Vilitra and Vardenafil: How It Compares

Sildenafil and tadalafil dominate the conversation about erectile dysfunction medicines, which leaves the third well-known ingredient — vardenafil — comparatively unexplained. Vilitra is one brand name under which vardenafil is sold. This article covers what it is, where it differs from its better-known relatives, and the safety considerations that are specific to it. There is no dosing information here.

What vardenafil is

Vardenafil is a phosphodiesterase type 5 (PDE5) inhibitor, the same class as sildenafil and tadalafil. Chemically it is closely related to sildenafil, and the general mechanism is identical: it slows the enzyme that breaks down the signalling molecule responsible for relaxing smooth muscle in penile blood vessels during arousal, so that relaxation persists longer.

Vardenafil is a Schedule 4 prescription-only medicine in Australia. The classification applies to the ingredient, so it covers every brand and every labelled strength. Supply requires a prescription from a registered Australian prescriber, and the TGA prohibits advertising prescription-only medicines directly to consumers.

Where a number appears in a product name, it refers to the labelled milligram content of active ingredient per tablet — a manufacturing specification. Which strength is appropriate for an individual, if any medicine is, is a prescriber's decision.

Where it sits between the other two

Broad, well-established characteristics of the three ingredients, without any efficacy claims:

• Duration. Vardenafil's half-life is broadly comparable to sildenafil's and considerably shorter than tadalafil's. Tadalafil is the outlier for duration.
• Food. Absorption of vardenafil, like sildenafil's, is more affected by a heavy or fatty meal than tadalafil's.
• Side-effect emphasis. All three share the class effects — headache, flushing, nasal congestion, indigestion, dizziness. Visual disturbance is more commonly discussed with sildenafil, back and muscle pain more commonly with tadalafil.
• Formulations. Vardenafil has been produced in an orally disintegrating presentation in some markets as well as conventional tablets.

None of this makes any one of them "the best". Individual response varies considerably, and prescribers often reassess after a trial period rather than treating the first choice as settled.

The safety consideration that is specific to vardenafil

Here is the point most worth knowing, and the reason vardenafil deserves its own article rather than a footnote.

Vardenafil has been associated with an effect on the heart's electrical activity known as QT interval prolongation. In practical terms, this means it warrants particular caution in people who have a congenital long QT syndrome, and in people taking other medicines that also affect the QT interval — certain antiarrhythmics, some antipsychotics, some antibiotics and some antidepressants among them.

This is not a reason for alarm; it is a reason the assessment must be done by someone with your medical history and your full medicines list in front of them. It is also a good illustration of why "they're all basically the same" is a poor assumption when choosing between medicines in a class.

Contraindications shared across the class

• Nitrates are an absolute contraindication. Glyceryl trinitrate, isosorbide products and the inhalants known as poppers must never be combined with a PDE5 inhibitor. The combination can cause a severe, potentially fatal drop in blood pressure.
• Riociguat is contraindicated.
• Alpha-blockers require careful medical management.
• Significant cardiovascular disease — recent heart attack or stroke, unstable angina, uncontrolled hypertension, severe heart failure, certain arrhythmias — must be assessed, because sexual activity places demand on the heart.
• Severe liver or kidney impairment, very low blood pressure and inherited retinal conditions such as retinitis pigmentosa are all relevant.

Interactions

Vardenafil is metabolised by liver enzymes shared with many other medicines. Certain antifungals, macrolide antibiotics and HIV protease inhibitors can substantially increase circulating levels; some other medicines reduce them; grapefruit juice is commonly cited.

Add the QT consideration above, and the interaction review for vardenafil is arguably the most important of the three ingredients to get right. Bring a complete list — prescription medicines, over-the-counter products, supplements, and anything obtained online — to your prescriber and pharmacist.

Side effects and urgent warning signs

Recognised effects include headache, flushing, nasal congestion, indigestion and dizziness. Uncommon but serious events include priapism, sudden hearing loss and sudden vision loss.

Seek urgent medical care for:

• Chest pain during or after sexual activity — and tell the treating team a PDE5 inhibitor has been taken, because nitrate-based emergency treatments cannot be used.
• An erection lasting more than four hours.
• Sudden vision loss, or sudden hearing loss or ringing.
• Palpitations, fainting or collapse, which given the QT consideration should be reported promptly.

Counterfeits and storage

Because vardenafil is less familiar, buyers are less able to recognise when something is wrong with a product supposedly containing it. The TGA has warned that medicines of this type bought through unregulated overseas channels have been found to contain undeclared ingredients or incorrect amounts.

Check whether a product is on the Australian Register of Therapeutic Goods, look for batch numbers, expiry dates and manufacturer details, and treat a seller willing to skip the prescription requirement as disqualifying. Store in original packaging, in a cool dry place away from sunlight, out of reach of children, and do not use past the expiry date.

The takeaway

Vardenafil is a legitimate member of the PDE5 inhibitor class with its own profile, including a cardiac consideration that makes a proper assessment particularly important. Which ingredient suits a person is a clinical judgement, not a preference. Talk to a GP, telehealth prescriber or pharmacist, and use Healthdirect Australia, the Australian Commission on Safety and Quality in Health Care and the TGA for independent reading.

This article is general educational information about a medicine ingredient, not medical advice, and not a recommendation to use any specific product. Speak with your doctor or pharmacist.