Vardenafil and Rifampicin: Can They Be Taken Together?

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Vardenafil and Rifampicin: Understanding the Interaction

Published: 3 November 2026

Vardenafil and rifampicin can interact in a way that significantly reduces the effectiveness of vardenafil for treating erectile dysfunction. Rifampicin is a powerful antibiotic commonly used to treat tuberculosis and other serious bacterial infections, whilst vardenafil (generic Levitra) is a PDE5 inhibitor prescribed for erectile dysfunction. When taken together, rifampicin speeds up the breakdown of vardenafil in your body, meaning the ED medicine may not work as well or may not work at all. This page explains how the interaction happens, what your prescriber will check, and what practical options are available if you need both treatments.

What Are Vardenafil and Rifampicin Used For?

Vardenafil is a prescription medicine licensed in the UK to treat erectile dysfunction in adult men. It belongs to a group of medicines called PDE5 inhibitors, which work by relaxing blood vessels in the penis during sexual stimulation, allowing increased blood flow and helping you achieve and maintain an erection. Vardenafil is available in 5 mg, 10 mg, and 20 mg tablets and is usually taken about 25 to 60 minutes before sexual activity, with effects lasting for several hours [5].

Rifampicin is a potent antibiotic used to treat serious bacterial infections, most commonly tuberculosis (TB), but also other conditions such as leprosy and certain types of meningitis. It is often prescribed as part of a combination treatment regimen and is typically taken for several months. Rifampicin works by killing or stopping the growth of bacteria, but it also has a significant effect on how your liver processes many other medicines, including vardenafil [12].

Both medicines are prescription-only in the UK and should only be taken under the guidance of a qualified healthcare professional. If you are prescribed rifampicin for an infection and are already taking or considering vardenafil for erectile dysfunction, it is essential to inform your prescriber so they can assess the interaction and advise on the safest approach.

How Do Vardenafil and Rifampicin Interact?

The interaction between vardenafil and rifampicin occurs because rifampicin is a very strong inducer of an enzyme system in the liver called CYP3A4. This enzyme is responsible for breaking down many medicines, including vardenafil. When rifampicin is present, it dramatically increases the activity of CYP3A4, causing vardenafil to be metabolised and eliminated from your body much more quickly than usual [5].

As a result, the levels of vardenafil in your bloodstream may be too low to produce the desired effect, meaning the medicine may not work effectively for erectile dysfunction. In some cases, vardenafil may not work at all whilst you are taking rifampicin. This type of interaction is known as a pharmacokinetic interaction, where one medicine affects how another is absorbed, distributed, metabolised, or eliminated.

Because of this significant reduction in effectiveness, vardenafil is generally not recommended for use during treatment with rifampicin. The British National Formulary advises caution or avoidance of vardenafil with potent CYP3A4 inducers such as rifampicin [5]. Your prescriber will need to review your full medication list and medical history to determine the most appropriate treatment plan for both your infection and erectile dysfunction.

Why CYP3A4 Induction Matters

CYP3A4 is one of the most important enzymes in drug metabolism, processing approximately half of all medicines used in clinical practice. When rifampicin induces this enzyme, it does not only affect vardenafil—it can reduce the effectiveness of many other medicines, including hormonal contraceptives, anticoagulants, and immunosuppressants. This is why rifampicin is known to have numerous drug interactions, and careful monitoring is essential whenever it is prescribed alongside other treatments [12].

What Your Prescriber Will Check Before Prescribing

Before prescribing vardenafil, your prescriber will take a full medical history and ask about all medicines you are currently taking, including prescription medicines, over-the-counter products, and herbal supplements. If you are taking rifampicin or have recently completed a course of rifampicin, your prescriber will need to know, as this will influence whether vardenafil is suitable for you [2].

Rifampicin's enzyme-inducing effects can persist for some time after you stop taking it—usually around two to three weeks—so your prescriber may advise waiting until rifampicin has fully cleared from your system before starting vardenafil. Alternatively, they may suggest a different PDE5 inhibitor that may be less affected by enzyme induction, or they may recommend non-oral treatments for erectile dysfunction if appropriate.

Your prescriber will also check for other conditions that might make PDE5 inhibitors unsuitable, such as recent heart attack or stroke, unstable angina, severe heart failure, very low blood pressure, or use of nitrate medicines (which must never be taken with PDE5 inhibitors). They will assess whether sexual activity is safe for you and whether any adjustments to your treatment plan are needed [2][5].

Practical Advice If You Need Both Treatments

If you are prescribed rifampicin for tuberculosis or another serious infection, completing the full course of antibiotics is essential for your health and to prevent antibiotic resistance. Do not stop or reduce your rifampicin without medical advice, even if you are concerned about its effect on erectile dysfunction treatment. Your infection must be treated effectively.

During the time you are taking rifampicin, vardenafil is unlikely to be effective, so your prescriber may advise pausing ED treatment temporarily. Once you have completed your rifampicin course and it has cleared from your system (usually two to three weeks after the last dose), you can discuss restarting vardenafil or trying an alternative PDE5 inhibitor with your prescriber.

If erectile dysfunction treatment is important to you during rifampicin therapy, speak to your prescriber about alternatives. Other PDE5 inhibitors such as sildenafil or tadalafil are also affected by rifampicin, but your prescriber may consider higher doses or different treatment options, such as alprostadil (a prescription medicine available as a cream or injection) or vacuum erection devices. Always have an open conversation with your healthcare professional about your priorities and concerns so they can tailor treatment to your individual needs [1][2].

What About Other CYP3A4 Inducers?

Rifampicin is not the only medicine that induces CYP3A4 and reduces the effectiveness of vardenafil. Other enzyme inducers include carbamazepine (used for epilepsy and nerve pain), phenytoin (another epilepsy medicine), and the herbal remedy St John's wort (often taken for low mood). If you are taking any of these, inform your prescriber, as they may also reduce the effectiveness of PDE5 inhibitors [5][12].

Are There Safer Alternatives to Vardenafil and Rifampicin?

There is no safer alternative to rifampicin if it has been prescribed for tuberculosis or another serious bacterial infection—rifampicin is a cornerstone of TB treatment and must be completed as directed by your doctor. However, there may be alternative approaches to managing erectile dysfunction whilst you are on rifampicin.

All PDE5 inhibitors (sildenafil, tadalafil, vardenafil, and avanafil) are metabolised by CYP3A4 and are therefore affected by rifampicin to varying degrees. Sildenafil and tadalafil may be considered, but their effectiveness will also be reduced. Your prescriber may suggest a higher dose or a different class of treatment altogether, such as alprostadil cream (Vitaros) or alprostadil injection (Caverject), which work by a different mechanism and are not affected by CYP3A4 induction [7].

Non-drug options such as vacuum erection devices or penile rings may also be discussed. These do not involve medicines and are therefore unaffected by rifampicin. Once your rifampicin treatment is complete and the medicine has cleared from your system, you can return to using PDE5 inhibitors such as vardenafil if they were effective for you previously. Always consult your prescriber before making any changes to your treatment plan [1][2].

Warning Signs and When to Seek Help with Vardenafil and Rifampicin

If you are taking vardenafil and rifampicin together (or have recently taken rifampicin), be aware that the ED medicine may simply not work, which is not dangerous but can be frustrating. Do not take extra doses of vardenafil to try to overcome the reduced effect, as this will not help and may increase the risk of side effects such as headache, flushing, indigestion, or dizziness.

Seek urgent medical help (call 999 or go to A&E) if you experience an erection lasting 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 of PDE5 inhibitors and require immediate attention [3][5].

If you develop new symptoms whilst taking rifampicin, such as yellowing of the skin or eyes, severe stomach pain, or unusual bruising or bleeding, contact your GP or the healthcare team managing your infection immediately, as these may be signs of a serious reaction to rifampicin. Always inform any healthcare professional you see about all the medicines you are taking, including both rifampicin and vardenafil, to ensure safe and coordinated care [12].

Reporting Side Effects

If you experience side effects from vardenafil or rifampicin, you can report them via the Yellow Card Scheme at yellowcard.mhra.gov.uk or by searching for the Yellow Card app. Reporting side effects helps improve the safety information available for all patients. You can also discuss any concerns with your prescriber or pharmacist, who can advise on managing side effects or adjusting your treatment if needed.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 3 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 3 November 2026]
3. Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 3 November 2026]
4. Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 3 November 2026]
5. Joint Formulary Committee. (n.d.). Alprostadil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/alprostadil/ [accessed 3 November 2026]
6. Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [accessed 3 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.

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