Vardenafil and Rilpivirine: Can They Be Taken 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 PDE5 inhibitors, which also includes sildenafil (Viagra) and tadalafil (Cialis). Vardenafil works by relaxing the blood vessels in the penis, allowing more blood to flow in when you're sexually aroused. This helps you get and keep an erection suitable for sexual activity.

Vardenafil is available in 5mg, 10mg, and 20mg tablets, and you usually take it about 25 to 60 minutes before sexual activity [5]. The medicine only works when you're sexually stimulated—it won't cause an erection on its own. The effect typically lasts for around four to five hours, though this varies between individuals. Like all PDE5 inhibitors, vardenafil requires a prescription and is only supplied after a consultation with a UK-registered prescriber who will check your medical history and current medicines.

What is rilpivirine and why is it prescribed?

Rilpivirine is an antiretroviral medicine used to treat HIV-1 infection in adults and adolescents [12]. It belongs to a class of medicines called non-nucleoside reverse transcriptase inhibitors (NNRTIs), which work by blocking an enzyme that HIV needs to multiply. Rilpivirine is usually taken once daily as part of combination antiretroviral therapy (ART), often in fixed-dose combination tablets such as Eviplera or Odefsey.

Maintaining effective HIV treatment is essential for your health and for preventing transmission of the virus. Rilpivirine must be taken consistently and exactly as prescribed to keep the virus suppressed. Because it's a long-term treatment, many people taking rilpivirine will at some point need treatment for other health conditions, including erectile dysfunction. Understanding how rilpivirine interacts with other medicines—including ED treatments—is an important part of managing your overall health safely.

How common is erectile dysfunction in men with HIV?

Erectile dysfunction can affect men with HIV for several reasons, including the psychological impact of living with a chronic condition, some antiretroviral medicines, and other health factors [1]. It's a common and treatable condition, and many men with HIV successfully use ED treatments alongside their HIV medication. The key is ensuring your prescriber knows all the medicines you're taking so they can choose the safest option and dose for you.

How do vardenafil and rilpivirine interact with each other?

Vardenafil and rilpivirine can interact because rilpivirine may affect how quickly your body breaks down vardenafil. Rilpivirine is a mild inhibitor of an enzyme system called CYP3A4, which is responsible for metabolising (breaking down) vardenafil in the liver [5][12]. When this enzyme is inhibited, vardenafil can stay in your body for longer and reach higher levels than usual, which may increase the risk of side effects such as headache, flushing, dizziness, or changes in blood pressure.

The interaction between vardenafil and rilpivirine is generally considered less significant than the interactions seen with potent CYP3A4 inhibitors such as ritonavir or cobicistat, which are often used as boosting agents in HIV treatment. However, it still requires careful consideration. Your prescriber will assess whether vardenafil is suitable for you and may recommend starting with a lower dose to minimise the risk of side effects. It's essential that you tell your prescriber about all your current medicines, including your HIV treatment, before starting any ED medication.

What about other HIV medicines?

If your HIV treatment includes a potent CYP3A4 inhibitor such as ritonavir, cobicistat, or darunavir/ritonavir, vardenafil is usually not recommended because the interaction is much stronger [5]. In these cases, your prescriber may suggest an alternative ED treatment such as sildenafil at a reduced dose, or tadalafil with a lower maximum dose. Always discuss your full HIV regimen during your ED consultation so the prescriber can choose the safest option for you.

What you need to know

• Vardenafil and rilpivirine can be used together, but rilpivirine may increase vardenafil levels, requiring dose adjustment.
• Your prescriber will review your full HIV regimen and may start you on a lower vardenafil dose to reduce side effects.
• Never take vardenafil with nitrates, nicorandil, riociguat, or another PDE5 inhibitor—these combinations are dangerous.
• Alternative ED treatments such as sildenafil or tadalafil may be more suitable depending on your HIV medication.
• All ED treatments at Cured Pharmacy require an online consultation reviewed by a UK-registered prescriber.

What will my prescriber check before prescribing vardenafil with rilpivirine?

Before prescribing vardenafil, your prescriber will review your full medical history and all current medicines, including rilpivirine and any other antiretroviral drugs [2][5]. They will check for conditions that make vardenafil unsuitable, such as recent heart attack or stroke, unstable angina, severe heart failure, very low blood pressure, or previous sudden vision loss (NAION). They will also ask about other medicines that can interact dangerously with vardenafil, including nitrates (GTN spray, isosorbide mononitrate), nicorandil, riociguat, and alpha-blockers such as doxazosin or tamsulosin.

Your prescriber will assess whether the combination of vardenafil and rilpivirine is appropriate for you, and if so, they may recommend starting with a lower dose of vardenafil to reduce the risk of side effects. They will also advise you on warning signs to watch for and when to seek help. If you're taking other medicines that affect blood pressure or are metabolised by the same enzyme system, these will be factored into the decision. The consultation ensures that ED treatment is tailored to your individual circumstances and is as safe as possible.

Practical advice for taking vardenafil and rilpivirine together

If your prescriber approves vardenafil while you're taking rilpivirine, follow their dosing instructions carefully. You may be started on a lower dose than the standard 10mg, and you should not increase the dose without consulting your prescriber first. Take vardenafil about 25 to 60 minutes before sexual activity, and remember it only works with sexual stimulation [5]. Do not take vardenafil more than once in 24 hours, and avoid grapefruit juice, as it can further increase vardenafil levels in your body.

Continue taking your rilpivirine and other HIV medicines exactly as prescribed—do not stop or change your HIV treatment without advice from your HIV specialist. If you experience side effects such as severe headache, dizziness, chest pain during sex, sudden vision or hearing loss, or an erection lasting more than four hours, seek medical help immediately. Keep both your HIV specialist and your ED prescriber informed about all the medicines you're taking, and report any new symptoms or concerns promptly.

Heavy alcohol can worsen erectile dysfunction and add to the blood-pressure-lowering effect of vardenafil, so it's best to limit alcohol when using ED treatment [1]. If vardenafil doesn't work well for you or causes troublesome side effects, discuss alternatives with your prescriber—other PDE5 inhibitors such as sildenafil or tadalafil may be more suitable depending on your full medication list.

What if I'm taking other medicines as well?

Many people take several medicines alongside their HIV treatment. During your consultation, declare every medicine you use, including over-the-counter products, herbal remedies (especially St John's wort, which can reduce the effectiveness of both rilpivirine and vardenafil), and recreational drugs. Your prescriber will check each one to ensure the combination is safe. Never take vardenafil with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor, as these combinations can cause a dangerous drop in blood pressure.

When to get urgent help

• An erection lasting more than 4 hours (priapism)—go to A&E immediately to prevent permanent damage
• Sudden loss of vision in one or both eyes—stop vardenafil and seek urgent medical help
• Sudden decrease or loss of hearing, sometimes with ringing in the ears or dizziness—seek medical advice promptly
• Chest pain during or after sexual activity—do not take nitrates; call 999 and tell them you have taken vardenafil
• Severe dizziness, fainting, or signs of a serious allergic reaction (swelling of face, lips, or throat, difficulty breathing)

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

Are there alternative ED treatments if vardenafil isn't suitable?

If vardenafil is not the best option for you while taking rilpivirine, several alternatives are available. Sildenafil (generic Viagra) is another PDE5 inhibitor that may be used at a reduced starting dose when taken with medicines that affect CYP3A4 [3]. Tadalafil (generic Cialis) is also an option, though the maximum dose may be reduced if you're taking interacting medicines [4]. Your prescriber will choose the most appropriate ED treatment based on your full medication list, medical history, and personal preferences.

Avanafil (Spedra) is a newer PDE5 inhibitor that works quickly, but it may not be suitable with certain HIV medicines, so your prescriber will assess this carefully [6]. Non-tablet options include Eroxon, a topical gel that works locally and does not interact with HIV medicines, and prescription treatments such as Vitaros (alprostadil cream) or Caverject (alprostadil injection), which work by a different mechanism and are not affected by CYP3A4 interactions [7]. Your prescriber can discuss these alternatives if oral PDE5 inhibitors are not suitable or effective for you.

At Cured Pharmacy, all ED treatments require an online consultation reviewed by a UK-registered prescriber. The consultation ensures that the treatment is safe and appropriate for you, taking into account your HIV medication and any other health conditions. If you have concerns about erectile dysfunction, it's also worth seeing your GP, as ED can sometimes be an early sign of other health issues such as heart disease or diabetes [1][2].