Vardenafil and Metoclopramide: Can They Be Taken Together?

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What is vardenafil and metoclopramide used for?

Vardenafil (also known by the brand name Levitra) is a phosphodiesterase type 5 (PDE5) inhibitor used to treat erectile dysfunction in men [5]. It works by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Vardenafil is available in 5mg, 10mg, and 20mg tablets, and is usually taken about 25 to 60 minutes before sexual activity. Like all PDE5 inhibitors, it requires sexual stimulation to work and should not be taken more than once a day [5].

Metoclopramide is a medicine that treats nausea, vomiting, and certain digestive problems such as gastroparesis (delayed stomach emptying). It works by blocking dopamine receptors in the brain and gut, which helps to reduce feelings of sickness and speeds up the movement of food through the stomach. Metoclopramide is available as tablets, liquid, and injections, and is often prescribed for short-term use. Common brand names include Maxolon, though many people take the generic version.

Both medicines are prescription-only in the UK, meaning they are only supplied after a healthcare professional has reviewed your medical history and current medications. At Cured Pharmacy, every order for vardenafil requires an online consultation reviewed by a UK-registered prescriber to ensure it is safe and suitable for you.

How do vardenafil and metoclopramide interact?

The interaction between vardenafil and metoclopramide relates to a heart rhythm effect known as QT prolongation. The QT interval is a measurement on an electrocardiogram (ECG) that shows how long it takes for the heart's electrical system to recharge between beats. Both vardenafil and metoclopramide can, in rare cases, slightly prolong this interval [5][12]. When the QT interval becomes too long, there is a small risk of a serious irregular heartbeat called torsades de pointes, which can be life-threatening.

In plain English, this means that taking both medicines together may very slightly increase the risk of an abnormal heart rhythm. However, this risk is generally low for most people, especially when both medicines are used at normal doses and you do not have other risk factors. The interaction is not an absolute contraindication (unlike vardenafil with nitrates, which must never be combined), but it does require careful assessment by your prescriber.

Your doctor or pharmacist will check whether you have any conditions or take any other medicines that might increase this risk. These include a history of heart rhythm problems, low potassium or magnesium levels, certain heart conditions, or other medicines that also prolong the QT interval. If you are taking both vardenafil and metoclopramide, it is important to report any new symptoms such as a fast or irregular heartbeat, dizziness, or fainting, and to seek medical advice promptly.

What does QT prolongation mean?

QT prolongation refers to a delay in the heart's electrical recharging cycle. Most people with a slightly prolonged QT interval have no symptoms and are unaware of it. However, in rare cases, a significantly prolonged QT interval can trigger a dangerous type of irregular heartbeat. This is why prescribers are cautious when combining medicines that can affect the QT interval, and why they check your heart health and other medications during the consultation.

When to get urgent help

• Erection lasting longer than 4 hours (priapism)—go to A&E or call 999 immediately
• Sudden loss of vision or hearing—stop vardenafil and seek urgent medical help
• Chest pain during or after sex—stop activity, do not take nitrates, and call 999
• Fast, pounding, or irregular heartbeat, severe dizziness, or fainting—stop both medicines and seek immediate advice
• Swelling of face, lips, tongue, or throat, or difficulty breathing—call 999 for allergic reaction

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

What your prescriber checks before combining these medicines

When you request vardenafil and are already taking metoclopramide (or vice versa), your prescriber will carry out a thorough review to ensure the combination is safe for you. They will ask about your heart health, including any history of heart rhythm problems, heart attacks, heart failure, or conditions such as long QT syndrome. They will also check whether you have ever experienced unexplained fainting or blackouts, as these can sometimes be a sign of a heart rhythm disturbance.

Your prescriber will review all your current medicines, including over-the-counter treatments and supplements, to identify any other drugs that might prolong the QT interval or interact with vardenafil. Examples include certain antibiotics (such as clarithromycin or erythromycin), antifungals (such as ketoconazole), some antidepressants, and medicines for irregular heartbeats. They will also check for medicines that affect potassium or magnesium levels, as low levels of these minerals can increase the risk of QT prolongation.

Blood tests may be recommended in some cases to check your potassium and magnesium levels, especially if you take diuretics (water tablets) or have conditions that affect these minerals. Your prescriber may also ask about your kidney and liver function, as both vardenafil and metoclopramide are processed by these organs. If you have significant kidney or liver problems, dose adjustments or alternative treatments may be needed. The goal is to ensure that the benefits of using both medicines outweigh any potential risks, and that you are monitored appropriately.

Practical advice for taking vardenafil and metoclopramide together

If your prescriber has confirmed that it is safe for you to take vardenafil and metoclopramide together, there are some practical steps you can take to minimise any risk. First, always take both medicines exactly as prescribed. Do not increase the dose of either medicine without consulting your doctor, as higher doses may increase the risk of side effects, including QT prolongation. Vardenafil should be taken no more than once a day, and metoclopramide is usually prescribed for short-term use (typically no longer than five days for nausea, or up to three months for gastroparesis under specialist supervision).

Be aware of symptoms that might suggest a heart rhythm problem. These include a fast, pounding, or irregular heartbeat, dizziness, light-headedness, or fainting. If you experience any of these symptoms, stop taking both medicines and seek medical advice immediately. You should also avoid other factors that can increase the risk of QT prolongation, such as excessive alcohol, dehydration, or taking other medicines that affect heart rhythm without your doctor's knowledge.

Keep your prescriber and pharmacist informed of any changes to your health or medications. If you are prescribed a new medicine by another doctor, mention that you are taking both vardenafil and metoclopramide so they can check for interactions. Similarly, if you develop a new health condition or are admitted to hospital, make sure the healthcare team knows about all your medicines. At Cured Pharmacy, our online consultation process captures your full medication list, and our prescribers review every detail to ensure your safety.

Can I take vardenafil if I only use metoclopramide occasionally?

If you only use metoclopramide occasionally (for example, for travel sickness or an occasional upset stomach), the risk of interaction with vardenafil is even lower. However, you should still declare this to your prescriber during the consultation. They may advise you to avoid taking both medicines on the same day if possible, or to use the lowest effective dose of each. Always follow the advice given during your consultation, and do not assume that occasional use means no interaction check is needed.

At a glance

Other medicines that interact with vardenafil

While vardenafil and metoclopramide can usually be taken together with caution, there are some medicines that must never be combined with vardenafil because they cause a dangerous drop in blood pressure. These include nitrates (such as GTN spray, isosorbide mononitrate, or isosorbide dinitrate), nicorandil, riociguat, and recreational drugs known as poppers (amyl or alkyl nitrites). Do not take vardenafil if you are using any of these medicines [5].

Alpha-blockers, which are used to treat high blood pressure or an enlarged prostate (such as doxazosin, tamsulosin, or alfuzosin), can also interact with vardenafil by causing low blood pressure and dizziness. If you take an alpha-blocker, you should be stable on it before starting vardenafil, and your prescriber will usually recommend the lowest dose of vardenafil to start. Potent CYP3A4 inhibitors, such as ritonavir, cobicistat, ketoconazole, itraconazole, and clarithromycin, can raise vardenafil levels in the blood. Vardenafil is generally avoided or contraindicated with these medicines, so your prescriber will check the summary of product characteristics (SmPC) carefully [5][12].

Other blood-pressure medicines, such as ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and beta-blockers, can add to the blood-pressure-lowering effect of vardenafil, potentially causing dizziness. This is usually manageable, but you must declare all your medicines during the consultation. Grapefruit juice can also raise vardenafil levels and should be avoided. Heavy alcohol can worsen erectile dysfunction and increase the risk of low blood pressure and dizziness when combined with vardenafil.

When to seek urgent medical help

While serious side effects from the combination of vardenafil and metoclopramide are rare, it is important to know the warning signs that require urgent medical attention. If you experience an erection that lasts longer than four hours (priapism), you should go to A&E immediately or call 999. Priapism is a medical emergency that can cause permanent damage to the penis if not treated promptly. It is a rare side effect of all PDE5 inhibitors, including vardenafil [5].

Sudden loss of vision in one or both eyes, or sudden decrease or loss of hearing (which may be accompanied by ringing in the ears or dizziness), are also medical emergencies. Stop taking vardenafil immediately and seek urgent medical help if you experience these symptoms. If you develop chest pain during or after sexual activity, do not continue. Stop what you are doing, sit or lie down, and seek medical advice. Do not take nitrate medicines (such as GTN spray) if you have used vardenafil within the past 24 hours, as this can cause a dangerous drop in blood pressure.

Symptoms that might suggest a heart rhythm problem include a fast, pounding, or irregular heartbeat, severe dizziness, fainting, or seizures. If you experience any of these while taking vardenafil and metoclopramide together, stop both medicines and seek immediate medical advice. Other serious allergic reactions, such as swelling of the face, lips, tongue, or throat, or difficulty breathing, also require emergency treatment. Always err on the side of caution and seek help if you are concerned about any new or unusual symptoms.

What should I do if I miss a dose?

Vardenafil is taken on demand, so there is no regular dosing schedule and no concept of a 'missed dose'. You simply take it when you plan to have sexual activity, no more than once a day. Metoclopramide is usually taken regularly for a short period. If you miss a dose of metoclopramide, take it as soon as you remember unless it is nearly time for your next dose. Do not take a double dose to make up for a missed one. If you are unsure, check the patient information leaflet or ask your pharmacist for advice.

In summary

• Vardenafil and metoclopramide can usually be taken together, but both may affect heart rhythm.
• Your prescriber checks your heart health and other medications before approving the combination.
• Report any fast or irregular heartbeat, dizziness, or fainting to your doctor immediately.
• Never take vardenafil with nitrates, nicorandil, riociguat, or poppers—this is dangerous.
• Prescription required: online consultation reviewed by a UK prescriber at Cured Pharmacy.

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