Vardenafil and Apomorphine: Can They Be Taken Together?

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At a glance

What is vardenafil and how does it work?

Vardenafil is a prescription medicine licensed in the UK for erectile dysfunction. It belongs to a group of medicines called PDE5 inhibitors, which also includes sildenafil (Viagra), tadalafil (Cialis), and avanafil (Spedra) [5]. Vardenafil works by relaxing the blood vessels in the penis, allowing more blood to flow in when you are sexually aroused.

You typically take vardenafil about 25 to 60 minutes before sexual activity. It comes in 5mg, 10mg, and 20mg tablets, and the usual starting dose is 10mg [5]. The medicine only works when you are sexually stimulated—it does not cause an automatic erection. Effects can last for several hours, though this varies between individuals.

Vardenafil is broken down in the body by liver enzymes, particularly one called CYP3A4. This means that other medicines affecting this enzyme can change how vardenafil works in your system [5]. Your prescriber will check your current medicines and health conditions before prescribing vardenafil to make sure it is safe for you.

What is apomorphine and is it still used for ED?

Apomorphine is a medicine that was previously available in the UK under the brand name Uprima for erectile dysfunction. Unlike PDE5 inhibitors such as vardenafil, apomorphine works on dopamine receptors in the brain to trigger the body's natural erection response [12]. It was taken as a tablet that dissolved under the tongue, usually 20 minutes before sexual activity.

However, apomorphine for erectile dysfunction is no longer marketed in the UK. It was discontinued several years ago, largely because PDE5 inhibitors like sildenafil, tadalafil, and vardenafil proved more effective and had fewer side effects [2]. Apomorphine is still used in the UK, but for a completely different condition: Parkinson's disease, where it helps control movement symptoms.

If you have been prescribed apomorphine for Parkinson's disease and are considering treatment for erectile dysfunction, it is essential to tell your prescriber. The apomorphine used for Parkinson's is given by injection or infusion and works differently in the body, but your prescriber still needs to know about all your medicines to assess safety and avoid interactions.

Why was apomorphine for ED discontinued?

Apomorphine for erectile dysfunction was withdrawn from the market because it was less effective than PDE5 inhibitors and caused more side effects, particularly nausea and dizziness. Clinical trials showed that PDE5 inhibitors had higher success rates and were better tolerated by most men [2]. Today, vardenafil and other PDE5 inhibitors are the first-line treatment for ED in the UK.

Can you take vardenafil and apomorphine together?

Because apomorphine for erectile dysfunction is no longer available in the UK, the question of combining it with vardenafil rarely arises in practice. However, if you were prescribed apomorphine for ED in the past or obtained it from another country, it is important to understand the interaction.

There is no absolute contraindication that says you must never take vardenafil and apomorphine together—unlike the dangerous combination of vardenafil with nitrates or poppers, which can cause a life-threatening drop in blood pressure [5]. However, combining two medicines for erectile dysfunction is not recommended because it does not improve results and increases the risk of side effects such as low blood pressure, dizziness, and priapism (a prolonged, painful erection).

If you are taking apomorphine for Parkinson's disease and want to use vardenafil for erectile dysfunction, your prescriber will assess your overall health, blood pressure, and other medicines. Apomorphine for Parkinson's can lower blood pressure, and vardenafil can have a similar effect, so the combination requires careful monitoring [5][12]. Always declare all your medicines, including those for other conditions, during your consultation.

What does the prescriber check with vardenafil and apomorphine?

Your prescriber will review your full medical history, including cardiovascular health, blood pressure, and any medicines that affect blood pressure or are broken down by the same liver enzymes as vardenafil. They will check whether you are taking nitrates, alpha-blockers, or other medicines that could interact [5]. If you are using apomorphine for Parkinson's disease, the prescriber will consider the risk of additive blood-pressure-lowering effects and may start you on a lower dose of vardenafil or recommend closer monitoring.

What you need to know

• Vardenafil is a PDE5 inhibitor; apomorphine for ED is no longer available in the UK
• Combining two ED medicines is not recommended and increases side effect risk
• If using apomorphine for Parkinson's, tell your prescriber before starting vardenafil
• Never take vardenafil with nitrates, nicorandil, riociguat, or poppers
• All ED prescriptions at Cured Pharmacy require a clinical consultation with a UK prescriber

Vardenafil and apomorphine: understanding the mechanism

Vardenafil and apomorphine work in completely different ways. Vardenafil acts locally in the penis by blocking an enzyme called phosphodiesterase type 5 (PDE5). This enzyme normally breaks down a chemical called cGMP, which relaxes smooth muscle and allows blood to flow into the penis. By blocking PDE5, vardenafil helps cGMP levels stay higher, making it easier to get and keep an erection when you are sexually aroused [5].

Apomorphine, on the other hand, acts centrally in the brain. It stimulates dopamine receptors in the hypothalamus, an area involved in sexual arousal and the erection reflex. This triggers signals that travel down the spinal cord to the penis, initiating an erection [12]. Because the two medicines work on different parts of the body, they do not directly interfere with each other's mechanism of action.

However, both medicines can lower blood pressure as a side effect. Vardenafil does this by relaxing blood vessels throughout the body, not just in the penis. Apomorphine, especially when used for Parkinson's disease, can also cause blood pressure to drop, particularly when standing up [12]. Combining medicines that both lower blood pressure can lead to dizziness, fainting, or falls, which is why your prescriber must assess the overall risk.

What are the risks of combining ED treatments like vardenafil and apomorphine?

Using two erectile dysfunction treatments at the same time is not recommended because it does not improve effectiveness and significantly increases the risk of side effects. The most common risks include low blood pressure (hypotension), dizziness, headache, flushing, and nausea. More seriously, combining ED medicines raises the risk of priapism—a painful erection lasting more than four hours that requires emergency treatment to prevent permanent damage [5].

If you are not getting the results you want from one ED medicine, the solution is not to add another but to speak to your prescriber. They can adjust the dose, try a different PDE5 inhibitor, or investigate underlying causes such as low testosterone, diabetes, or cardiovascular disease [2]. Sometimes lifestyle changes—losing weight, stopping smoking, reducing alcohol, or managing stress—can make a significant difference.

If you are taking apomorphine for Parkinson's disease and considering vardenafil for ED, your prescriber will weigh the benefits and risks carefully. They may recommend starting with the lowest dose of vardenafil and monitoring your blood pressure closely. Never take two ED medicines together without explicit advice from your prescriber, and never combine vardenafil with nitrates, nicorandil, riociguat, or poppers—these combinations are dangerous and can be life-threatening [5].

Warning signs to watch for

If you experience an erection lasting more than four hours, sudden loss of vision or hearing, severe dizziness or fainting, or chest pain during sexual activity, seek urgent medical help immediately. These are rare but serious side effects that require prompt treatment [5]. Always follow the prescribed dose and do not take vardenafil more than once in 24 hours.

When to get urgent help

• Erection lasting more than 4 hours (priapism)—go to A&E immediately
• Sudden loss of vision or hearing—seek urgent medical help
• Severe dizziness, fainting, or chest pain during or after sex—call 999
• Symptoms of a severe allergic reaction (swelling of face, lips, tongue, or throat; difficulty breathing)—call 999

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

Practical advice: using vardenafil safely and what to tell your prescriber

Before starting vardenafil, tell your prescriber about all medicines you take, including prescription medicines, over-the-counter treatments, herbal remedies, and recreational drugs. This includes medicines for high blood pressure, heart conditions, prostate problems, infections, and Parkinson's disease [5]. If you have ever used apomorphine for erectile dysfunction or are currently using it for Parkinson's, mention this during your consultation.

Your prescriber will also ask about your cardiovascular health. Vardenafil is not suitable if you have had a recent heart attack or stroke, have unstable angina, severe heart failure, very low blood pressure, or if sexual activity is inadvisable for other reasons [5]. They will check whether you are taking nitrates (such as GTN spray or isosorbide mononitrate), alpha-blockers (such as tamsulosin or doxazosin), or medicines that affect how vardenafil is broken down in the liver.

Take vardenafil about 25 to 60 minutes before sexual activity, with or without food, though a heavy, high-fat meal may delay its effect. Do not take more than one dose in 24 hours. Avoid drinking large amounts of alcohol, as this can make erectile dysfunction worse and increase the risk of side effects such as dizziness [5]. Grapefruit juice can raise vardenafil levels in your blood, so it is best avoided. If you experience any unexpected side effects or the medicine is not working as expected, contact your prescriber for advice rather than adjusting the dose yourself.

How Cured Pharmacy can help

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering discreet, convenient access to erectile dysfunction treatments. All prescriptions are issued after an online consultation reviewed by a UK-registered prescriber, who will check your medical history and current medicines to ensure vardenafil or another PDE5 inhibitor is safe and suitable for you. You can order vardenafil from £16.95, with first-order discounts available using code Ednew.

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