Vardenafil and Rotigotine: Can They Be Taken Together?

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Key takeaways

• No major direct interaction is reported between vardenafil and rotigotine, but both can lower blood pressure.
• Your prescriber will assess your blood pressure and may start vardenafil at a lower dose if you take rotigotine.
• Stand up slowly and avoid heavy alcohol to reduce the risk of dizziness.
• Seek urgent help if you have an erection lasting over four hours or sudden vision or hearing loss.
• All ED treatments at Cured Pharmacy require an online consultation reviewed by a UK prescriber.

What is vardenafil and rotigotine?

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 relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused [5]. Vardenafil is available in 5mg, 10mg, and 20mg tablets, and is usually taken about 25 to 60 minutes before sexual activity. It requires sexual stimulation to work and should not be taken more than once a day [5].

Rotigotine is a dopamine agonist used to treat the symptoms of Parkinson's disease and restless legs syndrome. It is delivered through a skin patch that releases the medicine slowly over 24 hours. Rotigotine works by mimicking the action of dopamine, a chemical messenger in the brain that helps control movement and coordination. Like many medicines used for Parkinson's disease, rotigotine can affect blood pressure, particularly when you stand up (a condition called orthostatic hypotension).

Both medicines are prescription-only in the UK and require careful assessment by a healthcare professional. At Cured Pharmacy, a UK-registered prescriber reviews your medical history and current medicines during an online consultation before any erectile dysfunction treatment is supplied.

How do vardenafil and rotigotine interact?

There is no major direct pharmacological interaction between vardenafil and rotigotine reported in standard drug interaction databases. This means that vardenafil does not significantly alter how rotigotine works, and rotigotine does not directly affect the way your body processes vardenafil [5]. However, both medicines can lower blood pressure, which means there is a potential additive effect when they are used together.

Rotigotine can cause orthostatic hypotension, where your blood pressure drops when you stand up, leading to dizziness or light-headedness. Vardenafil, like all PDE5 inhibitors, also has a mild blood-pressure-lowering effect because it relaxes blood vessels [5]. When these two effects combine, some men may experience more pronounced dizziness, particularly when moving from sitting or lying down to standing.

This does not mean the combination is unsafe for everyone, but it does mean your prescriber needs to know you are taking rotigotine. They will assess your overall cardiovascular health, check your blood pressure, and consider whether you have experienced any dizziness or fainting episodes. If you are stable on rotigotine and have no significant blood pressure problems, vardenafil may still be a suitable option, often starting at a lower dose to minimise any risk.

Understanding the blood pressure effect

Blood pressure naturally varies throughout the day and in response to different activities. When you take medicines that both lower blood pressure, the key concern is whether the combined effect is safe for you. For most men who are stable on rotigotine and have normal or well-controlled blood pressure, the additional effect of vardenafil is usually mild and manageable. However, if you already experience dizziness, fainting, or very low blood pressure, your prescriber may recommend an alternative ED treatment or suggest waiting until your Parkinson's medication is better stabilised.

At a glance

What does your prescriber check before prescribing vardenafil?

Before prescribing vardenafil to anyone taking rotigotine, a UK prescriber will carry out a thorough assessment. They will ask about your current blood pressure, whether you have experienced any dizziness or fainting, and whether you have any heart or circulation problems. They will also review all your other medicines, because some combinations with vardenafil are not safe (for example, nitrates, nicorandil, riociguat, or another PDE5 inhibitor must never be taken with vardenafil) [5].

Your prescriber will want to know how well controlled your Parkinson's symptoms are and whether you have had any recent changes to your rotigotine dose. If you have just started rotigotine or your dose has recently been increased, they may advise waiting until you are stable before starting an ED treatment. This is because it can take time for your body to adjust to a new medicine, and adding vardenafil too soon could make it harder to tell which medicine is causing any side effects.

If vardenafil is considered suitable, your prescriber may recommend starting with a lower dose (such as 5mg or 10mg) and monitoring how you respond. They will advise you to take the tablet when you are in a safe environment and to sit or lie down if you feel dizzy. At Cured Pharmacy, our online consultation includes detailed questions about your medical history and current medicines, and a UK-registered prescriber reviews every request individually to ensure your safety.

Practical advice for taking vardenafil with rotigotine

If your prescriber approves vardenafil while you are taking rotigotine, there are some practical steps you can take to minimise any risk of dizziness or low blood pressure. First, take vardenafil at a time when you can relax and are not planning to drive or operate machinery for a few hours. Avoid heavy alcohol, as this can make both dizziness and erectile dysfunction worse [5].

When you stand up, do so slowly, especially after sitting or lying down for a while. This gives your blood pressure time to adjust and reduces the chance of feeling light-headed. If you do feel dizzy, sit or lie down immediately and wait for the feeling to pass. Do not take more vardenafil than prescribed, and never take it more than once in 24 hours [5].

Keep your Parkinson's specialist or GP informed that you are using an ED treatment. They may want to monitor your blood pressure more closely, particularly if you have had any episodes of dizziness or fainting in the past. If you notice any new or worsening symptoms after starting vardenafil, contact your prescriber or GP for advice. Remember, vardenafil requires sexual stimulation to work, so it will not cause an erection on its own.

Timing and lifestyle tips

Vardenafil is usually taken about 25 to 60 minutes before sexual activity, and its effects can last for several hours [5]. You can take it with or without food, though a very heavy or high-fat meal may delay how quickly it works. Grapefruit juice should be avoided, as it can increase the level of vardenafil in your blood. If you are taking rotigotine, continue to apply your patch as usual and do not change your Parkinson's medication without advice from your specialist.

Are there alternative ED treatments if vardenafil is not suitable?

If your prescriber decides that vardenafil is not the best option for you while taking rotigotine, there are other erectile dysfunction treatments available. Sildenafil (generic Viagra) and tadalafil (generic Cialis) are also PDE5 inhibitors and work in a similar way to vardenafil, so the same blood pressure considerations apply [3][4]. However, some men find that one PDE5 inhibitor suits them better than another, so it may be worth discussing alternatives with your prescriber.

Tadalafil has a longer duration of action (up to 36 hours) and is also available as a low-dose daily tablet, which some men prefer [4]. Avanafil (Spedra) is another PDE5 inhibitor that works more quickly, often within 15 to 30 minutes [6]. All of these medicines require a prescription and a consultation to check they are safe for you.

If PDE5 inhibitors are not suitable, other options include alprostadil, which can be given as a cream (Vitaros) or injection (Caverject) [7]. These work differently and may be an option if oral tablets are not appropriate. Your GP or a specialist can also refer you for psychological support if anxiety or stress is contributing to erectile dysfunction. At Cured Pharmacy, our prescribers can discuss the full range of licensed ED treatments during your online consultation.

When to seek urgent help with vardenafil and rotigotine

While serious side effects are uncommon, 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 must go to A&E immediately, as this can cause permanent damage if not treated quickly [5]. Priapism is rare but is a medical emergency.

Seek urgent help if you have 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 [5]. These are rare but serious side effects that need immediate assessment. If you develop chest pain during or after sexual activity, stop and seek medical help straight away, as this could indicate a heart problem.

If you experience severe dizziness, fainting, or a very rapid or irregular heartbeat after taking vardenafil, contact your GP or call NHS 111 for advice. If you feel unwell and are unsure whether it is serious, it is always better to seek help. Do not take another dose of vardenafil until you have spoken to a healthcare professional. Remember, your safety is the priority, and your prescriber is there to support you.

Reporting side effects

If you experience any side effects while taking vardenafil, whether or not they are listed in the patient information leaflet, you can report them via the Yellow Card Scheme at yellowcard.mhra.gov.uk or by calling 0800 731 6789. Reporting side effects helps improve the safety information available for all patients. You should also inform your prescriber or pharmacist, who can advise whether you should continue taking the medicine.

When to get urgent help

• Erection lasting longer than four hours (priapism) – go to A&E immediately
• Sudden loss of vision in one or both eyes – seek urgent medical help
• Sudden decrease or loss of hearing, possibly with ringing in the ears – contact a doctor straight away
• Chest pain during or after sexual activity – stop and seek medical help immediately
• Severe dizziness, fainting, or very rapid heartbeat – contact your GP or call NHS 111

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

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