Vardenafil and Everolimus: Can They Be Taken Together?

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Key takeaways

• Vardenafil and everolimus can interact because both are processed by the liver enzyme CYP3A4.
• Everolimus may increase vardenafil levels, so a lower starting dose is usually needed.
• Always declare everolimus during your ED consultation so your prescriber can assess safety.
• Avoid grapefruit juice and limit alcohol when taking vardenafil with everolimus.
• Seek urgent help if you have chest pain, prolonged erection, or sudden vision or hearing loss.

What Is Vardenafil and How Does It Work?

Vardenafil is a prescription medicine licensed in the UK to treat erectile dysfunction in adult men [5]. 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. Vardenafil does not cause an erection on its own; sexual stimulation is still needed for it to work [5].

Vardenafil is available in 5 mg, 10 mg, and 20 mg tablets and is usually taken about 25 to 60 minutes before sexual activity [5]. The effect can last for several hours, but you should not take it more than once in 24 hours. Common side effects include headache, flushing, nasal congestion, and indigestion, which are usually mild and temporary [5].

At Cured Pharmacy, vardenafil (generic Levitra) is available on prescription after an online consultation with a UK-registered prescriber. The consultation ensures that vardenafil is suitable for you, taking into account your medical history and any other medicines you are taking, including everolimus.

What Is Everolimus and Why Is It Prescribed?

Everolimus is a prescription medicine used as an immunosuppressant to prevent organ rejection after kidney, heart, or liver transplants. It is also used to treat certain types of cancer, including advanced kidney cancer and some neuroendocrine tumours [12]. Everolimus works by suppressing the immune system and inhibiting a protein called mTOR, which controls cell growth and division.

Because everolimus affects the immune system, it requires careful monitoring by your specialist. You will usually have regular blood tests to check everolimus levels and ensure the dose is right for you. Common side effects include mouth ulcers, infections, tiredness, high blood sugar, and changes in blood counts [12].

Everolimus is broken down in the liver by an enzyme system called CYP3A4. This is important because many other medicines, including vardenafil, are also processed by the same enzyme system, which can lead to interactions. Your prescriber will always check for these interactions before prescribing any new medicine alongside everolimus.

How Everolimus Affects Other Medicines

Because everolimus is processed by CYP3A4, it can interact with other medicines that use the same pathway. Medicines that inhibit CYP3A4 can increase everolimus levels, while medicines that induce (speed up) CYP3A4 can reduce everolimus levels [12]. Your transplant or cancer specialist will monitor these interactions closely and adjust doses as needed. It is essential to tell every healthcare professional about all the medicines you take, including over-the-counter products and herbal supplements.

At a glance

The Interaction Between Vardenafil and Everolimus

Vardenafil and everolimus interact because everolimus can act as a moderate inhibitor of the CYP3A4 enzyme system, which is responsible for breaking down vardenafil in the liver [5][12]. When CYP3A4 is inhibited, vardenafil is cleared from the body more slowly, leading to higher levels in the bloodstream. This can increase the risk of side effects from vardenafil, such as headache, flushing, dizziness, and low blood pressure.

The interaction is not an absolute contraindication, meaning the two medicines can sometimes be used together, but only under careful medical supervision and usually with a lower starting dose of vardenafil [5]. Your prescriber will assess your individual situation, including the dose of everolimus you are taking, your kidney and liver function, and any other medicines or health conditions that might add to the risk.

It is important never to start vardenafil (or any other ED medicine) without declaring that you are taking everolimus. Your prescriber may recommend starting with the lowest available dose of vardenafil (5 mg) and monitoring how you respond. In some cases, your prescriber may suggest an alternative ED treatment that has a lower risk of interaction, depending on your overall treatment plan.

Why the CYP3A4 Enzyme Matters

CYP3A4 is one of the most important enzymes in the liver for breaking down medicines. When two medicines that both rely on CYP3A4 are taken together, they can compete for the same enzyme, leading to higher levels of one or both medicines in the blood. This is why prescribers must carefully review all your medicines and adjust doses to keep you safe. Grapefruit juice is also a well-known inhibitor of CYP3A4 and should be avoided when taking vardenafil or everolimus [5][12].

What Your Prescriber Will Check Before Prescribing Vardenafil and Everolimus Together

Before prescribing vardenafil to someone taking everolimus, your prescriber will carry out a thorough assessment. They will review your full medical history, including the reason you are taking everolimus, the dose you are on, and how well controlled your condition is. They will also check your kidney and liver function, as these organs play a key role in clearing both medicines from your body [5][12].

Your prescriber will ask about all other medicines you take, including over-the-counter products, herbal supplements, and recreational drugs. This is because some combinations are dangerous: for example, vardenafil must never be taken with nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or recreational drugs called 'poppers', as this can cause a severe and dangerous drop in blood pressure [5].

Your prescriber will also check your blood pressure and cardiovascular health, as PDE5 inhibitors like vardenafil can lower blood pressure slightly. If you are taking other blood-pressure medicines or alpha-blockers (such as doxazosin or tamsulosin), extra caution is needed [5]. Finally, your prescriber will discuss the symptoms of ED with you and may recommend lifestyle changes or addressing underlying causes, such as diabetes or heart disease, alongside any medicine [1][2].

Practical Advice for Taking Vardenafil with Everolimus

If your prescriber decides that vardenafil is suitable for you while you are taking everolimus, they will usually start you on the lowest dose (5 mg) and ask you to monitor for side effects [5]. Take vardenafil about 25 to 60 minutes before you plan to have sex, and remember that sexual stimulation is needed for it to work. Do not take more than one dose in 24 hours, and never increase the dose without consulting your prescriber first.

Avoid drinking grapefruit juice, as it can further increase vardenafil levels and raise the risk of side effects [5]. Limit alcohol intake, as heavy drinking can worsen erectile dysfunction and add to the blood-pressure-lowering effect of vardenafil. If you experience dizziness, lightheadedness, or fainting after taking vardenafil, sit or lie down and contact your prescriber or pharmacist for advice.

Keep all your follow-up appointments with your transplant or cancer specialist, as they will continue to monitor your everolimus levels and overall health. If you are prescribed any new medicines or if your everolimus dose is changed, inform your ED prescriber, as this may affect the safety or effectiveness of vardenafil. Always store both medicines in a cool, dry place out of reach of children, and check the expiry dates regularly.

When to Contact Your Prescriber

Contact your prescriber or pharmacist if you experience severe headaches, chest pain, prolonged dizziness, or any side effects that concern you after taking vardenafil with everolimus. If you develop an erection lasting more than four hours (priapism), sudden loss of vision or hearing, or chest pain during sex, seek urgent medical help by calling 999 or going to A&E immediately [5]. Do not stop taking everolimus without advice from your specialist, as this could put your transplant or cancer treatment at risk.

Alternative ED Treatments and What to Consider

If the interaction between vardenafil and everolimus is a concern, or if you experience side effects, your prescriber may discuss alternative treatments for erectile dysfunction. Other PDE5 inhibitors, such as sildenafil (Viagra) or tadalafil (Cialis), are also processed by CYP3A4 and can interact with everolimus in a similar way, so dose adjustments or caution are still needed [3][4]. Avanafil (Spedra) is another PDE5 inhibitor, but it is generally avoided or used with caution alongside potent CYP3A4 inhibitors [6].

Non-oral treatments may be an option for some men. These include Vitaros, an alprostadil cream applied to the tip of the penis, or Caverject, an alprostadil injection into the penis [7]. These treatments work locally rather than being absorbed into the bloodstream in large amounts, so they may have fewer interactions with everolimus. However, they still require a prescription and careful assessment by a healthcare professional.

Lifestyle changes can also improve erectile function and are recommended alongside any medicine. Stopping smoking, reducing alcohol intake, maintaining a healthy weight, exercising regularly, and managing stress can all help [1][2]. If ED is caused by an underlying condition such as diabetes, high blood pressure, or heart disease, treating that condition effectively can improve symptoms. Your GP or specialist can provide tailored advice and refer you for further support if needed.

How Cured Pharmacy Can Help

Cured Pharmacy is a GPhC-registered online pharmacy offering discreet, convenient access to ED treatments after a consultation with a UK-registered prescriber. During your online consultation, you will be asked detailed questions about your medical history, current medicines (including everolimus), and overall health. The prescriber will review your answers and, if appropriate, issue a prescription for the most suitable ED treatment at the right dose for you. Your medicine is then dispensed by our pharmacy and delivered discreetly to your door.

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 sex — stop activity and call 999
• Severe dizziness, fainting, or very low blood pressure — contact your prescriber or call 111
• Signs of allergic reaction (rash, swelling, difficulty breathing) — call 999

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