Vardenafil and Rimegepant: Can You Take Them Together?

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Key takeaways

• No major interaction between vardenafil and rimegepant is commonly reported in UK guidance.
• Both medicines are broken down by the same liver enzyme, so prescriber review is essential.
• Never take vardenafil with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor.
• Declare all medicines, including rimegepant, during your online consultation for safe prescribing.
• Seek urgent help for chest pain, erection over 4 hours, or sudden vision or hearing loss.

What Is Vardenafil and How Does It Work?

Vardenafil is a prescription-only medicine used to treat erectile dysfunction in adult men [5]. It belongs to a group of medicines called phosphodiesterase type 5 (PDE5) inhibitors, which work by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Vardenafil does not cause an erection on its own; sexual stimulation is still needed for it to work [5].

In the UK, vardenafil is available in 5mg, 10mg, and 20mg tablets. The usual starting dose is 10mg, taken about 25 to 60 minutes before sexual activity, with a maximum of one dose per day [5]. The effect can last for several hours, though this varies between individuals. Vardenafil is broken down in the liver by an enzyme system called CYP3A4, which is important when considering interactions with other medicines [5].

At Cured Pharmacy, vardenafil is available after an online consultation reviewed by a UK prescriber. During the consultation, the prescriber checks your medical history, current medicines, and whether vardenafil is suitable and safe for you.

What Is Rimegepant and What Is It Used For?

Rimegepant (brand name Vydura) is a prescription medicine used for the acute treatment of migraine with or without aura in adults, and for the preventive treatment of episodic migraine [12]. It belongs to a class of medicines called CGRP (calcitonin gene-related peptide) receptor antagonists, which work by blocking the action of CGRP, a protein involved in migraine attacks.

Rimegepant is taken as a 75mg oral lyophilisate (a tablet that dissolves on the tongue) and can be used either to treat a migraine attack when it occurs or, at a lower frequency, to help prevent migraines. Unlike older migraine treatments, it does not work by narrowing blood vessels, which makes it suitable for some people who cannot take triptans [12].

Rimegepant is also broken down in the body partly by the CYP3A4 enzyme system, the same pathway used by vardenafil. This shared metabolic route is the key reason why the interaction between vardenafil and rimegepant needs careful consideration. Both medicines can be affected by drugs that influence CYP3A4 activity, and taking them together may alter the levels of one or both medicines in your bloodstream [12].

Do Vardenafil and Rimegepant Interact?

There is a potential interaction between vardenafil and rimegepant because both medicines are metabolised (broken down) by the same liver enzyme, CYP3A4 [5][12]. When two medicines share the same metabolic pathway, they can compete for breakdown, which may lead to increased levels of one or both drugs in the body. However, rimegepant is not classified as a potent CYP3A4 inhibitor, so it is unlikely to cause a major increase in vardenafil levels.

The main concern with vardenafil is when it is taken alongside potent CYP3A4 inhibitors such as ritonavir, ketoconazole, itraconazole, or clarithromycin, which can significantly raise vardenafil levels and increase the risk of side effects [5]. Rimegepant does not fall into this category. Conversely, strong CYP3A4 inhibitors can increase rimegepant exposure, but vardenafil is not a strong inhibitor of this enzyme [12].

No major, clinically significant interaction between vardenafil and rimegepant is commonly reported in UK prescribing guidance. However, this does not mean the combination is automatically safe for everyone. Your prescriber or pharmacist will review your full medication list, medical history, and individual circumstances during the consultation to ensure the combination is appropriate for you. You should always declare all medicines you are taking, including those bought over the counter or prescribed by different doctors.

How the Interaction Mechanism Works in Plain English

Think of the CYP3A4 enzyme as a busy processing plant in your liver that breaks down many different medicines. Both vardenafil and rimegepant arrive at this plant to be processed and cleared from your body. If the plant is working normally and neither medicine overwhelms it, both can be broken down safely. The risk arises if a very powerful inhibitor blocks the plant's machinery, causing a backlog and higher drug levels. Because rimegepant is not a potent inhibitor, it is unlikely to cause a significant backlog for vardenafil, and vice versa. Nonetheless, individual factors such as liver function, age, other medicines, and overall health can influence how your body handles these drugs, which is why a prescriber review is essential.

What Does Your Prescriber Check Before Approving Vardenafil and Rimegepant?

When you request vardenafil through an online consultation at Cured Pharmacy, the UK prescriber will review your complete medical history and all current medicines, including rimegepant. They will check for any contraindications to vardenafil, such as recent heart attack or stroke, unstable angina, severe heart failure, very low blood pressure, or use of nitrates, nicorandil, riociguat, or recreational drugs known as poppers [5]. These combinations can cause a dangerous drop in blood pressure and must never be used together.

The prescriber will also assess whether you are taking any potent CYP3A4 inhibitors or inducers, alpha-blockers (such as tamsulosin or doxazosin), or other blood-pressure-lowering medicines, as these can interact with vardenafil [5]. If you are on an alpha-blocker, you should be stable on that treatment and start vardenafil at the lowest dose. The prescriber will also consider your kidney and liver function, as dose adjustments may be needed.

For rimegepant, the prescriber (or your GP who prescribed it) will have checked for severe liver or kidney impairment and interactions with strong CYP3A4 inhibitors or inducers [12]. During your ED consultation, you should mention rimegepant, the dose, how often you take it, and whether you have experienced any side effects. This allows the prescriber to make an informed decision about whether vardenafil is suitable and what dose to recommend.

Practical Advice: Taking Vardenafil Alongside Rimegepant Safely

If your prescriber approves the use of vardenafil while you are taking rimegepant, follow their instructions carefully. Take vardenafil about 25 to 60 minutes before planned sexual activity, and do not take more than one dose in 24 hours [5]. Rimegepant can be taken as needed for migraine attacks or on alternate days for prevention, depending on your prescription [12]. There is no need to time the two medicines apart, but always follow the dosing schedule given for each.

Be aware of potential side effects from vardenafil, which can include headache, flushing, indigestion, nasal congestion, dizziness, and visual disturbances [5]. Rimegepant may cause nausea or allergic reactions in some people [12]. If you notice unusual or severe side effects after starting the combination, contact your prescriber or pharmacist for advice. Do not stop either medicine without consulting a healthcare professional.

Avoid drinking large amounts of alcohol when taking vardenafil, as this can increase the risk of dizziness and low blood pressure, and may make erectile dysfunction worse [5]. Grapefruit juice can raise the levels of both vardenafil and rimegepant and should be avoided [5][12]. If you are prescribed a new medicine by your GP or another doctor, always mention that you are taking vardenafil and rimegepant so they can check for interactions.

What to Do If You Experience Side Effects

If you develop a severe headache, chest pain, sudden vision or hearing loss, or an erection lasting more than four hours (priapism) while taking vardenafil, seek urgent medical help immediately [5]. These are rare but serious side effects that require prompt attention. If you experience signs of an allergic reaction to rimegepant, such as swelling of the face, lips, or throat, or difficulty breathing, call 999 or go to A&E [12]. For less urgent concerns, contact your prescriber, pharmacist, or GP for advice.

Other Medicines and Vardenafil: What Else Should You Know?

Vardenafil must never be taken with nitrates (such as GTN spray, isosorbide mononitrate, or isosorbide dinitrate), nicorandil, riociguat, or recreational drugs containing amyl or alkyl nitrites (poppers), as the combination can cause a severe and potentially life-threatening drop in blood pressure [5]. Do not take vardenafil with another PDE5 inhibitor such as sildenafil, tadalafil, or avanafil on the same day.

If you are taking alpha-blockers for prostate symptoms or high blood pressure (such as tamsulosin, doxazosin, alfuzosin, or terazosin), tell your prescriber, as there is a risk of low blood pressure and dizziness [5]. You should be stable on the alpha-blocker before starting vardenafil, and the prescriber will usually recommend the lowest dose of vardenafil to start. Other blood-pressure medicines can also add to the blood-pressure-lowering effect of vardenafil, so always declare them during your consultation.

Potent CYP3A4 inhibitors such as ritonavir, cobicistat, ketoconazole, itraconazole, and clarithromycin can significantly increase vardenafil levels, and vardenafil is often contraindicated or requires a much lower dose when used with these medicines [5]. CYP3A4 inducers like rifampicin, carbamazepine, phenytoin, and St John's wort can reduce vardenafil's effectiveness. Your prescriber will review all your medicines and adjust the treatment plan accordingly. For any medicine not listed in this guidance, do not assume the combination is safe; always check with your prescriber or pharmacist.

Can You Take Vardenafil with Other Migraine Treatments?

Many people with migraine use triptans (such as sumatriptan or rizatriptan) or other preventive treatments. Triptans are not known to have a major interaction with vardenafil, but you should still declare them during your consultation. Some older migraine preventives, such as beta-blockers (e.g. propranolol), can lower blood pressure and may add to the blood-pressure-lowering effect of vardenafil [5]. Your prescriber will assess the overall picture and advise whether any dose adjustments are needed. Always be open about all treatments you use, including over-the-counter painkillers and supplements.

When to get urgent help

• Erection lasting more than 4 hours (priapism) – go to A&E immediately
• Sudden loss of vision or hearing – seek urgent medical attention
• Chest pain during or after sexual activity – call 999
• Severe allergic reaction (swelling of face, lips, throat, difficulty breathing) – call 999
• Severe dizziness or fainting – contact your GP urgently or call 111

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

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