat prostate problems, as the combination of these medications with vardenafil may add to the blood pressure-lowering effect of these medications.

Sexually transmitted infections: Vardenafil does not protect against sexually transmitted infections such as HIV. Vision problems/eye conditions: If you experience a sudden loss of vision in one or both eyes or other vision-related problems, contact your doctor immediately.

While in some cases the condition may improve over time, the loss can also be permanent. This rare condition is more likely to occur if you have heart disease, high blood pressure, high cholesterol, diabetes, or eye problems, or are over 50 years old or smoke.

Vardenafil should not be used by anyone with non-arteritic anterior ischemic optic neuropathy (NAION) or retinosa pigmentosa. Pregnancy and breast-feeding: Vardenafil is not intended for use by women.

Children: Vardenafil is not intended for use by children or adolescents under 18 years of age. Seniors: People over the age of 65 years may require lower doses of this medication.

What other drugs could interact with this medication? There may be an interaction between vardenafil and any of the following: Grapefruit juice may increase the amounts of vardenafil in the blood.

Only take vardenafil with other medications if prescribed by your doctor.

If you are taking any of these medications, speak with your doctor or pharmacist . Depending on your specific circumstances, your doctor may want you to: stop taking one of the medications, change one of the medications to another, change how you are taking one or both of the medications, or leave everything as is. An interaction between two medications does not always mean that you must stop taking one of them.

Speak to your doctor about how any drug interactions are being managed or should be managed.

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Ce medicament est habituellement prescrit pour : Indications + - Traitement de la dysfonction erectile chez l'homme adulte.

La dysfonction erectile correspond a l'incapacite d'obtenir ou de maintenir une erection du penis suffisante pour une activite sexuelle satisfaisante.

Une stimulation sexuelle est requise pour que Levitra soit efficace. Comment le prendre + - Utilisation chez l'homme adulte. La dose recommandee est de 10 mg a prendre selon les besoins, environ 25 a 60 minutes avant toute activite sexuelle.

En fonction de l'efficacite et de la tolerance, la dose peut etre portee a 20 mg ou reduite a 5 mg. Il est recommande d'utiliser le medicament au maximum une fois par jour.

Le delai d'action peut etre retarde en cas de prise au cours d'un repas riche en graisse (voir rubrique Proprietes pharmacocinetiques).

Patients ages (?65 ans) Un ajustement posologique n'est sildenafil generic cheap pas necessaire chez les patients ages. Cependant, une augmentation jusqu'a la dose maximale de 20 mg doit etre consideree avec prudence en tenant compte de la tolerance individuelle (voir rubriques Mises en garde et precautions d'emploi et Effets indesirables). Une dose initiale de 5 mg doit etre envisagee chez les patients presentant une insuffisance hepatique legere a moderee (classes A et B de Child-Pugh). En fonction de la tolerance et de l'efficacite, la dose pourra etre augmentee ulterieurement. La dose maximum recommandee chez les patients presentant une insuffisance hepatique moderee (classe B de Child-Pugh) est de 10 mg (voir rubriques Contre-indications et Proprietes pharmacocinetiques). Aucun ajustement posologique n'est necessaire chez les patients presentant une insuffisance renale legere a moderee. Chez les patients avec une insuffisance renale severe (clairance de la creatinine.

Effets indesirables possibles + - Conjonctivite Oedeme allergique Angioedeme Reaction allergique Trouble du sommeil Anxiete Cephalee.

Sensation vertigineuse Somnolence Paresthesie Dysesthesie Syncope Convulsions Amnesie Hyperhemie oculaire Alteration de la vision des couleurs Douleur oculaire Inconfort oculaire Photophobie Augmentation de la pression intra-oculaire Augmentation des secretions lacrymales Neuropathie optique ischemique anterieure non arteritique Anomalie visuelle Acouphene Vertige Surdite soudaine Palpitation Tachycardie Infarctus du myocarde Tachyarythmie ventriculaire Angine de poitrine Bouffee vasomotrice Hypotension Hypertension Congestion nasale Dyspnee Congestion des sinus Epistaxis Dyspepsie Reflux gastro-oesophagien Gastrite Douleur abdominale Douleur gastro-intestinale Diarrhee Vomissement Nausee Secheresse buccale Elevation des transaminases Elevation des gammaGT Erytheme cutane Rash cutane Reaction de photosensibilite Douleur dorsale Augmentation de la creatine phosphokinase sanguine Myalgie Augmentation du tonus musculaire Crampe Hematurie Erection prolongee Priapisme Hemorragie penienne Hemospermie Sensation de malaise Douleur thoracique Hemorragie cerebrovasculaire Mort subite d'origine cardiaque Accident ischemique transitoire Angor instable Arythmie ventriculaire.

Les effets indesirables rapportes dans les essais cliniques menes avec Levitra, comprime pellicule ou Levitra 10 mg, comprime orodispersible, etaient generalement transitoires et d'intensite legere a moderee. Les effets indesirables les plus couramment rapportes, se produisant chez au moins 10% des patients, sont les cephalees.

Dyspepsie Reflux gastro- Elevation des Elevation des. Douleurs dorsales Elevation de la CPK (creatine phosphokinase sanguine) Myalgies Augmentation du tonus musculaire et crampes.

Lors de l'utilisation de tous les inhibiteurs de la PDE5, y compris le vardenafil, des hemorragies peniennes, des hemospermies et des hematuries ont ete rapportees dans les essais cliniques et signalees en spontane dans le cadre du suivi de pharmacovigilance post-commercialisation. A la dose de 20 mg de Levitra, comprime pellicule, les patients ages (?65 ans) ont presente, comparativement aux patients plus jeunes ( La declaration des effets indesirables suspectes apres autorisation du medicament est importante. Elle permet une surveillance continue du rapport benefice/risque du medicament. Les professionnels de sante doivent declarer tout effet indesirable suspecte via le systeme national de declaration- voir Annexe V.

Contre-indications + - Hypersensibilite vardenafil Perte de la vision d'un oeil due a une neuropathie optique ischemique anterieure non cvs pharmacy sildenafil price arteritique Contre-indication a l'activite sexuelle Insuffisance hepatique severe Stade terminal d'insuffisance renale necessitant une dialyse Hypotension + Afficher plus - Afficher moins.

Hypersensibilite a la substance active ou a l'un des excipients mentionnes a la rubrique Composition. L'administration concomitante de vardenafil avec les derives nitres ou les donneurs de monoxyde d'azote (comme le nitrite d'amyle) quelle que soit la forme, est contre-indiquee (voir rubriques Interactions avec d'autres medicaments et autres formes d'interactions et Proprietes pharmacodynamiques). Levitra est contre-indique chez les patients ayant une perte de la vision d'un ?il due a une neuropathie optique ischemique anterieure non arteritique (NOIAN), que cet evenement ait ete associe ou non a une exposition anterieure a un inhibiteur de la phosphodiesterase de type 5 (PDE5) (voir rubrique Mises en garde et precautions d'emploi). Les medicaments utilises dans le traitement de la dysfonction erectile ne doivent pas etre utilises chez les hommes pour qui l'activite sexuelle est deconseillee (par exemple les patients avec des troubles cardiovasculaires severes tels que l'angor instable ou l'insuffisance cardiaque severe [NYHA III ou IV]). La tolerance du vardenafil n'a pas ete etudiee dans les sous-groupes de patients suivants et son utilisation chez ces patients est par consequent contre-indiquee sildenafil generic cheap jusqu'a ce que des informations complementaires soient disponibles : insuffisance hepatique severe (classe C de Child-Pugh), stade terminal d'insuffisance renale necessitant une dialyse, hypotension (pression arterielle. Precautions demploi + - Indications limitees a l'homme adulte de plus de 18 ans Risque cardiovasculaire Obstruction a l'ejection du ventricule gauche Malformation anatomique du penis Predisposition au priapisme Sujet age Anomalie visuelle.

Trouble hemorragique Ulcere gastroduodenal evolutif Insuffisance hepatique legere a moderee Insuffisance renale severe (Clcr + Afficher plus - Afficher moins. On pratiquera une anamnese et un examen clinique afin de diagnostiquer la dysfonction erectile et d'en determiner les causes sous-jacentes potentielles avant d'envisager un traitement medicamenteux. Avant d'instaurer un traitement de la dysfonction erectile, les medecins doivent examiner la fonction cardiovasculaire de leurs patients, dans la mesure ou toute activite sexuelle comporte un risque cardiaque (voir rubrique Contre-indications). Le vardenafil a des proprietes vasodilatatrices entrainant des diminutions legeres et transitoires de la pression arterielle (voir rubrique Proprietes pharmacodynamiques).

Les patients presentant une obstruction a l'ejection du ventricule gauche, par exemple stenose aortique, stenose sub-aortique hypertrophique idiopathique, peuvent etre sensibles a l'action de vasodilatateurs dont les inhibiteurs de la phosphodiesterase de type 5. Les medicaments utilises dans le traitement de la dysfonction erectile doivent etre prescrits avec prudence chez les patients presentant une malformation anatomique du penis (comme une angulation, une sclerose des corps caverneux ou la maladie de La Peyronie), ou chez les patients presentant des pathologies susceptibles de les predisposer au priapisme (comme une drepanocytose, un myelome multiple ou une leucemie).

La tolerance et l'efficacite de l'association de Levitra, comprime pellicule avec Levitra, comprime orodispersible ou avec d'autres traitements de la dysfonction erectile n'

ont

pas ete etudiees.

Il n'est donc pas recommande de recourir a de telles associations.

La tolerance a la dose maximale de 20 mg peut etre diminuee chez les patients ages (? 65 ans) (voir rubriques Posologie sildenafil generic cheap et mode d'administration et Effets indesirables).

L'administration concomitante d'alpha-bloquants et de vardenafil peut entrainer, chez certains patients, une hypotension symptomatique car ce sont tous deux des vasodilatateurs. Un traitement concomitant avec le vardenafil ne pourra seulement etre instaure que si le patient a ete stabilise sous son traitement par alpha-bloquant.

Chez les patients stabilises sous traitement par alpha-bloquants, le traitement par vardenafil doit etre instaure a la plus faible dose initiale recommandee, soit 5 mg en comprime pellicule.

Le vardenafil peut etre administre a tout moment avec la tamsulosine ou avec l'alfuzosine.

Pour les autres alpha-bloquants, un intervalle de temps entre les prises doit etre respecte en cas de prise concomitante du vardenafil (voir rubrique Interactions avec d'autres medicaments et autres formes d'interactions). Chez les patients deja traites par une dose optimale de vardenafil, le traitement par alpha-bloquants doit etre initie a la plus faible dose. Chez les patients traites par vardenafil, l'augmentation des doses d'alpha-bloquants par paliers peut entrainer une diminution supplementaire de la pression arterielle.

Administration concomitante d'inhibiteurs du CYP3A4.

L'administration concomitante de vardenafil avec de puissants inhibiteurs du CYP3A4 tels que l'itraconazole et le ketoconazole (forme orale) doit etre evitee (voir rubrique Interactions avec d'autres medicaments et autres formes d'interactions), car des concentrations plasmatiques elevees de vardenafil sont obtenues si ces medicaments sont associes (voir rubriques Contre-indications et Interactions avec d'autres medicaments et autres formes d'interactions).

Une adaptation de la posologie de vardenafil, peut etre necessaire en cas d'administration concomitante avec des inhibiteurs moderes du CYP3A4 tels que l'erythromycine ou la clarithromycine (voir rubriques Posologie et mode d'administration et Interactions avec d'autres medicaments et autres formes d'interactions).

La prise concomitante de pamplemousse ou de jus de pamplemousse est susceptible d'augmenter les concentrations plasmatiques de vardenafil. Cette association doit etre evitee (voir rubrique Interactions avec d'autres medicaments et autres formes d'interactions).

Il a ete demontre que la prise unique de 10 mg et 80 mg de vardenafil prolonge, respectivement, de 8 msec et 10 msec en moyenne l'intervalle QTc.

Aussi, la prise unique de 10 mg de vardenafil administre en association avec 400 mg de gatifloxacine (une substance active presentant un effet comparable sur l'intervalle QT), engendre un allongement additionnel de l'intervalle QTc de 4 msec compare a l'effet de chaque substance active prise separement.

L'impact clinique de ces modifications de QT est inconnu (voir rubrique Proprietes pharmacodynamiques). La pertinence clinique de ces resultats n'est pas connue et ne peut pas etre generalisee a tous les patients dans toutes les circonstances, car cela depend des facteurs individuels de risque ainsi que des sensibilites pouvant exister a un moment donne pour un patient donne.

Les medicaments qui peuvent prolonger l'intervalle QTc, dont le vardenafil, sont fortement deconseilles chez des patients presentant des facteurs de risque, par exemple, une hypokaliemie, un allongement congenital de l'intervalle QT, une administration concomitante d'anti-arythmique de Classe Ia (par exemple : quinidine, procainamide) ou de Classe III (par exemple : amiodarone, sotalol).

Des anomalies visuelles et des cas de neuropathie optique ischemique anterieure non arteritique (NOIAN) ont ete rapportes a la suite de la prise de Levitra et d'autres inhibiteurs de la PDE5.

L'analyse des donnees observationnelles suggere une augmentation du risque de NOIAN aigue chez les hommes atteints d'une dysfonction erectile apres une exposition a des inhibiteurs de PDE5 tels que le vardenafil, le tadalafil et le sildenafil (voir rubrique Effets indesirables).

Comme cela peut concerner tous les patients exposes au vardenafil, le patient doit etre averti qu'en cas d'anomalie visuelle soudaine, il doit arreter la prise de Levitra et consulter immediatement un medecin (voir rubrique Contre-indications). Des etudes in vitro sur les plaquettes sanguines humaines ont montre que le vardenafil n'a pas d'effet antiagregant plaquettaire a lui seul, mais a doses elevees (supra-therapeutiques), le vardenafil potentialise l'effet antiagregant d'un donneur de monoxyde d'azote, le nitroprussiate de sodium.

Chez l'homme, le vardenafil utilise seul ou en association avec l'acide acetylsalicylique n'a pas d'effet sur le temps de saignement (voir rubrique Interactions avec d'autres medicaments et autres formes d'interactions).

Il n'y a pas d'informations disponibles sur la tolerance du vardenafil chez les patients presentant des troubles hemorragiques ou un ulcere gastroduodenal evolutif. Aussi, chez ces patients, le vardenafil ne doit etre administre qu'apres une evaluation minutieuse du rapport benefice-risque.

Interactions medicamenteuses + - Effets d'autres medicaments sur le vardenafil.

Le vardenafil est principalement metabolise par les enzymes hepatiques via l'isoforme 3A4 du cytochrome P450 (CYP), avec la contribution des isoformes CYP3A5 et CYP2C.

Les inhibiteurs de ces isoenzymes peuvent de ce fait, diminuer la clairance du vardenafil. L'administration concomitante de l'antiprotease, indinavir (800 mg trois fois par jour), un puissant inhibiteur du CYP3A4, et de vardenafil (10 mg sous forme de comprime pellicule) a entraine une augmentation de 16 fois l'AUC et de 7 fois la Cmax du vardenafil.

A 24 heures, les concentrations plasmatiques de vardenafil sont tombees a environ 4% de la concentration plasmatique maximale du vardenafil (Cmax). L'administration concomitante de ritonavir (600 mg 2 fois par jour) et de vardenafil 5 mg a entraine une augmentation de 13 fois la Cmax du vardenafil et de 49 fois l'AUC0-24 du vardenafil.

Cette interaction resulte d'une inhibition du metabolisme hepatique du vardenafil par le ritonavir, tres puissant inhibiteur du CYP3A4 et egalement inhibiteur du CYP2C9. Le ritonavir prolonge significativement la demi-vie du vardenafil a 25,7 heures (voir rubrique Contre-indications). L'administration concomitante de ketoconazole (200 mg), un puissant inhibiteur du CYP3A4, et de vardenafil (5 mg) a entraine une augmentation de 10 fois l'AUC et de 4 fois la Cmax du vardenafil (voir rubrique Mises en garde et precautions d'emploi). Bien que des etudes portant specifiquement sur les interactions n'aient pas ete conduites, on peut s'attendre a ce que l'administration concomitante d'autres puissants inhibiteurs du CYP3A4 (tels que l'itraconazole) induise une concentration plasmatique en vardenafil comparable a celle induite par le ketoconazole.

L'administration concomitante de vardenafil avec des inhibiteurs puissants du CYP3A4 tels que itraconazole et ketoconazole (par voie orale) doit etre evitee (voir rubriques Contre-indications et Mises en garde et precautions d'emploi). Chez les hommes ages de plus de 75 ans, l'administration concomitante de vardenafil et d'itraconazole ou de ketoconazole est contre-indiquee (voir rubrique Contre-indications).

L'administration concomitante d'erythromycine (500 mg trois fois par jour), un inhibiteur du CYP3A4, et de vardenafil (5 mg) a entraine une augmentation de 4 fois l'AUC et de 3 fois la Cmax du vardenafil. Bien qu'aucune etude portant specifiquement sur les interactions n'ait ete conduite, il est possible que la co-administration de clarithromycine induise un effet similaire sur l'AUC et la Cmax du vardenafil.

En cas d'utilisation concomitante avec un inhibiteur modere du CYP3A4 tel que l'erythromycine ou la clarithromycine, une adaptation de la posologie du vardenafil peut etre necessaire (voir rubriques Posologie et mode d'administration et Mises en garde et precautions d'emploi).

La cimetidine (400 mg deux fois par jour), inhibiteur non specifique du cytochrome P450, associee au vardenafil (20 mg) chez le volontaire sain, n'a pas eu d'effet sur l'AUC et la Cmax du vardenafil. Le jus de pamplemousse etant un inhibiteur leger du metabolisme du sildenafil generic cheap CYP3A4 au niveau de la paroi intestinale, il pourrait augmenter faiblement les concentrations plasmatiques de vardenafil (voir rubrique Mises en garde et precautions d'emploi).

La pharmacocinetique du vardenafil (20 mg) n'a pas ete modifiee par l'administration concomitante d'un antagoniste-H2, la ranitidine (150 mg deux fois par jour), de digoxine, de warfarine, de glibenclamide, d'alcool (niveau d'alcool sanguin maximal moyen de 73 mg/dl) ou des doses uniques d'antiacide gastrique (hydroxyde de magnesium ou d'aluminium).



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