Vardenafil and Alfuzosin: Can They Be Taken Together?

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Key takeaways

• Vardenafil and alfuzosin can be taken together, but only under medical supervision due to blood pressure interaction.
• Your prescriber will start you on the lowest dose of vardenafil (5 mg) if you take alfuzosin.
• Stand up slowly and avoid heavy alcohol to reduce the risk of dizziness or fainting.
• Never take vardenafil with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor.
• Seek urgent help if you have an erection lasting over 4 hours or sudden vision or hearing loss.

What is vardenafil and alfuzosin used for?

Vardenafil (also known by the brand name Levitra) is a prescription medicine used to treat erectile dysfunction in adult men [5]. It belongs to a group of medicines called PDE5 inhibitors, which work by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Vardenafil is available in 5 mg, 10 mg, and 20 mg tablets and is usually taken about 25 to 60 minutes before sexual activity [5]. It does not work without sexual stimulation and should not be taken more than once a day.

Alfuzosin is an alpha-blocker prescribed to relieve urinary symptoms in men with benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland [12]. It works by relaxing the muscles in the prostate and bladder neck, making it easier to pass urine. Alfuzosin is typically taken once daily, and many men find that their urinary flow improves within a few days to weeks of starting treatment. Because both vardenafil and alfuzosin affect blood vessels and blood pressure, their interaction must be carefully managed [2][5].

How do vardenafil and alfuzosin interact?

Both vardenafil and alfuzosin can lower blood pressure, and when taken together, this effect can be amplified [5]. Vardenafil relaxes blood vessels in the penis to improve erectile function, but it also has a mild blood-pressure-lowering effect throughout the body. Alfuzosin relaxes smooth muscle in the prostate and bladder, but it also relaxes blood vessels, which can reduce blood pressure. When you take both medicines, the combined effect on blood pressure can lead to symptoms such as dizziness, light-headedness, or even fainting, especially when standing up quickly [2][5].

This interaction is not an absolute contraindication—meaning the two medicines are not forbidden together—but it does require caution and medical oversight [5]. The risk is highest when you first start vardenafil or if your alfuzosin dose has recently been changed. Your prescriber will assess your overall cardiovascular health, check that you are stable on alfuzosin, and usually recommend starting vardenafil at the lowest effective dose (typically 5 mg) to reduce the chance of a significant blood pressure drop [2][5].

Why does this interaction matter?

A sudden drop in blood pressure can cause you to feel dizzy, weak, or faint, which can be dangerous if you are driving, operating machinery, or standing on stairs [5]. In rare cases, a severe drop in blood pressure can reduce blood flow to vital organs. That is why your prescriber needs to know about all your current medicines, including alfuzosin, before prescribing vardenafil. By starting with a low dose and monitoring your response, the risk can be managed safely, and many men successfully use both medicines together without problems [2][5].

At a glance

What does your prescriber check before prescribing vardenafil and alfuzosin together?

When you request vardenafil through an online consultation at Cured Pharmacy, our UK-registered prescribers will ask detailed questions about your current medicines, including any alpha-blockers such as alfuzosin [2]. They will check that you have been taking alfuzosin for a stable period (usually at least a few weeks) and that you are not experiencing troublesome side effects such as dizziness or low blood pressure. If you are new to alfuzosin or your dose has recently been adjusted, the prescriber may advise waiting until you are stable before starting vardenafil [5].

Your prescriber will also review your cardiovascular health, including any history of heart disease, stroke, or blood pressure problems [2]. They will ask about other medicines you take, because some drugs (such as potent CYP3A4 inhibitors like ritonavir or ketoconazole) can raise vardenafil levels in your blood and increase the risk of side effects [5]. If the prescriber judges that the combination of vardenafil and alfuzosin is appropriate for you, they will usually recommend starting with the lowest dose of vardenafil (5 mg) and advise you to monitor for any signs of low blood pressure, such as dizziness or feeling faint [2][5].

Starting on a lower dose

The British National Formulary advises that men taking alpha-blockers should start vardenafil at a reduced dose [5]. This cautious approach allows your body to adjust to the combination and helps your prescriber assess how you respond. If the lower dose is effective and well tolerated, it may be continued; if not, and if you experience no troublesome side effects, the dose may be increased under medical guidance. Never increase the dose yourself or take vardenafil more frequently than prescribed, as this raises the risk of side effects, including a dangerous drop in blood pressure [5].

Practical advice for taking vardenafil and alfuzosin safely

If you are prescribed vardenafil while taking alfuzosin, follow your prescriber's instructions carefully [5]. Take vardenafil about 25 to 60 minutes before you plan to have sex, and do not take it more than once in 24 hours. Swallow the tablet whole with water; you can take it with or without food, although a heavy or high-fat meal may delay its effect. Because both medicines can lower blood pressure, be cautious when standing up from sitting or lying down, especially in the first few hours after taking vardenafil. Stand up slowly and steady yourself to avoid dizziness or fainting [2][5].

Avoid drinking large amounts of alcohol when taking vardenafil, as alcohol can worsen erectile dysfunction and add to the blood-pressure-lowering effect, increasing the risk of dizziness [5]. Grapefruit juice can raise vardenafil levels in your blood and should be avoided. If you experience persistent dizziness, light-headedness, or feel faint after taking vardenafil, sit or lie down and contact your GP or pharmacist for advice. Do not drive or operate machinery if you feel dizzy or unwell [5].

Never take vardenafil with nitrate medicines (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or recreational drugs known as 'poppers' (amyl or alkyl nitrites), as these combinations can cause a dangerous fall in blood pressure [5]. Do not take vardenafil with another PDE5 inhibitor (such as sildenafil or tadalafil) on the same day. Always tell your prescriber and pharmacist about all the medicines you take, including over-the-counter products and herbal supplements, so they can check for interactions [2][5].

Warning signs and when to seek help with vardenafil and alfuzosin

Most men who take vardenafil and alfuzosin together tolerate the combination well, but it is important to know the warning signs that need urgent attention [5]. If you develop an erection that lasts longer than four hours (a condition called priapism), seek emergency medical help immediately by calling 999 or going to A&E. Priapism can damage the penis permanently if not treated quickly [5]. Although rare, sudden loss of vision in one or both eyes or sudden decrease or loss of hearing (sometimes with ringing in the ears or dizziness) requires urgent medical assessment; stop taking vardenafil and contact a doctor straight away [5].

If you experience chest pain during or after sex, stop the activity and seek medical advice [5]. Do not take nitrate medicines (such as GTN spray) for chest pain if you have taken vardenafil within the last 24 hours, as this combination can cause a life-threatening drop in blood pressure. Tell the healthcare professional that you have taken vardenafil. If you feel severely dizzy, faint, or have a rapid or irregular heartbeat after taking vardenafil with alfuzosin, sit or lie down and seek medical advice promptly [2][5].

Common side effects to be aware of

Common side effects of vardenafil include headache, flushing (redness or warmth in the face or chest), nasal congestion, indigestion, and dizziness [5]. These are usually mild and short-lived. Because you are also taking alfuzosin, you may be more likely to notice dizziness or light-headedness, especially when you first start vardenafil or if the dose is increased. If side effects are troublesome or persistent, speak to your prescriber or pharmacist, who may adjust your dose or suggest an alternative treatment [2][5].

Alternatives and other considerations for vardenafil and alfuzosin users

If you find that vardenafil and alfuzosin together cause troublesome side effects, or if your prescriber advises against the combination, there are other options for treating erectile dysfunction [2]. Other PDE5 inhibitors, such as sildenafil (Viagra) or tadalafil (Cialis), also interact with alpha-blockers in a similar way, so the same caution and dose adjustments apply [3][4]. Avanafil (Spedra) is another PDE5 inhibitor that may be considered; your prescriber will discuss which medicine is most suitable for your individual circumstances [6].

Some men with ED and prostate symptoms may benefit from a daily low-dose PDE5 inhibitor, such as tadalafil 5 mg once daily, which can help both conditions [4]. This approach requires careful assessment by a prescriber and is not suitable for everyone. Non-drug treatments for ED, such as vacuum erection devices, are also available and do not interact with alfuzosin. If ED persists despite treatment, or if you have concerns about your prostate symptoms, your GP may refer you to a specialist urologist for further assessment [2].

Remember that erectile dysfunction can be an early warning sign of cardiovascular disease or diabetes, so it is important to see your GP for a full health check if you have new or worsening ED [1][2]. Lifestyle changes—such as losing weight if you are overweight, exercising regularly, stopping smoking, and reducing alcohol intake—can improve both erectile function and prostate symptoms, and they work well alongside medicine [1][2]. At Cured Pharmacy, our online consultation allows a UK prescriber to review your full medical history and current medicines, including alfuzosin, to ensure that any ED treatment prescribed is safe and appropriate for you.

When to get urgent help

• Erection lasting longer than 4 hours (priapism) — call 999 or go to A&E immediately
• Sudden loss of vision in one or both eyes — stop vardenafil and seek urgent medical help
• Sudden decrease or loss of hearing, possibly with ringing in the ears or dizziness — stop vardenafil and contact a doctor
• Chest pain during or after sex — stop activity, do not take nitrates, and seek medical advice
• Severe dizziness, fainting, or rapid/irregular heartbeat — sit or lie down and seek medical advice promptly

Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.

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