Vardenafil and Dipyridamole: 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 used to treat erectile dysfunction (ED) in adult men. It belongs to a group of medicines called PDE5 inhibitors, which also includes sildenafil (Viagra) and tadalafil (Cialis). Vardenafil works by relaxing the blood vessels in the penis, allowing more blood to flow in when you are sexually aroused, which helps you achieve and maintain an erection [5].

Vardenafil is usually taken about 25 to 60 minutes before sexual activity, and its effects can last for several hours. It is available in 5 mg, 10 mg, and 20 mg tablets, and the usual starting dose is 10 mg. Vardenafil only works when you are sexually stimulated—it does not cause an automatic erection and does not increase sexual desire [5].

Like all PDE5 inhibitors, vardenafil can lower blood pressure slightly, which is why it must never be taken with nitrates, nicorandil, riociguat, or poppers (amyl/alkyl nitrites), as the combination can cause a dangerous drop in blood pressure. Your prescriber will check your current medicines and medical conditions before prescribing vardenafil to ensure it is safe for you [5].

What Is Dipyridamole and Why Is It Prescribed?

Dipyridamole is a prescription medicine used to help prevent blood clots and reduce the risk of stroke, particularly in people who have already had a stroke or transient ischaemic attack (TIA, sometimes called a 'mini-stroke'). It is also sometimes used to prevent blood clots after heart valve replacement surgery. Dipyridamole works in two ways: it stops platelets in the blood from sticking together, and it widens (dilates) blood vessels, which can improve blood flow.

Dipyridamole is often prescribed alongside aspirin (as a combination tablet called Asasantin Retard) to provide extra protection against stroke. It is usually taken twice a day, and common side effects include headache, dizziness, nausea, and diarrhoea. Because dipyridamole can widen blood vessels, it may cause a small drop in blood pressure, especially when you first start taking it or if the dose is increased.

If you have been prescribed dipyridamole, it is important to tell your prescriber about all other medicines you are taking, including over-the-counter medicines, supplements, and any treatments for erectile dysfunction. This allows your healthcare team to check for interactions and ensure your treatment plan is safe and effective.

Vardenafil and Dipyridamole: Is There an Interaction?

No major interaction is commonly reported between vardenafil and dipyridamole, and many men take both medicines together without problems. However, both medicines can lower blood pressure—vardenafil by relaxing blood vessels in the penis and elsewhere, and dipyridamole by widening blood vessels throughout the body. When taken together, there is a theoretical risk that the combined blood-pressure-lowering effect could cause dizziness, light-headedness, or fainting, particularly when standing up quickly.

This does not mean the combination is unsafe, but it does mean your prescriber will need to assess your individual situation carefully. They will check your current blood pressure, review your full list of medicines (including any other blood-pressure-lowering drugs), and ask about any symptoms such as dizziness or fainting. If you are stable on dipyridamole and have no concerning symptoms, your prescriber may approve vardenafil at the usual starting dose, or they may recommend starting with a lower dose to minimise the risk of side effects.

It is important to be honest during your consultation about all your current medicines, including dipyridamole, so your prescriber can make an informed decision. Never stop or change your dipyridamole without medical advice, as it is protecting you from serious complications such as stroke. If you experience unusual dizziness, fainting, or any other concerning symptoms after starting vardenafil, contact your GP or pharmacist promptly for advice.

How the Interaction Works in Plain English

Both vardenafil and dipyridamole affect blood vessels, though in different parts of the body and for different reasons. Vardenafil relaxes the smooth muscle in the walls of blood vessels, particularly in the penis, to improve blood flow and help with erections. Dipyridamole also widens blood vessels and reduces the stickiness of platelets (the cells that help blood clot). When both medicines are working at the same time, the combined effect on blood vessels can lead to a slightly greater drop in blood pressure than either medicine alone. For most people, this is not a problem, but it can occasionally cause dizziness or light-headedness, especially when moving from sitting to standing. Your prescriber will take this into account when deciding whether vardenafil is suitable for you.

What you need to know

• No major interaction is commonly reported between vardenafil and dipyridamole.
• Both medicines can lower blood pressure, so your prescriber will check your health carefully.
• Do not stop dipyridamole without medical advice—it protects you from stroke.
• Stand up slowly and avoid heavy alcohol to reduce the risk of dizziness.
• Never take vardenafil with nitrates, nicorandil, riociguat, or poppers.

What Your Prescriber Checks Before Approving Vardenafil and Dipyridamole

Before prescribing vardenafil to someone taking dipyridamole, your prescriber will carry out a thorough assessment to ensure the combination is safe. They will ask about your current blood pressure and whether you have experienced any dizziness, fainting, or falls. They will also review your full medication list to check for other medicines that lower blood pressure (such as ACE inhibitors, beta-blockers, calcium-channel blockers, or alpha-blockers), as these can add to the effect.

Your prescriber will ask about your cardiovascular health, including any history of heart attack, stroke, angina, or heart failure. Sexual activity itself places demands on the heart, so it is important to ensure your heart is healthy enough for sex before starting any ED treatment. If you have unstable angina, severe heart failure, or have had a heart attack or stroke in the past six months, vardenafil may not be suitable [5].

Your prescriber will also check for any medicines that are absolutely contraindicated with vardenafil, such as nitrates (GTN spray, isosorbide mononitrate or dinitrate), nicorandil, riociguat, or poppers. If you are taking any of these, do not take vardenafil, as the combination can cause a dangerous drop in blood pressure. Finally, your prescriber will ask about any allergies, kidney or liver problems, and other health conditions to ensure vardenafil is the right choice for you.

Starting Dose and Monitoring

If your prescriber approves vardenafil while you are taking dipyridamole, they will usually start you on the standard 10 mg dose, unless there are other reasons to use a lower dose (such as kidney or liver problems, or if you are taking certain other medicines). They may advise you to take the first dose at a time when you can monitor how you feel—for example, not before driving or operating machinery—in case you experience dizziness. If you tolerate the medicine well and it is effective, you can continue at that dose. If you experience side effects such as dizziness or headache, your prescriber may suggest reducing the dose to 5 mg. Always follow the dosing instructions provided by your prescriber and do not take more than one dose in 24 hours.

Practical Advice for Taking Vardenafil and Dipyridamole Together

If you have been prescribed vardenafil and are already taking dipyridamole, there are some practical steps you can take to minimise the risk of side effects. First, take vardenafil exactly as prescribed—usually 25 to 60 minutes before sexual activity, and no more than once a day. Do not take a double dose to make up for a missed one, and do not take vardenafil with another PDE5 inhibitor (such as sildenafil or tadalafil) [5].

Be mindful of your blood pressure, especially when standing up from sitting or lying down. Stand up slowly and pause for a moment to let your body adjust, which can help prevent dizziness or light-headedness. 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 or fainting.

Continue taking your dipyridamole exactly as prescribed by your doctor. Do not stop or change the dose without medical advice, as dipyridamole is protecting you from serious complications such as stroke. If you experience any new or worsening symptoms—such as severe dizziness, fainting, chest pain, or an erection lasting more than four hours—seek medical help immediately. Keep all your medicines in their original packaging, store them safely, and check the expiry dates regularly.

When to get urgent help

• Erection lasting more than 4 hours (priapism)—call 999 or go to A&E immediately
• Sudden loss of vision or hearing—seek urgent medical help
• Chest pain during or after sexual activity—stop and call 999
• Severe dizziness, fainting, or collapse—call 999 or go to A&E
• 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.

Other Medicines and Lifestyle Factors to Consider with Vardenafil and Dipyridamole

In addition to dipyridamole, your prescriber will check for other medicines that may interact with vardenafil. Alpha-blockers (such as doxazosin, tamsulosin, or alfuzosin, used for prostate problems or high blood pressure) can increase the risk of low blood pressure and dizziness when taken with vardenafil. If you are taking an alpha-blocker, you should be stable on that medicine before starting vardenafil, and your prescriber may recommend a lower starting dose of vardenafil [5].

Certain medicines that affect how the liver breaks down vardenafil—such as ritonavir, cobicistat (used in HIV treatment), ketoconazole, itraconazole (antifungal medicines), or clarithromycin (an antibiotic)—can increase vardenafil levels in the blood and raise the risk of side effects. Vardenafil is often contraindicated or requires dose adjustment with these medicines, so always tell your prescriber about any antibiotics, antifungals, or HIV medicines you are taking [5].

Lifestyle factors also matter. Smoking, heavy alcohol use, lack of exercise, and obesity can all worsen erectile dysfunction and reduce the effectiveness of ED treatments. Eating a healthy diet, staying active, limiting alcohol, and not smoking can improve your overall cardiovascular health and may improve your response to vardenafil. Grapefruit juice can increase vardenafil levels in the blood, so it is best to avoid it while taking this medicine. If you have any questions about your medicines or lifestyle, speak to your GP or pharmacist for personalised advice [1][2].

When to Seek Medical Advice

You should contact your GP or pharmacist if you experience persistent or troublesome side effects from vardenafil, such as severe headache, dizziness, flushing, indigestion, or nasal congestion. Seek urgent medical help (call 999 or go to A&E) if you develop an erection that lasts more than four hours (priapism), sudden loss of vision or hearing, or chest pain during or after sexual activity. If you feel dizzy or faint after taking vardenafil, sit or lie down until you feel better, and contact your healthcare provider for advice. Never ignore new or worsening symptoms, and always keep your prescriber informed about any changes to your health or medicines.

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