Vardenafil*—*Vardenafil is available as a 10 and 20 mg dose. Although there are no direct comparison studies, vardenafil appears to be as effective as sildenafil. The duration of action, like sildenafil, is approximately four hours. The following observations illustrate both efficacy and potential concerns: In a trial of 805 men ages 57 to 78 with erectile dysfunction of various etiologies randomly assigned to receive vardenafil 5, 10, or 20 mg or placebo as needed for six months, vardenafil was more effective than placebo for improving penetration (64 to 80 versus 50 percent, respectively) and maintenance of erections (50 to 67 versus 32 percent, respectively). Similar results were noted in a second large, randomized trial. Vardenafil is also more effective than placebo for men with erectile dysfunction due to diabetes mellitus or nerve-sparing radical prostatectomy. High-fat, but not moderate-fat meals, may lower vardenafil's peak serum concentration by approximately 18 percent, and delay its absorption by one hour. A slight prolongation of the QT interval may occur, but this is not thought to be clinically important. However, vardenafil should not be used in men with congenital QT prolongation or in those taking antiarrhythmics drugs such as quinidine, procainamide, amiodarone, or sotalol. Side effects are similar to those seen with sildenafil, and include headache, flushing, and rhinitis, in 13, 10, 10 and 5 percent, respectively. In one trial, side effects decreased over time. Changes in color vision (blue vision) have not been reported thus far. Issues related to ######ual activity in men with coronary heart disease are similar to those with sildenafil.
order cialis
buy brand levitra online
cialis online
In summary, vardenafil appears to be as effective as sildenafil with no evidence of a more rapid onset of action or other clinical advantages. Like sildenafil, vardenafil is contraindicated in men taking concurrent nitrates. Package labeling for vardenafil had initially listed concurrent use of alpha-blockers as a contraindication. However, the labeling has been revised to state that patients should be stable on alpha-blocker therapy prior to initiating vardenafil (which should be started at the lowest recommended dose). In patients already taking vardenafil, alpha-blocker therapy should be started at the lowest dose possible.