Vardenafil and Eplerenone: Can They Be Taken Together?

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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 [5].

The medicine is usually taken about 25 to 60 minutes before sexual activity, and its effects can last for several hours. Common doses are 5 mg, 10 mg, or 20 mg, and you should not take more than one dose in 24 hours [5]. Vardenafil does not cause an erection on its own; sexual stimulation is still needed for the medicine to work.

Like all PDE5 inhibitors, vardenafil can lower blood pressure slightly. This is usually not a problem for most men, but it becomes important when you are taking other medicines that also affect blood pressure, such as eplerenone. Your prescriber will assess whether the combination is safe for you based on your current blood pressure, heart health, and other medicines you take.

What Is Eplerenone and Why Is It Prescribed?

Eplerenone is a prescription medicine used to treat high blood pressure (hypertension) and heart failure. It belongs to a class of medicines called potassium-sparing diuretics, which help your body get rid of excess fluid and salt while retaining potassium. Eplerenone works by blocking the action of a hormone called aldosterone, which can raise blood pressure and strain the heart.

Unlike some other diuretics, eplerenone does not cause your body to lose potassium, which is why it is called 'potassium-sparing'. It is often prescribed after a heart attack in people with heart failure, or as part of treatment for resistant high blood pressure. Common side effects include dizziness (especially when standing up), headache, and changes in potassium levels.

Because eplerenone lowers blood pressure, there is a potential for an additive effect when taken with vardenafil, which also lowers blood pressure. This does not mean the combination is unsafe, but it does mean your prescriber needs to check that your blood pressure is stable and that you are not at risk of it dropping too low when the medicines are used together.

When to get urgent help

• Chest pain or discomfort during or after sex (call 999; do not take nitrates if you have used vardenafil in the past 24 hours)
• Erection lasting longer than 4 hours (priapism) – go to A&E immediately
• Sudden loss of vision in one or both eyes – seek urgent medical attention
• Sudden loss or decrease in hearing, sometimes with ringing in the ears or dizziness
• Severe dizziness, fainting, or feeling like you are going to pass out after taking vardenafil

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

How Do Vardenafil and Eplerenone Interact?

Vardenafil and eplerenone do not have a direct drug-to-drug interaction at the chemical level, meaning one medicine does not significantly change how the other is broken down or absorbed by your body. However, both medicines can lower blood pressure, so there is a risk of an additive blood-pressure-lowering effect when they are taken together [5].

In plain English, this means that if you take both medicines, your blood pressure might drop more than it would with either medicine alone. For most men whose blood pressure is well controlled on eplerenone, this is not a problem, but it can cause symptoms such as dizziness, light-headedness, or feeling faint, especially when standing up quickly.

Your prescriber will review your current blood pressure readings, how long you have been taking eplerenone, and whether your dose is stable. If your blood pressure is well controlled and you have no symptoms of low blood pressure, vardenafil is usually considered safe to use. The prescriber may recommend starting on the lowest effective dose of vardenafil (5 mg or 10 mg) to minimise the risk of side effects.

What Your Prescriber Will Check

Before approving vardenafil, your prescriber will ask about your current blood pressure, whether you have experienced dizziness or fainting, and how well your heart condition is controlled. They will also check for any other medicines you take that might interact with vardenafil, such as nitrates (which are absolutely contraindicated), alpha-blockers, or other blood-pressure medicines. If you have recently started eplerenone or had a dose change, your prescriber may advise waiting until your blood pressure is stable before starting vardenafil. Always answer the consultation questions fully and honestly to ensure safe treatment.

Practical Advice for Taking Vardenafil and Eplerenone Together

If your prescriber approves vardenafil while you are taking eplerenone, there are some practical steps you can take to use both medicines safely. First, take vardenafil exactly as prescribed, usually starting with the lowest effective dose. Do not take more than one dose in 24 hours, and do not take vardenafil if you are also taking nitrates, nicorandil, riociguat, or recreational drugs called 'poppers', as these combinations can cause a dangerous drop in blood pressure.

Be aware of how you feel when you stand up, especially in the first few hours after taking vardenafil. If you feel dizzy or light-headed, sit or lie down until the feeling passes. Avoid drinking large amounts of alcohol, as this can make low blood pressure worse and reduce the effectiveness of vardenafil. If you experience persistent dizziness, fainting, or chest pain, stop taking vardenafil and contact your GP or pharmacist for advice.

Continue taking eplerenone exactly as your doctor has prescribed, and do not stop or change the dose without medical advice. If you have any concerns about side effects or how the medicines are working together, speak to your GP or the prescriber who approved your vardenafil. Regular blood pressure monitoring, either at home or at your GP surgery, can help ensure both medicines are working safely.

At a glance

Are There Any Medicines That Should Not Be Taken with Vardenafil?

Yes, there are some medicines that must never be taken with vardenafil because the combination can cause a dangerous drop in blood pressure. These include nitrates (such as GTN spray, isosorbide mononitrate, or isosorbide dinitrate), nicorandil (often used for angina), riociguat (used for pulmonary hypertension), and recreational drugs known as 'poppers' (amyl or alkyl nitrites). Do not take vardenafil if you are using any of these medicines [5].

Vardenafil should also not be taken with another PDE5 inhibitor (such as sildenafil, tadalafil, or avanafil) at the same time. If you are taking alpha-blockers for an enlarged prostate (such as doxazosin, tamsulosin, or alfuzosin), vardenafil can still be used, but you must be stable on the alpha-blocker and your prescriber will usually start you on the lowest dose of vardenafil to reduce the risk of low blood pressure.

Some medicines can increase the level of vardenafil in your blood, making side effects more likely. These include potent CYP3A4 inhibitors such as ritonavir, cobicistat, ketoconazole, itraconazole, and clarithromycin. Vardenafil is often avoided or used at a reduced dose if you are taking these medicines [5]. Always declare every medicine, supplement, and herbal remedy you take during your consultation, even if you think it is unrelated.

Other Blood Pressure Medicines

If you take other blood pressure medicines in addition to eplerenone (such as ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, or beta-blockers), the additive blood-pressure-lowering effect may be greater. This does not automatically mean you cannot take vardenafil, but your prescriber will need to assess your overall blood pressure control and may recommend a lower starting dose. Always mention every medicine you take during your consultation so the prescriber can make a safe decision.

When to Seek Urgent Medical Help

Most men taking vardenafil and eplerenone together do not experience serious problems, but it is important to know the warning signs that need urgent medical attention. If you develop chest pain or discomfort during or after sexual activity, stop what you are doing and seek medical help immediately. Do not take a nitrate medicine (such as GTN spray) if you have taken vardenafil in the past 24 hours, as this can cause a life-threatening drop in blood pressure. Call 999 or go to A&E.

If you have an erection that lasts longer than four hours (priapism), seek urgent medical help. Priapism is rare but can cause permanent damage to the penis if not treated quickly. 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 also medical emergencies and require immediate attention [5].

If you experience severe dizziness, fainting, or feel like you are going to pass out, especially after taking vardenafil, stop taking the medicine and contact your GP or NHS 111 for advice. These symptoms may indicate that your blood pressure has dropped too low. Always read the patient information leaflet that comes with your medicine and follow the advice of your prescriber or pharmacist.

Reporting Side Effects

If you experience any side effects while taking vardenafil, whether or not they are listed in the patient information leaflet, you can report them to your GP, pharmacist, or directly to the Medicines and Healthcare products Regulatory Agency (MHRA) via the Yellow Card scheme at yellowcard.mhra.gov.uk. Reporting side effects helps improve the safety information available for all patients.

In summary

• Vardenafil and eplerenone can usually be taken together if your blood pressure is stable and well controlled.
• Both medicines lower blood pressure, so your prescriber will check your readings and may start vardenafil at a lower dose.
• Never take vardenafil with nitrates, nicorandil, riociguat, or poppers, as this can cause dangerous low blood pressure.
• Watch for dizziness when standing up and contact your GP if symptoms are severe or persistent.
• Always declare every medicine you take during your consultation to ensure safe treatment.

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