Vardenafil and Indoramin: Can They Be Taken Together?

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At a glance

What is vardenafil and how does it work?

Vardenafil (generic 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, allowing more blood to flow in when you are sexually aroused. This helps you get and keep an erection suitable for sexual activity.

Vardenafil is available in 5mg, 10mg and 20mg tablets and is usually taken about 25 to 60 minutes before sex [5]. The effect can last for several hours, but you will only get an erection when you are sexually stimulated – the medicine does not work automatically. The usual starting dose is 10mg, which your prescriber may adjust depending on how well it works and whether you experience any side effects.

Like all PDE5 inhibitors, vardenafil also has a mild blood-pressure-lowering effect because it relaxes blood vessels throughout the body, not just in the penis [5]. This is why interactions with other blood-pressure medicines, including alpha-blockers like indoramin, need careful management.

What is indoramin and why is it prescribed?

Indoramin is an alpha-blocker medicine used to treat two main conditions: high blood pressure (hypertension) and urinary symptoms caused by an enlarged prostate gland (benign prostatic hyperplasia) [12]. It works by blocking alpha receptors in smooth muscle, which causes blood vessels to relax and widen, lowering blood pressure. In the prostate and bladder neck, this relaxation helps urine flow more easily.

Indoramin is usually taken two or three times a day, and the dose is built up gradually to reduce the risk of side effects such as dizziness, especially when standing up quickly [12]. Common side effects include drowsiness, dry mouth, nasal congestion and a drop in blood pressure when changing position (postural hypotension).

Because indoramin lowers blood pressure, combining it with other medicines that have the same effect – including vardenafil – requires careful assessment by your prescriber. The goal is to ensure that the combination does not cause your blood pressure to drop too low, which can lead to dizziness, fainting or falls.

How do vardenafil and indoramin interact?

The interaction between vardenafil and indoramin is pharmacodynamic, meaning both medicines have effects that add together [5]. Vardenafil relaxes blood vessels to improve blood flow to the penis, and this also causes a small reduction in overall blood pressure. Indoramin relaxes blood vessels to lower blood pressure and improve urine flow. When taken together, the blood-pressure-lowering effects can add up, increasing the risk of symptomatic low blood pressure (hypotension).

Symptoms of low blood pressure include dizziness (especially when standing up), light-headedness, fainting, blurred vision and feeling weak or unsteady. In most cases, this interaction can be managed safely by ensuring you are stable on your indoramin dose before starting vardenafil, and by using the lowest effective dose of vardenafil [5].

This interaction applies to all alpha-blockers, including doxazosin, tamsulosin, alfuzosin, terazosin, prazosin and silodosin, as well as indoramin. Your prescriber will review your current dose of indoramin, how long you have been taking it, and whether you have experienced any dizziness or low blood pressure symptoms before deciding whether vardenafil is suitable for you.

Why the interaction matters

A sudden drop in blood pressure can cause you to feel faint or dizzy, which increases the risk of falls and injury, particularly in older men or those with other health conditions. This is why the combination of vardenafil and indoramin must be prescribed and monitored by a healthcare professional who can assess your individual risk and adjust doses if needed [5].

What you need to know

• Vardenafil and indoramin can be taken together under medical supervision
• Both medicines lower blood pressure, so the combination increases dizziness risk
• You must be stable on indoramin before starting vardenafil
• Your prescriber will use the lowest effective dose of vardenafil
• Stand up slowly and limit alcohol to reduce the risk of low blood pressure

What your prescriber checks before combining vardenafil and indoramin

Before prescribing vardenafil to someone taking indoramin, your prescriber will carry out a thorough assessment to ensure the combination is safe for you. They will ask how long you have been taking indoramin and whether your dose has been stable, as it is important that you are not experiencing ongoing dizziness or blood pressure problems. They will also ask about any other medicines you take, particularly other blood-pressure treatments, and whether you have a history of low blood pressure or fainting.

Your prescriber will check your current blood pressure and review your medical history, including any heart conditions, recent heart attack or stroke, and whether sexual activity is safe for you [2]. They will also ask about other conditions that might affect the safety of vardenafil, such as severe liver or kidney disease, inherited eye disorders, or a history of priapism (prolonged erection).

If vardenafil is considered appropriate, your prescriber will usually start you on the lowest dose (5mg or 10mg) and advise you to take it at a different time of day from your indoramin if possible, to reduce the chance of both medicines lowering your blood pressure at the same time [5]. They will also give you clear advice on what to do if you experience dizziness or other side effects.

Declaring all your medicines

It is essential to tell your prescriber about every medicine you take, including over-the-counter medicines, herbal remedies and supplements. Some medicines can interact with vardenafil in other ways – for example, certain antibiotics and antifungals can increase vardenafil levels in your blood, requiring a dose adjustment [5].

Practical advice for taking vardenafil and indoramin together

If your prescriber has approved the combination of vardenafil and indoramin, there are several practical steps you can take to use both medicines safely. Always take vardenafil exactly as prescribed – do not take more than one dose in 24 hours, and do not exceed the dose your prescriber has recommended. Start with the lowest dose and only increase it if advised by your prescriber.

Be especially careful when standing up from sitting or lying down, as this is when you are most likely to feel dizzy. Stand up slowly and steady yourself before walking. Avoid drinking large amounts of alcohol, as this can make low blood pressure and dizziness worse, and can also make it harder to get an erection [1]. Limit grapefruit juice, as it can increase the level of vardenafil in your blood.

If you feel dizzy, light-headed or faint after taking vardenafil, sit or lie down until the feeling passes. Do not drive or operate machinery if you feel unsteady. If dizziness is severe or does not go away, contact your GP or pharmacist for advice. Keep all your follow-up appointments so your prescriber can monitor how you are getting on and adjust your treatment if needed.

When to get urgent help

• Erection lasting longer than 4 hours – go to A&E immediately
• Sudden loss of vision in one or both eyes – stop vardenafil and seek urgent medical advice
• Chest pain during or after sex – call 999 and tell paramedics you have taken vardenafil
• Severe dizziness, fainting or very fast heartbeat – seek medical help the same day
• Sudden hearing loss or ringing in the ears – stop vardenafil and contact a doctor

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

Warning signs and when to seek help with vardenafil and indoramin

Most men taking vardenafil and indoramin together do not experience serious problems, but it is important to know the warning signs that need urgent attention. If you develop an erection that lasts longer than four hours (priapism), go to A&E immediately, as this can cause permanent damage to the penis if not treated quickly [5]. If you experience sudden loss of vision in one or both eyes, stop taking vardenafil and seek urgent medical advice, as this may be a sign of a rare condition called non-arteritic anterior ischaemic optic neuropathy (NAION).

Sudden hearing loss or ringing in the ears (tinnitus) is another rare but serious side effect that requires you to stop vardenafil and contact a doctor straight away [5]. If you develop chest pain during or after sex, do not use nitrate medicines (such as GTN spray) to relieve it, as the combination with vardenafil can cause a dangerous drop in blood pressure. Instead, call 999 and tell the paramedics you have taken vardenafil.

If you experience severe dizziness, fainting, or a very fast or irregular heartbeat, seek medical help the same day. These symptoms may indicate that your blood pressure has dropped too low. Your prescriber may need to adjust the dose of vardenafil, indoramin or both. Never stop taking indoramin suddenly without medical advice, as this can cause a rebound increase in blood pressure.

Reporting side effects

If you experience any side effects, whether listed in the patient information leaflet or not, talk to your doctor or pharmacist. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. Reporting helps improve the safety information available about medicines.