Vardenafil and Dronedarone: Can They Be Taken Together?

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Key takeaways

• Vardenafil and dronedarone can interact, raising vardenafil levels and affecting heart rhythm.
• Your prescriber will assess your heart health before deciding if vardenafil is safe for you.
• A lower vardenafil dose or an alternative ED treatment may be recommended.
• Never take vardenafil with nitrates, nicorandil, riociguat, or poppers—this is dangerous.
• Seek urgent help for chest pain, a prolonged erection, or sudden vision or hearing loss.

What is vardenafil and dronedarone?

Vardenafil (also known by the brand name Levitra) is a prescription medicine used to treat erectile dysfunction in men [5]. It belongs to a group of medicines called PDE5 inhibitors, which work by relaxing blood vessels in the penis to improve blood flow when you are sexually aroused. Vardenafil is usually taken about 25–60 minutes before sexual activity, and its effect can last for several hours. It is available in 5 mg, 10 mg, and 20 mg tablets, and you should not take it more than once a day [5].

Dronedarone (brand name Multaq) is a prescription medicine used to control abnormal heart rhythms, particularly atrial fibrillation or atrial flutter. It helps to keep your heart beating in a regular rhythm and may reduce the risk of needing hospital admission for heart rhythm problems. Dronedarone works by affecting the electrical signals in the heart, and it is usually taken twice a day as a long-term treatment. Because it affects the heart and can interact with many other medicines, your doctor will monitor you closely while you are taking it [12].

Both medicines are only available on prescription in the UK, and your prescriber will need to review your full medical history and current medicines before deciding whether either treatment is safe for you.

How do vardenafil and dronedarone interact?

The interaction between vardenafil and dronedarone happens in two main ways. First, dronedarone is a moderate inhibitor of an enzyme in the liver called CYP3A4, which is responsible for breaking down vardenafil. When dronedarone slows this process, the level of vardenafil in your blood can rise higher than expected, increasing the risk of side effects such as headache, flushing, dizziness, or a drop in blood pressure [5][12].

Second, both medicines can affect the electrical activity of the heart, specifically something called the QT interval on an ECG (electrocardiogram). A prolonged QT interval can, in rare cases, lead to a serious abnormal heart rhythm. Dronedarone is known to prolong the QT interval, and vardenafil may also have a small effect, so combining them requires careful consideration by your prescriber [5][12].

This does not mean the combination is always unsafe, but it does mean your prescriber must assess your individual heart health, check for other risk factors (such as low potassium or magnesium levels, or other medicines that affect the QT interval), and decide whether vardenafil is appropriate or whether a different erectile dysfunction treatment would be better for you. If vardenafil is prescribed, your doctor may recommend a lower starting dose and closer monitoring.

What happens in your body

When you take vardenafil, it is absorbed into your bloodstream and then broken down by liver enzymes, mainly CYP3A4. Dronedarone slows down this enzyme, so vardenafil stays in your system longer and reaches higher levels than it would on its own. At the same time, both medicines can affect the timing of electrical signals in your heart muscle. Your prescriber will weigh these effects against the benefits of treating erectile dysfunction and will only prescribe vardenafil if they judge it to be safe in your particular situation.

At a glance

What will your prescriber check before prescribing vardenafil with dronedarone?

If you are taking dronedarone and request treatment for erectile dysfunction, your prescriber will carry out a thorough assessment. They will ask about your heart health, including any history of heart rhythm problems, heart failure, recent heart attack or stroke, and whether you have ever had an ECG that showed a prolonged QT interval. They will also ask about all your current medicines, including over-the-counter products and supplements, because some can add to the risk of QT prolongation or interact with vardenafil [2][5].

Your prescriber will check whether you are taking any other medicines that are not safe with PDE5 inhibitors, such as nitrates (GTN spray, isosorbide mononitrate or dinitrate), nicorandil, riociguat, or recreational drugs known as 'poppers'. If you are taking any of these, you cannot take vardenafil or any other PDE5 inhibitor because the combination can cause a dangerous drop in blood pressure [5].

They will also review your blood pressure and ask about symptoms such as dizziness, fainting, or chest pain. If your prescriber decides that vardenafil is suitable, they may start you on a lower dose (such as 5 mg) and advise you to watch for side effects. In some cases, they may recommend an alternative ED treatment that has fewer interactions with dronedarone, such as a lower dose of sildenafil or a non-oral option. The decision will be tailored to your individual health and the severity of your erectile dysfunction.

Are there safer alternatives to vardenafil if you take dronedarone?

If your prescriber is concerned about the interaction between vardenafil and dronedarone, they may suggest an alternative erectile dysfunction treatment. Sildenafil (generic Viagra) is also a PDE5 inhibitor and is affected by CYP3A4 inhibitors, but it has a shorter half-life and may be easier to manage at a lower dose [3]. Tadalafil (generic Cialis) has a longer duration of action and is also metabolised by CYP3A4, so a dose adjustment may be needed, but it can be a convenient option for some men [4].

Avanafil (Spedra) is another PDE5 inhibitor that works quickly, but it is also metabolised by CYP3A4 and may not be suitable if you are taking dronedarone, depending on your prescriber's assessment [6]. In some cases, your prescriber may recommend a non-oral treatment such as Vitaros (alprostadil cream applied to the tip of the penis) or Caverject (alprostadil injection), which do not interact with dronedarone in the same way because they are not taken by mouth and do not rely on the CYP3A4 enzyme [7].

Your prescriber will discuss the options with you, taking into account your preferences, lifestyle, and the severity of your erectile dysfunction. It is important not to switch or stop any medicine on your own; always follow the advice of your prescriber or pharmacist.

Comparing PDE5 inhibitors with dronedarone

All PDE5 inhibitors (sildenafil, tadalafil, vardenafil, and avanafil) are metabolised by the CYP3A4 enzyme to some extent, so dronedarone can raise the levels of any of them. However, the degree of interaction and the recommended dose adjustments vary. Your prescriber will refer to the Summary of Product Characteristics for each medicine to decide which is safest for you, and they may choose a lower starting dose or recommend closer monitoring. The key is that the decision must be individualised, and you should never take more than one PDE5 inhibitor at a time.

Practical advice for taking vardenafil and dronedarone together

If your prescriber decides that vardenafil is suitable for you while you are taking dronedarone, follow their instructions carefully. Take vardenafil exactly as prescribed—usually about 25–60 minutes before you plan to have sex—and do not take more than one dose in 24 hours [5]. Swallow the tablet whole with water, and you can take it with or without food, although a heavy or high-fat meal may slow down how quickly it works.

Watch for side effects such as headache, flushing, indigestion, nasal congestion, or dizziness. These are common with PDE5 inhibitors and are usually mild, but if they are severe or persistent, contact your prescriber or pharmacist. More importantly, be alert for warning signs that need urgent attention: if you develop chest pain during sex, stop and seek medical help immediately. If you have an erection that lasts longer than four hours (priapism), go to A&E straight away, as this can cause permanent damage if not treated promptly [5].

Avoid drinking grapefruit juice while taking vardenafil, as it can raise the level of the medicine in your blood. Limit alcohol, as heavy drinking can worsen erectile dysfunction and increase the risk of dizziness or low blood pressure. Do not use recreational drugs known as 'poppers' (amyl or alkyl nitrites), as the combination with vardenafil can be dangerous. Always tell any healthcare professional you see—including your GP, pharmacist, or hospital doctor—that you are taking both dronedarone and vardenafil, so they can check for interactions with any new medicines.

When to seek help and what to watch for

Most men who take vardenafil with dronedarone under medical supervision do not experience serious problems, but it is important to know the warning signs. Seek urgent medical help (call 999 or go to A&E) if you experience chest pain or discomfort during or after sex, as this could be a sign of a heart problem. Also seek emergency help if you have an erection lasting more than four hours, sudden loss of vision in one or both eyes, or sudden decrease or loss of hearing, which may be accompanied by ringing in the ears or dizziness [5].

Contact your GP or prescriber promptly if you feel dizzy or faint when standing up, have a fast or irregular heartbeat, or notice any new or worsening symptoms after starting vardenafil. These could be signs that the dose needs adjusting or that the combination is not suitable for you. Do not simply stop taking dronedarone without medical advice, as this could affect your heart rhythm control.

If vardenafil does not work for you after trying it on several occasions (remember, it needs sexual stimulation to work and may not be effective every time), speak to your prescriber. They can review your dose, check whether other factors are affecting your erectile dysfunction (such as stress, anxiety, or other medicines), and discuss alternative treatments. Erectile dysfunction is very common and treatable, and there are several options available, so do not be discouraged if the first treatment does not suit you [1][2].

Ongoing monitoring and follow-up

Your prescriber may recommend follow-up appointments or checks, especially if you have other health conditions or are taking several medicines. Be open and honest about how the treatment is working, any side effects you experience, and any changes in your health. If you develop a new heart problem, have a change in your dronedarone dose, or start any new medicines, let your prescriber know before taking vardenafil again. Regular communication with your healthcare team is the best way to ensure safe and effective treatment.

When to get urgent help

• Chest pain or discomfort during or after sex—call 999 immediately
• Erection lasting more than 4 hours (priapism)—go to A&E straight away
• Sudden loss of vision in one or both eyes—seek emergency medical help
• Sudden decrease or loss of hearing, possibly with ringing in the ears or dizziness—get urgent medical advice
• Severe dizziness, fainting, or fast/irregular heartbeat—contact your GP or call 111 for same-day advice

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