Vardenafil and Methotrexate: Can They Be Taken Together?

Vardenafil and Methotrexate: Understanding the Interaction

Published: 1 November 2026

Many men taking methotrexate for conditions such as rheumatoid arthritis or psoriasis wonder whether vardenafil and methotrexate can be taken together safely. The good news is that no major direct interaction between these two medicines is commonly reported, and many patients use them together without problems. However, because methotrexate can affect liver function and overall health, your prescriber will carefully review your medical history and current condition during the consultation to ensure vardenafil is suitable for you.

What is vardenafil and methotrexate used for?

Vardenafil (also known by the brand name Levitra) is a prescription medicine used to treat erectile dysfunction in men. It belongs to a group of medicines called PDE5 inhibitors, which work by increasing blood flow to the penis when you are sexually aroused [5]. Vardenafil is usually taken about 25 to 60 minutes before sexual activity, and its effect can last for several hours. It is available in doses of 5mg, 10mg, and 20mg, and you should not take it more than once a day.

Methotrexate is a disease-modifying medicine used to treat a range of conditions including rheumatoid arthritis, psoriasis, psoriatic arthritis, and some types of cancer. It works by suppressing the immune system and reducing inflammation. Methotrexate is usually taken once a week (not daily) for arthritis and skin conditions, and it requires regular blood tests to monitor liver function, kidney function, and blood counts because it can affect these systems over time.

Both medicines are prescription-only in the UK, and your doctor or prescriber will need to know about all your current medicines and health conditions before starting either treatment.

Is there an interaction between vardenafil and methotrexate?

There is no well-documented direct drug interaction between vardenafil and methotrexate. This means that the two medicines do not interfere with each other's chemical breakdown or action in the body in a way that would make either one unsafe or ineffective when taken together [5]. Many men with rheumatoid arthritis, psoriasis, or other conditions requiring methotrexate have been prescribed vardenafil without significant problems.

However, this does not mean the combination is automatically suitable for everyone. Methotrexate can cause side effects that affect your liver, kidneys, and general health, and these factors can influence whether vardenafil is safe for you. For example, if methotrexate has caused liver problems or if you have other health conditions related to your underlying disease (such as heart or blood vessel problems), your prescriber will need to assess whether a PDE5 inhibitor like vardenafil is appropriate.

During your online consultation at Cured Pharmacy, the UK-registered prescriber will review your full medical history, including your methotrexate dose, how long you have been taking it, your recent blood test results, and any other medicines you are on. This ensures that vardenafil is both safe and likely to be effective for you.

How vardenafil works in the body

Vardenafil works by blocking an enzyme called phosphodiesterase type 5 (PDE5). When you are sexually aroused, your body releases a chemical called nitric oxide, which triggers the production of another chemical (cyclic GMP) that relaxes the smooth muscle in the blood vessels of the penis. This allows more blood to flow in, producing an erection. PDE5 normally breaks down cyclic GMP, so by blocking PDE5, vardenafil helps maintain higher levels of cyclic GMP and supports a firmer, longer-lasting erection [5]. Vardenafil does not cause an erection on its own; sexual stimulation is still needed.

What does your prescriber check before prescribing vardenafil and methotrexate together?

When you request vardenafil and you are already taking methotrexate, the prescriber will ask detailed questions about your health. They will want to know why you are taking methotrexate, how long you have been on it, what dose you take, and whether you have had any side effects or complications. They will also ask about your most recent blood test results, particularly liver and kidney function, because vardenafil is processed by the liver and any impairment could affect how the medicine works or increase the risk of side effects [5].

The prescriber will also check for other medicines you are taking alongside methotrexate. For example, many people with arthritis also take anti-inflammatory painkillers (NSAIDs) or other immunosuppressants, and some may be on blood pressure medicines. If you take an alpha-blocker (such as doxazosin or tamsulosin) for prostate symptoms, the prescriber must ensure you are stable on that medicine and will usually start you on the lowest dose of vardenafil to reduce the risk of dizziness or low blood pressure.

Importantly, the prescriber will confirm that you are not taking any medicines that are absolutely contraindicated with vardenafil. Do not take vardenafil if you use nitrates (such as GTN spray or isosorbide mononitrate for angina), nicorandil, riociguat, or recreational drugs known as 'poppers' (amyl or alkyl nitrites), as the combination can cause a dangerous drop in blood pressure [5]. You must also not take vardenafil at the same time as another PDE5 inhibitor (such as sildenafil or tadalafil).

Practical advice for taking vardenafil and methotrexate safely

If your prescriber approves vardenafil, take it exactly as directed. The usual starting dose is 10mg, taken about 25 to 60 minutes before you plan to have sex. Swallow the tablet whole with water; you can take it with or without food, although a very heavy or high-fat meal may delay how quickly it works [5]. Do not take more than one dose in 24 hours, and remember that sexual stimulation is needed for the medicine to work.

Continue taking your methotrexate exactly as your rheumatologist or specialist has prescribed. Do not stop or change the dose of methotrexate without speaking to the doctor who prescribed it, even if you experience side effects from vardenafil. If you have any concerns about either medicine, contact your GP or specialist for advice. Keep up with your regular blood tests for methotrexate monitoring, as these are essential for your safety.

Avoid drinking large amounts of alcohol when taking vardenafil, as alcohol can make erectile dysfunction worse and can add to the blood-pressure-lowering effect of the medicine, increasing the risk of dizziness [5]. Grapefruit juice can also raise the level of vardenafil in your blood, so it is best to avoid it. If you feel dizzy or lightheaded after taking vardenafil, sit or lie down until the feeling passes, and do not drive or operate machinery.

When to contact your doctor

Seek urgent medical help if you develop an erection that lasts longer than four hours (priapism), sudden loss of vision in one or both eyes, sudden decrease or loss of hearing, or chest pain during sexual activity. These are rare but serious side effects that require immediate attention [5]. If you experience severe dizziness, fainting, or an allergic reaction (such as swelling of the face, lips, or throat, or difficulty breathing), call 999 or go to A&E straight away.

Other medicines and health conditions to consider with vardenafil and methotrexate

Because methotrexate is often used alongside other medicines, it is important to declare everything you take during your consultation. Common medicines used with methotrexate include folic acid (which helps reduce side effects), NSAIDs such as ibuprofen or naproxen, corticosteroids like prednisolone, and other disease-modifying drugs such as sulfasalazine or hydroxychloroquine. None of these have a major direct interaction with vardenafil, but the prescriber needs the full picture to assess your overall health and any cumulative effects on blood pressure or other systems.

If you take medicines that strongly inhibit an enzyme called CYP3A4 (such as ritonavir, cobicistat, ketoconazole, itraconazole, or clarithromycin), vardenafil may not be suitable or the dose may need to be adjusted, as these medicines can raise vardenafil levels in the blood [5]. Conversely, medicines that induce CYP3A4 (such as rifampicin, carbamazepine, phenytoin, or St John's wort) can reduce the effectiveness of vardenafil.

Certain health conditions can make vardenafil unsuitable. Do not use vardenafil if you have been advised that sexual activity is not safe for you (for example, if you have had a recent heart attack or stroke, unstable angina, or severe heart failure), if you have very low blood pressure, or if you have a history of non-arteritic anterior ischaemic optic neuropathy (NAION, a type of sudden vision loss) [5]. Your prescriber will ask about these conditions during the consultation.

Alternatives to vardenafil if you take methotrexate

If vardenafil is not suitable for you, or if you would prefer to try a different option, there are several other licensed treatments for erectile dysfunction available in the UK. Sildenafil (the generic version of Viagra) is another PDE5 inhibitor that works in a similar way to vardenafil; it is taken about one hour before sex and is available at Cured Pharmacy from £0.45 per tablet (or £0.36 with first-order code Ednew). Tadalafil (generic Cialis) is a longer-acting option that can be taken on-demand (at least 30 minutes before sex, with effects lasting up to 36 hours) or as a low daily dose; prices start at £7.95 (or £6.36 with code Ednew) [3][4].

Avanafil (Spedra) is a newer PDE5 inhibitor that can work in as little as 15 to 30 minutes and may be suitable if you want a faster-acting option [6]. All of these medicines work in a similar way and have similar precautions regarding other medicines and health conditions. The same contraindications apply: do not take any PDE5 inhibitor with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor.

If oral tablets are not suitable, other prescription options include Vitaros (alprostadil cream applied to the tip of the penis) and Caverject (alprostadil injection). Eroxon is a topical gel medical device that can be purchased without a prescription. Your GP or a specialist can also refer you for other treatments such as vacuum devices or, in some cases, surgery. It is always worth seeing your GP if you have new or worsening erectile dysfunction, as it can be an early warning sign of heart disease or diabetes [1][2].

How Cured Pharmacy can help

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering discreet, convenient access to erectile dysfunction treatments. After you complete a short online consultation, a UK-registered prescriber will review your answers, including all your current medicines and health conditions, to ensure the treatment is safe and appropriate for you. If approved, your medicine is dispensed by our pharmacy team and delivered in plain, discreet packaging. You can ask questions at any stage, and our pharmacists are here to provide advice and support.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 1 November 2026]
2. National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 1 November 2026]
3. Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 1 November 2026]
4. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 1 November 2026]
5. Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 1 November 2026]
6. Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 1 November 2026]

Information on this page is for educational purposes only and is not medical advice. Prescription treatments require clinical assessment by a UK-registered prescriber. Always consult a qualified healthcare professional before starting or changing any medication.