Vardenafil and Fluticasone: Can You Take Them 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 [5]. It belongs to a group of medicines called phosphodiesterase type 5 (PDE5) inhibitors, which also includes sildenafil (Viagra) and tadalafil (Cialis). Vardenafil is the generic version of the branded medicine Levitra.

Vardenafil works by relaxing the blood vessels in the penis, allowing more blood to flow into the area when you are sexually aroused [5]. It does not cause an erection on its own—sexual stimulation is still needed. The medicine is usually taken about 25 to 60 minutes before sexual activity, and the effect can last for several hours. The usual starting dose is 10 mg, which may be adjusted by your prescriber depending on how well it works and whether you experience any side effects [5].

Vardenafil is available in 5 mg, 10 mg and 20 mg tablets. It should be taken no more than once a day. Like all PDE5 inhibitors, vardenafil is only available on prescription in the UK after a clinical assessment by a registered prescriber.

What is fluticasone and what is it used for?

Fluticasone is a corticosteroid (a type of steroid medicine) that reduces inflammation in the body. It is commonly used to treat asthma and chronic obstructive pulmonary disease (COPD) when inhaled, and to relieve symptoms of allergic rhinitis (hay fever) or nasal polyps when used as a nasal spray. Brand names include Flixotide (inhaler), Flixonase (nasal spray), and Avamys (nasal spray).

Fluticasone works by calming down the immune response in the airways or nasal passages, reducing swelling, mucus production and irritation. Inhaled and nasal fluticasone are absorbed into the body in very small amounts, which is why they are generally considered safe for long-term use with minimal systemic (whole-body) effects.

Fluticasone is also found in combination inhalers such as Seretide (fluticasone with salmeterol) and Relvar Ellipta (fluticasone furoate with vilanterol). These are widely prescribed for asthma and COPD management. Because fluticasone is used locally in the lungs or nose, it does not usually interact with medicines taken by mouth in the same way that oral steroids might.

Do vardenafil and fluticasone interact with each other?

No major interaction is commonly reported between vardenafil and fluticasone when fluticasone is used as an inhaler or nasal spray. Inhaled and intranasal corticosteroids like fluticasone are absorbed into the bloodstream in very small amounts, so they are unlikely to affect how vardenafil works or increase the risk of side effects.

Vardenafil is broken down in the liver by an enzyme called CYP3A4 [5]. Some medicines that strongly inhibit (block) this enzyme can raise vardenafil levels in the blood, which may increase the risk of side effects. However, inhaled and nasal fluticasone do not have a clinically significant effect on CYP3A4 in most people, so the interaction risk is low.

That said, it is still essential to tell your prescriber about all medicines you use, including inhalers, nasal sprays, and any other treatments. Your prescriber will review your full medication list and medical history to ensure vardenafil is safe and appropriate for you. If you are taking oral (tablet) corticosteroids or other medicines that affect CYP3A4, your prescriber will take that into account during your assessment.

What about other corticosteroids?

Oral corticosteroids (such as prednisolone tablets) are absorbed much more into the bloodstream than inhaled or nasal steroids. While they are not known to have a major interaction with vardenafil, your prescriber will still need to know if you are taking them, especially if you are on long-term treatment or high doses. Always declare every medicine, supplement, and herbal product during your consultation.

What you need to know

• No major interaction is commonly reported between vardenafil and fluticasone inhalers or nasal sprays
• Always declare all medicines, including inhalers, during your online consultation
• Never take vardenafil with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor
• Vardenafil is taken 25–60 minutes before sex and requires sexual stimulation to work
• Seek urgent help for chest pain during sex, erection over 4 hours, or sudden vision or hearing loss

What does your prescriber check before prescribing vardenafil?

Before prescribing vardenafil, your prescriber will review your full medical history and current medicines to ensure the treatment is safe for you [2][5]. This includes checking for conditions that make PDE5 inhibitors unsuitable, such as recent heart attack or stroke, unstable angina, severe heart failure, very low blood pressure, or a history of sudden vision loss (non-arteritic anterior ischaemic optic neuropathy, or NAION).

Your prescriber will also check whether you are taking any medicines that must not be combined with vardenafil. These include nitrates (such as GTN spray, isosorbide mononitrate or dinitrate), nicorandil, riociguat, or recreational drugs called 'poppers' (amyl or alkyl nitrites). Taking vardenafil with any of these can cause a dangerous drop in blood pressure [5]. You must never take vardenafil alongside another PDE5 inhibitor (such as sildenafil or tadalafil).

If you take alpha-blockers (such as tamsulosin or doxazosin) for prostate symptoms or high blood pressure, your prescriber will ensure you are stable on that medicine and may start you on a lower dose of vardenafil to reduce the risk of dizziness or low blood pressure [5]. Medicines that strongly inhibit CYP3A4 (such as ritonavir, ketoconazole, itraconazole, or clarithromycin) can raise vardenafil levels; vardenafil is often avoided or contraindicated with these medicines, so your prescriber will check the product information carefully [5][12].

Declaring all your medicines

It is vital to list every medicine you take during your consultation, including prescription medicines, over-the-counter treatments, inhalers, nasal sprays, eye drops, vitamins, supplements, and herbal remedies. Even if you think a medicine is unlikely to interact, your prescriber needs the full picture to make a safe decision. Do not stop or change any prescribed medicine without advice from your doctor or pharmacist.

Practical advice when taking vardenafil and fluticasone together

If your prescriber has confirmed that vardenafil is suitable for you and you are using fluticasone inhalers or nasal sprays, you can generally use both medicines as directed without concern. Take vardenafil about 25 to 60 minutes before you plan to have sex, and use your fluticasone inhaler or nasal spray as prescribed by your doctor for your asthma, COPD, or hay fever.

Avoid drinking large amounts of alcohol when taking vardenafil, as alcohol can make erectile dysfunction worse and add to the blood-pressure-lowering effect of the medicine, increasing the risk of dizziness [5]. Grapefruit juice can raise vardenafil levels in the blood, so it is best to avoid it while using this treatment.

If you experience any side effects from vardenafil—such as headache, flushing, indigestion, nasal congestion, or dizziness—speak to your prescriber or pharmacist. Most side effects are mild and temporary. However, if you develop chest pain during sex, a painful erection lasting more than four hours (priapism), or sudden loss of vision or hearing, seek urgent medical help immediately [5].

When to get urgent help

• Chest pain during or after sexual activity
• An erection lasting more than 4 hours (priapism)
• Sudden loss of vision in one or both eyes
• Sudden decrease or loss of hearing, possibly with ringing in the ears or dizziness
• Severe dizziness or fainting after taking vardenafil

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

Other medicines and vardenafil: what else should you know?

Vardenafil can interact with several other types of medicine, so it is important to be aware of the key interactions [5]. As mentioned, you must never take vardenafil with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor—these combinations can cause a dangerous fall in blood pressure.

If you take medicines for high blood pressure or heart conditions (other than nitrates), your prescriber will assess whether vardenafil is safe. Many men with well-controlled blood pressure can use vardenafil, but the combination may increase the risk of dizziness, so your prescriber may start you on a lower dose. Alpha-blockers used for prostate symptoms require careful dose adjustment and timing [5].

Medicines that induce (speed up) the CYP3A4 enzyme—such as rifampicin, carbamazepine, phenytoin, or St John's wort—can reduce vardenafil levels and make it less effective [5]. If you are taking any of these, your prescriber will discuss whether vardenafil is the best option or whether an alternative ED treatment might be more suitable. Always complete the online consultation form fully and honestly so your prescriber can make the safest choice for you.

When to see your GP about erectile dysfunction

If you are experiencing erectile dysfunction for the first time, it is a good idea to see your GP [1][2]. ED can be an early warning sign of underlying health conditions such as heart disease, diabetes, or high blood pressure. Your GP can arrange tests, review your overall health, and discuss treatment options. Online pharmacies like Cured Pharmacy can provide convenient access to ED treatment after a clinical assessment, but they work alongside—not instead of—your GP.

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