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These findings are consistent with the inhibition of PDE6 in rods and cones, which is involved in phototransduction in the retina. The findings were most evident one hour after administration, diminishing but still present 6 hours after administration. In a single dose study in 25 normal males, LEVITRA 40 mg, twice the maximum daily recommended dose, did not alter visual acuity, intraocular pressure, fundoscopic and slit lamp findings. Cases of sudden decrease or loss of hearing have been reported postmarketing in temporal association with the use of PDE5 inhibitors, including vardenafil. In some cases, medical conditions and other factors were reported that may have also played a role in the otologic adverse events. It is not possible to determine whether these reported events are related directly to the use of vardenafil, to the patient’s underlying risk factors for hearing loss, a combination of these factors, or to other factors.
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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. The plasma concentration of M1 is approximately 26% that of the parent compound. 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. Therefore, M1 accounts for approximately 7% of total pharmacologic activity.
Because ritonavir prolongs LEVITRA elimination half-life (5-6-fold), no more than a single 2.5 mg dose of LEVITRA should be taken in a 72-hour period by patients also taking ritonavir. Patients taking indinavir, ketoconazole 400 mg daily, or itraconazole 400 mg daily should not exceed LEVITRA 2.5 mg once daily. For patients taking ketoconazole or itraconazole 200 mg daily, a single dose of 5 mg LEVITRA should not be exceeded in a 24-hour period (see PRECAUTIONS, Drug Interactions and DOSAGE AND ADMINISTRATION). Levitra must not be used in people who are hypersensitive (allergic) to vardenafil or any of the other ingredients.
Refilling medications
Tell your healthcare provider if you are or plan to become pregnant. Do not take vardenafil unless it has been prescribed to you by a healthcare provider. Your pharmacist can tell you all of the ingredients in the specific vardenafil products they stock.
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Talk to your healthcare provider to see if your heart is strong enough for sex. If you feel chest pain, dizziness, or nausea during sex, buy xanax without prescrition stop and contact your healthcare provider right away. Vardenafil should not be taken while you are using certain other medicines. Before taking vardenafil, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.