Who Should Not Take Vardenafil? Safety Guide

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Who should not take vardenafil: absolute contraindications

Certain medical situations make vardenafil completely unsuitable. You must never take vardenafil if you are using nitrate medicines for angina or chest pain, including GTN spray, isosorbide mononitrate, or isosorbide dinitrate. The combination can cause a dangerous, potentially life-threatening drop in blood pressure [5]. This also applies to recreational drugs called 'poppers' (amyl or alkyl nitrites), which work in a similar way.

Vardenafil is also contraindicated if you take nicorandil (another angina medicine) or riociguat (for pulmonary hypertension). You should never combine vardenafil with another PDE5 inhibitor such as sildenafil, tadalafil, or avanafil [5]. Men who have had a previous episode of non-arteritic anterior ischaemic optic neuropathy (NAION), a rare form of sudden vision loss, should not use vardenafil because of the risk of recurrence.

If you have severe liver disease or end-stage kidney disease requiring dialysis, vardenafil is not recommended. Similarly, if you have hereditary degenerative retinal disorders such as retinitis pigmentosa, vardenafil should be avoided [5]. Your prescriber will check your medical history carefully during the online consultation to ensure vardenafil is safe for you.

Heart conditions and when vardenafil is not safe

Vardenafil is not suitable when sexual activity itself is inadvisable. This includes men who have had a heart attack or stroke within the last six months, those with unstable angina (chest pain that occurs unpredictably or at rest), or anyone with severe heart failure [2][5]. If your doctor has told you to avoid strenuous physical activity because of your heart, you should not take vardenafil or any other erectile dysfunction medicine.

Men with very low blood pressure (hypotension) or uncontrolled high blood pressure should not use vardenafil until their blood pressure is stable and controlled. Vardenafil can lower blood pressure, and this effect is more pronounced in people whose blood pressure is already low or unstable [5]. If you have any form of heart disease, it is essential to discuss this with your GP or cardiologist before considering ED treatment.

Certain heart rhythm problems (arrhythmias) or a history of QT prolongation on an ECG may also make vardenafil unsuitable, as the medicine can affect the electrical activity of the heart in rare cases [5]. Your prescriber will assess your cardiovascular health as part of the consultation process to ensure treatment is safe.

When to see your GP first

If you have any heart condition or cardiovascular risk factors, see your GP before using an online service for erectile dysfunction treatment. ED can be an early warning sign of heart disease or diabetes, so a face-to-face assessment is important [1][2]. Your GP can perform tests, review your overall health, and advise whether vardenafil or an alternative treatment is appropriate for you.

When to get urgent help

• Chest pain during or after sex—stop activity, do not take nitrates, and call 999 immediately.
• Erection lasting more than 4 hours (priapism)—go to A&E straight away to prevent permanent damage.
• Sudden loss of vision or hearing—stop vardenafil and seek urgent medical help.
• Signs of allergic reaction (swelling of face or throat, difficulty breathing, severe rash)—call 999.
• Severe dizziness, fainting, or very low blood pressure—seek same-day medical advice or call 111.

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

Vardenafil and drug interactions: who should not take vardenafil with other medicines

Vardenafil interacts with several common medicines, and some combinations are not safe. Potent CYP3A4 inhibitors—medicines that slow the breakdown of vardenafil in the body—can raise vardenafil levels to unsafe concentrations. These include ritonavir and cobicistat (used in HIV treatment), Paxlovid (a COVID-19 antiviral), and antifungal medicines such as ketoconazole and itraconazole [5]. Vardenafil is contraindicated or requires significant dose reduction with these medicines, and your prescriber must check the product information carefully.

Alpha-blocker medicines for prostate enlargement or high blood pressure (such as doxazosin, tamsulosin, alfuzosin, or terazosin) can interact with vardenafil, causing dizziness or fainting due to low blood pressure. If you take an alpha-blocker, you must be stable on that treatment, and vardenafil should be started at the lowest dose with careful monitoring [5]. Some prescribers may advise avoiding the combination altogether, depending on your individual circumstances.

Other medicines that lower blood pressure—including common treatments for hypertension—can add to the blood-pressure-lowering effect of vardenafil. While this is usually manageable, it must be declared during your consultation [5]. CYP3A4 inducers such as rifampicin, carbamazepine, phenytoin, and St John's wort can make vardenafil less effective by speeding up its breakdown. Always tell your prescriber about every medicine you take, including over-the-counter products and herbal supplements.

Age, lifestyle factors, and who should avoid vardenafil

Vardenafil is licensed for adult men aged 18 and over. It is not intended for use by women or children. Older men, particularly those over 65, may be more sensitive to the effects of vardenafil and may require a lower starting dose [5]. Age alone is not a contraindication, but older men are more likely to have other health conditions or take medicines that interact with vardenafil, so a thorough assessment is essential.

Heavy alcohol consumption can worsen erectile dysfunction and increase the risk of side effects such as dizziness, headache, and low blood pressure when combined with vardenafil [5]. While moderate alcohol is usually acceptable, it is best to limit intake when using ED treatment. Grapefruit juice can raise vardenafil levels in the blood and should be avoided during treatment.

Men with anatomical deformities of the penis (such as Peyronie's disease, angulation, or cavernosal fibrosis) or conditions that predispose to priapism (a prolonged, painful erection)—including sickle cell anaemia, multiple myeloma, or leukaemia—should use vardenafil with caution and only under medical supervision [5]. If you have any of these conditions, discuss them with your prescriber before starting treatment.

Allergies and previous reactions

If you have ever had an allergic reaction to vardenafil or any of the ingredients in the tablets, you should not take this medicine [5]. Symptoms of an allergic reaction can include rash, itching, swelling of the face or throat, or difficulty breathing. If you have had a severe reaction to another PDE5 inhibitor (such as sildenafil or tadalafil), tell your prescriber, as cross-sensitivity is possible.

At a glance

What to do if vardenafil is not suitable for you

If vardenafil is contraindicated or not suitable because of your medical history or current medicines, there may be alternative treatments available. Other PDE5 inhibitors—such as sildenafil (Viagra) or tadalafil (Cialis)—have different interaction profiles and may be safer in some situations, though they share many of the same contraindications [3][4]. Your prescriber can advise which option is most appropriate for you.

For men who cannot use any oral PDE5 inhibitor, alternatives include Eroxon gel (a topical medical device that does not require a prescription), Vitaros cream (a prescription alprostadil treatment applied to the urethra), or Caverject injections (alprostadil injected into the penis) [7]. These treatments work differently and may be suitable when tablets are not. A GP or specialist can discuss these options and refer you if needed.

Addressing underlying causes of erectile dysfunction is also important. Lifestyle changes—such as losing weight, stopping smoking, reducing alcohol, and increasing physical activity—can improve ED and overall cardiovascular health [1][2]. Treating conditions such as diabetes, high blood pressure, or high cholesterol can also help. Psychological factors, including stress, anxiety, or relationship difficulties, may benefit from counselling or therapy. Your GP can provide a holistic assessment and support.

How Cured Pharmacy assesses who should not take vardenafil

At Cured Pharmacy, every request for vardenafil or any other prescription erectile dysfunction treatment is reviewed by a UK-registered prescriber. The online consultation asks detailed questions about your medical history, current medicines, allergies, and cardiovascular health to identify any contraindications or interactions [2]. This ensures that vardenafil is only supplied when it is safe and clinically appropriate for you.

If the prescriber identifies that vardenafil is not suitable—for example, because you take nitrates, have severe heart disease, or use a medicine that interacts—they will explain why and may suggest an alternative treatment. You can also ask questions or provide additional information if needed. The consultation process is designed to be thorough, confidential, and supportive, with your safety as the priority.

Vardenafil is available at Cured Pharmacy for £16.95, or £13.56 for first orders with code Ednew. If vardenafil is not right for you, the prescriber may recommend sildenafil (from £0.45, or £0.36 with code Ednew), tadalafil (from £7.95, or £6.36 with code Ednew), or avanafil (Spedra, £20.95, or £16.76 with code Ednew), depending on your individual circumstances. All treatments require a prescription following clinical assessment, and discreet delivery is included.

When to seek urgent medical help

If you take vardenafil and experience chest pain during sexual activity, stop immediately and seek urgent medical help. Do not take nitrate medicines such as GTN spray, as the combination can be dangerous [5]. If you develop an erection lasting more than four hours (priapism), sudden loss of vision or hearing, or signs of an allergic reaction (swelling, difficulty breathing), call 999 or go to A&E straight away. These are rare but serious side effects that require immediate treatment.

In summary

• Never take vardenafil with nitrates, nicorandil, riociguat, poppers, or another PDE5 inhibitor.
• Vardenafil is not safe after recent heart attack or stroke, or with severe heart, liver, or kidney disease.
• Some medicines interact with vardenafil, including certain HIV drugs, antifungals, and alpha-blockers.
• Every prescription request is reviewed by a UK prescriber to check for contraindications and interactions.
• If vardenafil is unsuitable, alternatives such as sildenafil, tadalafil, or non-tablet treatments may be available.

Frequently Asked Questions