Vardenafil and Ciclosporin: Can They Be Taken Together?

Takes less than 2 minutes to complete 100% online

Vardenafil and Ciclosporin: Understanding the Interaction

Published: 28 October 2026

Vardenafil and ciclosporin can interact because ciclosporin affects how your body breaks down vardenafil, potentially raising its levels in your bloodstream. This interaction does not mean the two medicines cannot be used together, but it does require careful prescriber assessment and often a lower starting dose of vardenafil to reduce the risk of side effects. If you are taking ciclosporin for an organ transplant or an autoimmune condition and are considering treatment for erectile dysfunction, your prescriber will review your full medication list and adjust your treatment plan accordingly.

What is vardenafil and ciclosporin used for?

Vardenafil (generic Levitra) is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK to treat erectile dysfunction (ED) in men [5]. It works by relaxing the blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Vardenafil is available in 5mg, 10mg, and 20mg tablets and is typically taken about 25 to 60 minutes before sexual activity. Like all PDE5 inhibitors, it requires sexual stimulation to work and should be taken no more than once a day [5].

Ciclosporin is a potent immunosuppressant medicine used to prevent organ rejection after transplant surgery and to treat certain autoimmune conditions such as severe rheumatoid arthritis, psoriasis, and nephrotic syndrome. It works by dampening the immune system's response. Ciclosporin is also a strong inhibitor of an enzyme system in the liver called CYP3A4, which is responsible for breaking down many medicines, including vardenafil [12]. This means ciclosporin can slow the removal of vardenafil from your body, leading to higher levels and a greater risk of side effects.

How do vardenafil and ciclosporin interact?

The interaction between vardenafil and ciclosporin occurs because ciclosporin is a potent inhibitor of the CYP3A4 enzyme system in the liver [5][12]. CYP3A4 is the main pathway your body uses to metabolise (break down) vardenafil. When ciclosporin blocks this enzyme, vardenafil stays in your bloodstream for longer and at higher concentrations than it would otherwise. This can increase both the therapeutic effects and the risk of side effects such as headache, flushing, dizziness, and a drop in blood pressure.

Because of this interaction, the Summary of Product Characteristics for vardenafil advises caution and dose adjustment when it is used alongside potent CYP3A4 inhibitors like ciclosporin [5][12]. In many cases, vardenafil may be contraindicated or require a significantly reduced starting dose. Your prescriber will check the specific guidance for your dose of ciclosporin and your overall health before deciding whether vardenafil is suitable, or whether an alternative PDE5 inhibitor with a different interaction profile might be safer for you.

Why enzyme inhibition matters

Enzyme inhibition is a common cause of drug interactions. When one medicine blocks the enzyme that breaks down another, the second medicine builds up in your system. This is not always dangerous, but it does mean that a standard dose may have a stronger-than-expected effect. For vardenafil and ciclosporin, this interaction is well recognised, and prescribers are trained to adjust doses or choose alternative treatments to keep you safe [5][12].

What does your prescriber check before prescribing vardenafil with ciclosporin?

Before prescribing vardenafil to someone taking ciclosporin, your prescriber will carry out a thorough medication review. They will check the dose and formulation of ciclosporin you are taking, how long you have been on it, and whether your ciclosporin levels are stable. They will also review your blood pressure, cardiovascular health, kidney and liver function, and any other medicines you take, as these can all influence how vardenafil is handled by your body [2][5].

If vardenafil is deemed appropriate, your prescriber will usually start you on the lowest available dose (often 5mg) and monitor your response closely. They may advise you to take vardenafil less frequently or to watch carefully for side effects such as dizziness, headache, or visual disturbances. In some cases, your prescriber may recommend an alternative PDE5 inhibitor such as sildenafil, which may have a more manageable interaction profile with ciclosporin, or they may suggest a non-oral treatment for ED [3][5]. The decision will be individualised based on your full clinical picture.

Are there safer alternatives to vardenafil if you take ciclosporin?

If you are taking ciclosporin, your prescriber may consider other PDE5 inhibitors that have different interaction profiles. Sildenafil (generic Viagra) is also metabolised by CYP3A4, but dose adjustments are more straightforward: a lower starting dose (25mg) is typically recommended when used with potent CYP3A4 inhibitors [3]. Tadalafil (generic Cialis) is another option; the maximum recommended dose is reduced (to 10mg for on-demand use) when taken with strong CYP3A4 inhibitors, but it may still be suitable for some patients [4]. Avanafil (Spedra) is generally avoided or contraindicated with potent CYP3A4 inhibitors [6].

Your prescriber will weigh the benefits and risks of each option based on your individual circumstances, including the stability of your transplant or autoimmune condition, your blood pressure, and any other health concerns. Non-oral treatments such as Vitaros (alprostadil cream) or Caverject (alprostadil injection) are also available and do not interact with ciclosporin in the same way, though they have their own side effects and practical considerations [7]. The key is to have an open conversation with your prescriber about your priorities and concerns so that together you can choose the safest and most effective treatment for your erectile dysfunction.

What about other immunosuppressants?

If you take other immunosuppressants such as tacrolimus (also a CYP3A4 inhibitor), sirolimus, or mycophenolate, similar caution applies. Tacrolimus, like ciclosporin, can raise vardenafil levels and requires dose adjustment [5][12]. Mycophenolate and azathioprine do not significantly interact with PDE5 inhibitors, but your prescriber will still review your full medication list during the consultation to ensure safety. Always declare every medicine, supplement, and herbal product you take.

Practical advice: taking vardenafil and ciclosporin safely

If your prescriber has approved vardenafil while you are taking ciclosporin, follow their instructions carefully. Take vardenafil exactly as prescribed—do not increase the dose or take it more often than advised, even if you feel it is not working as well as you hoped. Vardenafil should be taken about 25 to 60 minutes before sexual activity, and you should not take it more than once in 24 hours [5]. Remember that sexual stimulation is needed for the medicine to work; it will not cause an automatic erection.

Avoid drinking grapefruit juice while taking vardenafil, as it can further inhibit CYP3A4 and raise vardenafil levels even more [5]. Limit alcohol intake, as heavy drinking can worsen erectile dysfunction and add to the blood-pressure-lowering effect of vardenafil, increasing the risk of dizziness or fainting. If you experience side effects such as severe headache, dizziness, visual changes, or an erection lasting more than four hours, stop taking vardenafil and seek medical advice immediately. Keep all your follow-up appointments with your transplant or rheumatology team, and let them know you are taking an ED treatment so they can monitor for any interactions or changes in your ciclosporin levels.

When to seek urgent help with vardenafil and ciclosporin

Most men taking vardenafil alongside ciclosporin under prescriber supervision do not experience serious problems, but it is important to know the warning signs that require urgent medical attention. If you develop an erection that lasts longer than four hours (priapism), go to A&E immediately, as this can cause permanent damage to the penis if not treated promptly. Sudden loss of vision in one or both eyes, or sudden decrease or loss of hearing (sometimes with ringing in the ears or dizziness), are rare but serious side effects that require emergency care [5][12].

If you experience chest pain during or after sexual activity, stop and seek urgent medical help—do not take any nitrate medicines (such as GTN spray) if you have used vardenafil in the past 24 hours, as the combination can cause a dangerous drop in blood pressure. Severe dizziness, fainting, or signs of an allergic reaction (such as swelling of the face, lips, or throat, or difficulty breathing) also require immediate attention. If you are ever unsure whether a symptom is serious, err on the side of caution and contact NHS 111 or your GP, or call 999 if it is an emergency.

Monitoring your overall health

Erectile dysfunction can be an early warning sign of cardiovascular disease or diabetes, so if you are experiencing ED for the first time, it is important to see your GP for a full health check [1][2]. This is especially important if you are taking ciclosporin, as immunosuppressants can have effects on blood pressure, kidney function, and cholesterol, all of which can contribute to ED. Your GP can arrange blood tests, check your blood pressure, and review your overall cardiovascular risk. Treating the underlying cause of ED—such as improving blood sugar control, stopping smoking, or adjusting blood pressure medicines—can sometimes improve erectile function on its own or make ED treatments work better.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 28 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 28 October 2026]
3. Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 28 October 2026]
4. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 28 October 2026]
5. Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 28 October 2026]
6. Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 28 October 2026]
7. Joint Formulary Committee. (n.d.). Alprostadil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/alprostadil/ [accessed 28 October 2026]
8. Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [accessed 28 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.