Vardenafil and Amitriptyline: Can You Take Them Together?

Vardenafil and Amitriptyline: Understanding the Interaction

Published: 27 October 2026

Many men wonder whether vardenafil and amitriptyline can be taken together safely. The good news is that there is no major direct interaction between vardenafil (generic Levitra), a medicine used to treat erectile dysfunction, and amitriptyline, a tricyclic antidepressant commonly prescribed for depression, nerve pain, and migraine prevention. However, both medicines can affect your heart rhythm and blood pressure, so your prescriber will carefully review your medical history and current medications during your consultation to ensure the combination is appropriate for you.

What is vardenafil and how does it work?

Vardenafil is a prescription medicine used to treat erectile dysfunction (ED) in 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. This helps you get and keep an erection suitable for sexual activity.

Vardenafil is available in 5mg, 10mg, and 20mg tablets and is usually taken about 25 to 60 minutes before sexual activity [5]. The effect can last for several hours, but you should not take it more than once a day. It's important to remember that vardenafil only works when you are sexually stimulated—it does not cause an automatic erection.

At Cured Pharmacy, vardenafil is available after an online consultation reviewed by a UK-registered prescriber. The prescriber will check your medical history, current medicines, and any conditions that might make vardenafil unsuitable, such as recent heart problems, very low blood pressure, or certain eye conditions.

What is amitriptyline and why is it prescribed?

Amitriptyline is a tricyclic antidepressant that has been used for many years to treat depression, but it is now more commonly prescribed for other conditions. These include chronic pain (especially nerve pain), migraine prevention, and certain sleep disorders. It works by affecting the balance of chemical messengers in the brain, particularly serotonin and noradrenaline.

Amitriptyline is usually taken once daily, often at bedtime because it can cause drowsiness. Common side effects include dry mouth, constipation, blurred vision, and dizziness, especially when standing up. These effects are due to amitriptyline's action on certain receptors in the body, including those that control heart rate and blood pressure.

It's worth noting that amitriptyline itself can sometimes contribute to erectile difficulties as a side effect, particularly at higher doses. If you think your antidepressant may be affecting your sexual function, speak to your GP—never stop a prescribed medicine without medical advice, as stopping amitriptyline suddenly can cause withdrawal symptoms.

Can amitriptyline cause erectile dysfunction?

Yes, tricyclic antidepressants like amitriptyline can sometimes cause or worsen erectile dysfunction as a side effect. This happens because these medicines affect the nervous system and certain chemical messengers involved in sexual arousal and erection. If you have noticed ED symptoms since starting amitriptyline, it's important to discuss this with your GP. They may be able to adjust your dose or suggest an alternative treatment that has fewer sexual side effects.

The interaction between vardenafil and amitriptyline explained

There is no major direct pharmacological interaction between vardenafil and amitriptyline that would prevent them from being used together. However, both medicines can affect your cardiovascular system in ways that need careful consideration.

Amitriptyline can cause changes in heart rhythm (QT prolongation) and may lower blood pressure, especially when you stand up (postural hypotension). Vardenafil can also cause a small drop in blood pressure as it relaxes blood vessels. When taken together, there is a theoretical risk that these blood-pressure-lowering effects could add up, potentially causing dizziness, light-headedness, or fainting.

Additionally, both medicines are partly broken down in the liver by similar enzyme systems. While amitriptyline is not a potent inhibitor of the enzymes that metabolise vardenafil, individual variation in how people process these medicines means your prescriber will want to know about all your current medications. This is why a thorough consultation is essential before vardenafil is prescribed to anyone taking amitriptyline.

What your prescriber checks before prescribing vardenafil and amitriptyline together

When you request vardenafil through Cured Pharmacy's online consultation, the UK-registered prescriber will ask detailed questions about your medical history and all medicines you currently take, including amitriptyline. They will check for any conditions that make PDE5 inhibitors unsuitable, such as recent heart attack or stroke, unstable angina, severe heart failure, very low blood pressure, or previous sudden vision loss (NAION) [5].

The prescriber will also review whether you take any medicines that must never be combined with vardenafil. These include nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, and recreational drugs called 'poppers' (amyl or alkyl nitrites). Taking vardenafil with any of these can cause a dangerous drop in blood pressure [5].

If you are on amitriptyline, the prescriber will consider your dose, how long you have been taking it, whether you have any heart rhythm problems, and whether you experience dizziness or low blood pressure. They may recommend starting with a lower dose of vardenafil (such as 5mg) to minimise the risk of side effects. If you also take other medicines that lower blood pressure or affect heart rhythm, extra caution is needed.

Alpha-blockers and other blood pressure medicines

If you take alpha-blockers (such as tamsulosin or doxazosin) for prostate symptoms or high blood pressure, this is particularly important to declare. Alpha-blockers combined with PDE5 inhibitors can cause a significant drop in blood pressure. You should be stable on the alpha-blocker before starting vardenafil, and your prescriber will choose the lowest suitable dose of the ED medicine [5]. Similarly, if you take other blood-pressure medicines, the prescriber will assess whether the combination is safe for you.

Practical advice for taking vardenafil and amitriptyline safely

If your prescriber approves the combination of vardenafil and amitriptyline, there are several practical steps you can take to use these medicines safely. First, always take vardenafil exactly as prescribed—usually one tablet about 25 to 60 minutes before sexual activity, and no more than once in 24 hours [5]. Do not take a higher dose than recommended.

Be aware of how you feel when you stand up, especially in the first few hours after taking vardenafil. Both medicines can cause dizziness or light-headedness, particularly when moving from sitting or lying to standing. Take your time getting up, and sit down if you feel dizzy. Avoid heavy alcohol, as this can worsen low blood pressure and make erectile dysfunction worse.

Continue taking your amitriptyline as prescribed by your doctor—do not stop or change the dose without medical advice. If you experience any new or worsening symptoms after starting vardenafil, such as chest pain, severe dizziness, fainting, palpitations, or an erection lasting more than four hours, seek urgent medical help. Always keep your GP informed about all the medicines you are taking, including those obtained online.

Alternatives to vardenafil and when to see your GP about ED

If vardenafil is not suitable for you, or if you would prefer to try a different option, there are several other licensed treatments for erectile dysfunction available in the UK. These include sildenafil (generic Viagra), tadalafil (generic Cialis), and avanafil (Spedra)—all PDE5 inhibitors that work in a similar way to vardenafil [3][4][6]. Your prescriber can discuss which option may be best based on your individual circumstances and preferences.

Tadalafil is often chosen by men who prefer a longer-lasting option, as its effects can last up to 36 hours, or it can be taken daily at a lower dose [4]. Sildenafil is the most widely used and is available at a lower cost [3]. Avanafil works more quickly, often within 15 to 30 minutes [6]. All of these medicines require the same careful checks for interactions and contraindications.

It's important to see your GP if you have new or worsening erectile dysfunction, especially if you have not discussed it with a doctor before. ED can be an early warning sign of cardiovascular disease or diabetes [1][2]. Your GP can investigate underlying causes, review all your medicines (including whether amitriptyline or other drugs might be contributing), and refer you to a specialist if needed. Treating the underlying cause, alongside ED medication if appropriate, often gives the best results.

Other treatment options for erectile dysfunction

In addition to oral PDE5 inhibitors, other treatments are available for men who cannot take tablets or for whom they are not effective. These include Eroxon, a topical gel medical device that can be purchased without prescription, and prescription-only options such as Vitaros (alprostadil cream) and Caverject (alprostadil injection) [7]. Vacuum erection devices and penile implants are also options in certain cases. Your GP or a specialist can advise on the full range of treatments.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 27 October 2026]
2. National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 27 October 2026]
3. Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 27 October 2026]
4. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 27 October 2026]
5. Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 27 October 2026]
6. Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 27 October 2026]
7. Joint Formulary Committee. (n.d.). Alprostadil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/alprostadil/ [accessed 27 October 2026]

Information on this page is for educational purposes only and is not medical advice. Prescription treatments require clinical assessment by a UK-registered prescriber. Always consult a qualified healthcare professional before starting or changing any medication.