Addressing Common Patient Concerns

Nitric oxide activates the enzyme guanylate cyclase resulting in increased synthesis of cyclic guanosine monophosphate (cGMP) in the smooth muscle cells of the corpus cavernosum. The cGMP in turn triggers smooth muscle relaxation, allowing increased blood flow into the penis, resulting in erection. The tissue concentration of cGMP is regulated by both the rates of synthesis and degradation via phosphodiesterases (PDEs). The most abundant PDE in the human corpus cavernosum is the cGMP-specific phosphodiesterase type 5 (PDE5); therefore, the inhibition of PDE5 enhances erectile function by increasing the amount of cGMP.

Warnings of Levitra and Cialis

Taking vardenafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure. To make sure Levitra is safe for you, tell your doctor if you have ever had: a heart attack, stroke, or congestive heart failure; a heart attack, stroke, or congestive heart failure; long QT syndrome (in you or a family member); long QT syndrome (in you or a family member); a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia; a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia; an eye disorder such as retinitis pigmentosa (an inherited condition of the eye); an eye disorder such as retinitis pigmentosa (an inherited condition of the eye); a physical deformity of the penis (such as Peyronie's disease); a physical deformity of the penis (such as Peyronie's disease); if you have been told you should not have sexual intercourse for health reasons; or if you have been told you should not have sexual intercourse for health reasons; or liver disease, kidney disease (or if you are on dialysis). liver disease, kidney disease (or if you are on dialysis). Vardenafil can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoked or were over 50 years old.

Who should not take vardenafil?

It is not clear whether vardenafil is the actual cause of vision loss. Levitra is not approved for use in women, and the effects of this medicine during pregnancy or in breastfeeding women are unknown. Take Levitra exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Levitra can be taken with or without food. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 has no effect in the absence of sexual stimulation.

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In vitro studies have shown that vardenafil is a selective inhibitor of PDE5.

Shipping Information

-Maximum dose: 20 mg once a day Patients on stable alpha blocker therapy: -Initial dose: 5 mg orally once a day Comments: -Sexual stimulation is required for a response to treatment. -A time interval between dosing should be considered when administering this drug concomitantly with alpha-blockers. 65 years bayer levitra 20mg or older: -Initial dose: 5 mg orally once a day, as needed, approximately 60 minutes before sexual activity Comments: Sexual stimulation is required for a response to treatment. Since Levitra is used as needed, you are not likely to be on a dosing schedule. Do not take Levitra more than once a day.

Are Levitra and Cialis the same?

Allow 24 hours to pass between doses. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Grapefruit and Seville oranges may interact with vardenafil and cause side effects. Avoid consuming grapefruit products and orange marmalades. Drinking alcohol can increase certain side effects of Levitra. The inhibitory effect of vardenafil is more selective on PDE5 than for other known phosphodiesterases (>15-fold relative to PDE6, >130-fold relative to PDE1, >300-fold relative to PDE11, and >1,000-fold relative to PDE2, 3, 4, 7, 8, 9, and 10).

What benefit has Levitra shown during the studies?

This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Levitra only for the for the indication prescribed. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. LEVITRA- vardenafil hydrochloride tablet, film buy levitra 60mg coated APHENA PHARMA SOLUTIONS - TENNESSEE, INC.

Report Problems to the Food and Drug Administration

LEVITRA® is an oral therapy for the treatment of erectile dysfunction. Vardenafil HCl is designated chemically as piperazine, 1-[[3-(1,4-dihydro-5-methyl-4-oxo-7-propylimidazo[5,1-f ][1,2,4]triazin-2-yl)-4-ethoxyphenyl]sulfonyl]-4-ethyl-, monohydrochloride and has the following structural formula: Vardenafil HCl is a nearly colorless, solid substance with a molecular weight of 579.1 g/mol and a solubility of 0.11 mg/mL in water. LEVITRA is formulated as orange, round, film-coated tablets with “BAYER” cross debossed on one side and “2.5”, “5”, “10”, and “20” on the other side corresponding to 2.5 mg, 5 mg, 10 mg, and 20 mg of vardenafil, respectively. Penile erection is a hemodynamic process initiated by the relaxation of smooth muscle in the corpus cavernosum and its associated arterioles. During sexual stimulation, nitric oxide is released from nerve endings and endothelial cells in the corpus cavernosum. The pharmacokinetics of vardenafil are approximately dose proportional over the recommended dose range.

• Levitra 5mg can improve sexual performance for some men.
• No need to take Levitra 5mg daily, only before sexual activity.
• Store Levitra 5mg tablets away from heat and moisture.
• Contact a healthcare provider if you experience sudden vision loss.
• Levitra 5mg may cause priapism, which requires urgent treatment.

Vardenafil is eliminated predominantly by hepatic metabolism, mainly by CYP3A4 and to a minor extent, CYP2C isoforms. Concomitant use with potent CYP3A4 inhibitors such as ritonavir, indinavir, ketoconazole, as well as moderate CYP3A inhibitors such as erythromycin results in significant increases of plasma levels of vardenafil (see PRECAUTIONS, WARNINGS and DOSAGE AND ADMINISTRATION).

• Levitra 5mg is often prescribed for men with mild to moderate ED.
• Do not exceed the prescribed dose of Levitra 5mg.
• Levitra 5mg may interact with certain heart medications.
• Take Levitra 5mg 30-60 minutes before intimacy.
• Seek medical advice if you experience prolonged erection.

Mean vardenafil plasma concentrations measured after the administration of a single oral dose of 20 mg to healthy male volunteers are depicted in Figure 1.

• The medication is generally safe when used as prescribed.
• Keep Levitra 5mg out of reach of children.
• Levitra 5mg may cause a sore throat or upset stomach.
• Alcohol intake can reduce the effectiveness of Levitra 5mg.
• A medical history of heart problems should be disclosed before use.

Figure 1: Plasma Vardenafil Concentration (Mean ± SD) Curve for a Single 20 mg LEVITRA Dose 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 high-fat meals caused a reduction in Cmax by 18%-50%. The mean steady-state volume of distribution (Vss) for vardenafil is 208 L, indicating extensive tissue distribution. 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. 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.

Condition	Explanation	Alternative advice
Severe cardiovascular disease	Risk of adverse cardiac events	Consult cardiologist
Hypotension (<90/60 mm Hg)	Risk of worsening hypotension	Medical assessment required
Nitrate medication use	Contraindicated because of severe hypotension	Do not use concurrently
Retinitis Pigmentosa	Possible vision side effects	Medical consultation advised

The plasma concentration of M1 is approximately 26% that of the parent compound.

Why has Levitra been approved?

Do not use any other medicine to treat impotence unless your doctor tells you to. Get emergency medical help if you have signs of an allergic reaction to Levitra: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using Levitra and get emergency medical help if you have: heart attack symptoms - chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating; heart attack symptoms - chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating; vision changes or sudden vision loss; or vision changes or sudden vision loss; or erection is painful or lasts longer than 4 hours (prolonged erection can damage the penis). erection is painful or lasts longer than 4 hours (prolonged erection can damage the penis). Stop using Levitra and call your doctor at once if you have: ringing in your ears, or sudden hearing loss; ringing in your ears, or sudden hearing loss; swelling in your hands, ankles, or feet; swelling in your hands, ankles, or feet; a light-headed feeling, like you might pass out; or a light-headed feeling, like you might pass out; or flushing (sudden warmth, redness, or tingly feeling); flushing (sudden warmth, redness, or tingly feeling); This is not a complete list of side effects and others may occur.

How should I store vardenafil?

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Do not use Levitra with similar medications such as avanafil (Stendra), sildenafil (Viagra), or tadalafil (Cialis). Tell your doctor about all other medications you use for erectile dysfunction. This list is not complete and many Other drugs may interact with vardenafil. 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.

What is vardenafil?

Staxyn (vardenafil disintegrating tablets) should not be used in place of Levitra (vardenafil regular tablets). Avoid medication errors by using only the form and strength your doctor prescribes. Levitra is taken only when needed, about 60 minutes before sexual activity. The medicine can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill.

How is vardenafil supplied (dosage forms)?

If you receive medical care for heart problems, tell your caregivers when you last took Levitra. This medicine does not prevent the spread of sexually transmitted diseases such as human immunodeficiency virus (HIV). Store at room temperature away from moisture and heat. -Initial dose: 10 mg orally once a day, as needed, approximately 60 minutes before sexual activity. Increase to 20 mg or decrease to 5 mg based on efficacy and tolerability. Therefore, M1 accounts for approximately 7% of total pharmacologic activity.