Vardenafil and Enalapril: Can You Take Them Together?

Takes less than 2 minutes to complete 100% online

At a glance

What is vardenafil and enalapril used for?

Vardenafil is a prescription medicine used to treat erectile dysfunction (ED) in men. 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 [5]. Vardenafil is the generic version of Levitra and is available in 5mg, 10mg, and 20mg tablets. You typically take it about 25 to 60 minutes before sexual activity, and it requires sexual stimulation to work [5].

Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure (hypertension) and heart failure. It works by relaxing and widening your blood vessels, which lowers blood pressure and reduces the strain on your heart. Enalapril is usually taken once or twice daily as a long-term treatment. Many men with high blood pressure also experience erectile dysfunction, so it's common for these two medicines to be considered together [1].

How do vardenafil and enalapril interact with each other?

Vardenafil and enalapril can both lower blood pressure, which means taking them together may add to this effect [5]. This is not usually dangerous, but it does mean there is a higher chance of experiencing dizziness, light-headedness, or fainting, especially when standing up quickly. The interaction is not severe enough to prevent the two medicines being used together, but it does require careful monitoring.

The mechanism is straightforward: enalapril lowers blood pressure by relaxing blood vessels throughout the body, while vardenafil causes blood vessels to relax primarily in the penis but can also have a mild effect on overall blood pressure [5]. When both medicines are working at the same time, the combined blood-pressure-lowering effect can be more pronounced. This is why your prescriber will check that your blood pressure is well controlled on enalapril before adding vardenafil, and may start you on the lowest effective dose of vardenafil.

Is this interaction dangerous?

For most men, the interaction between vardenafil and enalapril is manageable and not dangerous, provided your blood pressure is stable and you are monitored appropriately [5]. However, if your blood pressure drops too low, you may feel dizzy, weak, or faint. In rare cases, a significant drop in blood pressure could lead to a fall or injury. This is why it's essential to be honest during your online consultation about all medicines you take, including enalapril, so the prescriber can assess whether vardenafil is suitable for you and choose the right starting dose.

What does the prescriber check before prescribing vardenafil and enalapril together?

During your online consultation at Cured Pharmacy, the prescriber will ask about your current blood pressure readings, how long you have been taking enalapril, and whether your blood pressure is well controlled. They will also ask about any symptoms of low blood pressure, such as dizziness or fainting, and whether you take any other medicines that affect blood pressure [5]. This information helps them decide whether vardenafil is safe for you and what dose to start with.

The prescriber will also check for any other conditions or medicines that could make vardenafil unsuitable. For example, vardenafil must never be taken with nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or recreational drugs called 'poppers', because these combinations can cause a dangerous drop in blood pressure [5]. If you take an alpha-blocker for prostate symptoms (such as tamsulosin or doxazosin) as well as enalapril, extra caution is needed, and you will usually be started on the lowest dose of vardenafil.

Your prescriber will also consider your heart health. If you have had a recent heart attack or stroke, have unstable angina, or have been told that sexual activity is not advisable, vardenafil will not be suitable [5]. The consultation is designed to ensure that vardenafil is both safe and likely to be effective for you.

What you need to know

• Vardenafil and enalapril can usually be taken together if your blood pressure is stable
• Both medicines lower blood pressure, so dizziness is possible; start with the lowest vardenafil dose
• Never take vardenafil with nitrates, nicorandil, riociguat, or poppers
• Declare all medicines during your online consultation for safe prescribing
• Seek urgent help for chest pain during sex or an erection lasting over four hours

Practical advice for taking vardenafil with enalapril

If you are prescribed vardenafil while taking enalapril, start with the lowest effective dose (usually 5mg or 10mg) and see how you respond [5]. Take vardenafil about 25 to 60 minutes before you plan to have sex, and remember that it only works when you are sexually aroused. Do not take more than one dose in 24 hours. Continue taking your enalapril exactly as prescribed by your GP; do not stop or change the dose without medical advice.

Be cautious when standing up from sitting or lying down, especially in the first few hours after taking vardenafil, as this is when dizziness is most likely. Avoid drinking large amounts of alcohol, as this can make both dizziness and erectile dysfunction worse [5]. If you feel very dizzy, light-headed, or faint, sit or lie down until the feeling passes, and contact your GP or NHS 111 for advice if it does not improve.

Keep your GP informed that you are using vardenafil, especially if your blood pressure control changes or if your enalapril dose is adjusted. If you experience chest pain during sex, stop immediately and seek urgent medical help, as this could be a sign of a heart problem [5]. Store vardenafil at room temperature, away from moisture, and keep it out of reach of children.

Can I take vardenafil if I'm on other blood pressure medicines?

Many men take more than one blood-pressure medicine, and vardenafil can usually still be prescribed, but every medicine must be declared during your consultation [5]. If you take an alpha-blocker (such as tamsulosin, doxazosin, or alfuzosin) for prostate symptoms, the risk of low blood pressure is higher, and you must be stable on the alpha-blocker before starting vardenafil at the lowest dose. If you take a calcium-channel blocker (such as amlodipine) or a diuretic (water tablet), the prescriber will assess the overall effect on your blood pressure. Never take vardenafil with nitrates, nicorandil, or riociguat, as this combination is dangerous.

Warning signs and when to seek help with vardenafil and enalapril

Most men tolerate vardenafil and enalapril together without problems, but you should be aware of warning signs that need medical attention. Seek urgent help (call 999 or go to A&E) if you experience chest pain during or after sex, as this could indicate a heart problem [5]. Also seek emergency help if you have an erection that lasts longer than four hours (priapism), as this can cause permanent damage if not treated promptly.

Contact your GP or NHS 111 the same day if you experience 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]. These are rare but serious side effects. If you feel severely dizzy, faint, or your blood pressure feels very low (for example, you cannot stand without feeling faint), stop taking vardenafil and seek medical advice the same day.

Common side effects of vardenafil include headache, flushing, nasal congestion, and indigestion, which are usually mild and temporary [5]. If these are troublesome or persistent, speak to your GP or pharmacist. Do not stop taking enalapril without medical advice, even if you think it is causing side effects, as suddenly stopping blood-pressure medicines can be harmful.

When to get urgent help

• Chest pain during or after sex (call 999 immediately)
• An erection lasting longer than four hours (go to A&E)
• Sudden loss of vision or hearing (contact GP or NHS 111 same day)
• Severe dizziness or fainting that does not improve (seek medical advice same day)

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

Other erectile dysfunction treatments and enalapril

If vardenafil is not suitable or effective for you, there are other PDE5 inhibitors that can be considered alongside enalapril. Sildenafil (generic Viagra) and tadalafil (generic Cialis) are also commonly prescribed and have similar interactions with enalapril: they can be used together, but blood pressure must be monitored and the lowest effective dose used [3][4]. Tadalafil has the advantage of lasting up to 36 hours, which some men prefer, while sildenafil is taken about one hour before sex [3][4].

Avanafil (Spedra) is another PDE5 inhibitor that works more quickly, often within 15 to 30 minutes, and may also be used with enalapril under the same precautions [6]. All PDE5 inhibitors share the same important contraindications: never take them with nitrates, nicorandil, riociguat, or poppers, and always declare all your medicines during the consultation [3][4][5][6].

If oral treatments are not suitable, your GP may discuss alternatives such as Vitaros (alprostadil cream) or Caverject (alprostadil injection), which work by a different mechanism and do not have the same blood-pressure interactions [7]. Eroxon is a topical gel medical device available without prescription. It is important to see your GP if you have new or worsening erectile dysfunction, as it can be an early sign of heart disease or diabetes [1][2].

How Cured Pharmacy can help

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering convenient access to erectile dysfunction treatments after a confidential online consultation reviewed by a UK prescriber. If you take enalapril or any other blood-pressure medicine, simply declare this during your consultation, and the prescriber will assess whether vardenafil or another ED treatment is safe and appropriate for you. Prescription medicines are only supplied after clinical approval, ensuring your safety. Discreet delivery is available across the UK, and our pharmacy team is here to answer any questions about your treatment.