He is on amiodarone. Can he still try vardenafil 5 mg?
QT line first, then the 5 mg film
Vardenafil is the PDE5 inhibitor with a named QT warning. In 59 healthy men aged 45 to 60, a 10 mg film tablet raised QTcF by 8 ms versus placebo at 1 hour. An 80 mg supratherapeutic dose raised it 10 ms. Moxifloxacin 400 mg, the active control, was also 8 ms on that correction.
A later study in 44 volunteers found a placebo-subtracted QTcF change of 5 ms after 10 mg. Adding gatifloxacin produced an additive QT effect. The clinical impact of those millisecond shifts is unknown. The counseling is not unknown: do not start vardenafil in congenital long QT or on a Class IA or Class III antiarrhythmic.
Helion's usual start is 5 mg. The label's usual start is 10 mg, about 60 minutes before sex, with a rise to 20 mg or a fall to 5 mg. We start at the fall-to-5 rung because the QT conversation belongs at the first tablet, not after someone has already taken 20 mg.
Nitrates and nitric-oxide donors are still a hard ban. So is riociguat. Vardenafil does not get a free pass because the QT line was clean. Sexual stimulation is still required. The tablet is a short clock: Tmax median 60 minutes (30 minutes to 2 hours), half-life about 4 to 5 hours.
If the man only wanted a long weekend window, he is on the wrong profile. That is tadalafil 20 mg. If he wanted a food-sensitive first tablet without a QT chapter, that is sildenafil 25 mg. Stay here only if the QT screen is part of the plan.
Price ten of 5 mg, not the thirty-count board
Generic vardenafil 5 mg, ten tablets, the Helion usual-start lock, marked September 2026. GoodRx's Levitra table lists 5 mg x 30 at $1,093.22 average retail and $125.33 with a coupon. Drugs.com price guide lists 5 mg oral tablets from $441.53 for thirty. Those two services stay in this caption. Each link is that pharmacy only. Staxyn 10 mg ODT is a different fill. Helion does not dispense. Prescription and a QT screen still come first. ZIP moves the number.
The quote card is generic vardenafil 5 mg, ten tablets, the usual-start lock. Helion does not fill prescriptions. The nearest published GoodRx and Drugs.com boards are 5 mg by thirty. Ask the window to price ten. Those thirty-count prints stay in the caption under the quote card.
Harris Teeter, Meijer, Safeway, and H-E-B are the four chains on this quote card. Each href is that pharmacy only. GoodRx and Drugs.com stay in the caption. Staxyn 10 mg ODT is a different fill. ZIP moves the number. Prescription required.
If the script is 10 mg or 20 mg after a fair 5 mg test, that is a different NDC. Do not invent a 10 mg price from the 5 mg thirty-count board. If the QT screen is still pending, do not send the claim.
Ritonavir, a strong CYP3A4 inhibitor, or Child-Pugh B may mean the tablet that should be priced is 5 mg with a longer interval, or is not vardenafil at all. Settle that with the prescriber before the window runs the coupon.
A ten-count is enough for a fasted start and a planned step to 10 mg if the screen still holds. It is not a reason to price Staxyn on the same ticket. If the clerk hears Levitra and types thirty of 10 mg, stop the claim and say 5 mg film, ten.
The 59-man QT study in milliseconds
| Arm | QTcF vs placebo (ms) | Individual QTc (ms) | Heart-rate vs placebo |
|---|---|---|---|
| Vardenafil 10 mg | +8 (6-9) | +4 (3-6) | +5 / min |
| Vardenafil 80 mg | +10 (8-11) | +6 (4-7) | +6 / min |
| Moxifloxacin 400 mg | +8 (6-9) | +7 (5-8) | active control |
The thorough QT study used 10 mg and 80 mg vardenafil film, placebo, and moxifloxacin 400 mg, crossover, in 59 men (81% White, 12% Black, 7% Hispanic), ages 45 to 60. QT was read at 1 hour, near expected peak. Heart-rate rise versus placebo was 5 beats per minute on 10 mg and 6 on 80 mg.
Fridericia correction: +8 ms on 10 mg (90% CI 6 to 9), +10 ms on 80 mg (8 to 11), +8 ms on moxifloxacin (6 to 9). Individual correction was smaller: +4, +6, and +7 ms. Uncorrected QT went slightly down on vardenafil because the heart-rate rose. No single correction is known to be the right one.
Eighty milligrams is four times the labeled ceiling. It was chosen because those concentrations cover 5 mg plus ritonavir 600 mg twice daily. That is the interaction that turns a modest tablet into a QT-study dose. If ritonavir is on the list, you are already in that concentration band on a small tablet.
The study was not built to declare vardenafil equal to moxifloxacin. It was built to show the size of the shift. I treat +8 ms as a reason to take the history, not as a reason to start 20 mg because 8 is a small number. Congenital long QT and Class IA or III drugs remain a stop.
Sildenafil and tadalafil do not carry this same labeled QT chapter. That does not make them safe on amiodarone. It makes vardenafil the one that forces the question on paper. Ask it. Then pick the clock.
Ritonavir can stretch the half-life to 26 hours
Vardenafil is a CYP3A4 substrate. Ritonavir 600 mg twice daily with vardenafil 5 mg raised vardenafil AUC sharply, raised Cmax 13-fold, and stretched half-life to 26 hours. That is no longer a 4 to 5 hour clock. The labeled response is a hard dose and interval cut, not a shrug.
Indinavir, ketoconazole, itraconazole, and erythromycin also raise levels. The film label walks those caps by inhibitor. I will not compress them into one folk rule. If a strong inhibitor is on the list, 5 mg may already be too much, and 20 mg is off the table.
Moderate hepatic impairment is its own cap: start 5 mg, maximum 10 mg. Severe hepatic impairment was not studied. Renal impairment is less dramatic for film; Staxyn's label allows ODT across mild to severe renal impairment, which does not make ODT the start on an alpha-blocker.
Grapefruit is a CYP3A4 problem I mention because men ask. I do not have a labeled vardenafil grapefruit percent to quote, so I will not invent one. I do have the ketoconazole and ritonavir story. Treat strong inhibitors as the model.
If the medication list is the real problem, a different PDE5 clock will not erase CYP3A4. It may erase the QT chapter. That can still be the right switch - to sildenafil 25 mg or tadalafil 20 mg - after the nitrate hold is confirmed on the new tablet too.
A high-fat meal can cut Cmax by 18 to 50 percent
Levitra may be taken with or without food. High-fat meals still reduced Cmax by 18% to 50% in the food-effect studies. That is a wider and uglier range than sildenafil's tidy 29%. If the first 5 mg looks weak after a heavy dinner, suspect the plate before you jump to 20 mg.
Fasted Tmax is 30 minutes to 2 hours, median 60 minutes. That is why the leaflet says about an hour. A fatty meal can flatten the peak without moving the half-life. The 4 to 5 hour terminal half-life still governs how long the parent hangs around.
Protein binding is about 95% for parent and M1. Clearance is about 56 L/h. After an oral dose, metabolites leave mainly in feces (91 to 95%) and a little in urine (2 to 6%). A mean 0.00018% of a 20 mg dose showed up as parent in semen. Food does not rewrite those exits.
Compared with sildenafil 25 mg, the meal story is the same idea and a sloppier number. Compared with tadalafil 20 mg, there is no meal story at all. If the man will not control dinner, tadalafil is the cleaner clock.
Alcohol still blunts arousal. I do not have a vardenafil-specific 0.08% pressure study to quote the way Viagra does, so I will not invent one. Keep the first 5 mg test sober enough to mean something.
Staxyn 10 mg ODT is not a 10 mg film tablet
| Form | Helion note | Tmax | Exposure vs 10 mg film |
|---|---|---|---|
| Film 5 mg | Usual start on this site | Median 60 min | Half the labeled start |
| Film 10 mg | Label usual start | Median 60 min | Reference |
| Film 20 mg | Ceiling; QT again | Median 60 min | Double the start |
| Staxyn 10 ODT | Not interchangeable | Median 1.5 h | Cmax +15%, AUC +44%* |
Staxyn is vardenafil 10 mg as an orally disintegrating tablet. It is not interchangeable with Levitra 10 mg film. In healthy men 18 to 50, the ODT raised mean Cmax 15% and AUC 44% versus the 10 mg film. In ED patients the AUC bump versus film was 21 to 29% with a slightly lower Cmax.
Place it on the tongue. It disintegrates. Take it without liquid, as soon as the blister is open. Food is allowed. The median Tmax on ODT is 1.5 hours (0.75 to 2.5). Half-life on ODT is about 4 to 6 hours. Those are ODT numbers, not film numbers.
If the man needs 5 mg or 20 mg, he needs a film tablet. Staxyn only exists as 10 mg. Using ODT to approximate a 5 mg start is the wrong product. Using two ODT tablets to invent 20 mg is also the wrong product.
Do not start Staxyn on an alpha-blocker. Do not treat ODT as a faster film. Some men like not needing a glass of water. That convenience is not a reason to skip the QT screen or the nitrate hold.
Brand Levitra is largely gone from US shelves. Generic film 2.5, 5, 10, and 20 mg remain. Generic ODT exists in the Staxyn lane. Write the form on the script. A 5 mg film and a 10 mg ODT are easy to mix up at a noisy window.
Five milligrams is the usual Helion start. Ten and twenty come later.
For most patients the labeled Levitra start is 10 mg orally about 60 minutes before sex. Maximum is 20 mg once a day. Five milligrams is the labeled step down for side effects, for age 65 and over, for moderate hepatic impairment, and for men already stable on an alpha-blocker.
Elderly men (65 and over) had Cmax 34% higher and AUC 52% higher than men 18 to 45. Phase 3 still enrolled more than 834 elderly men on 5, 10, or 20 mg without a safety split by age. The start is still 5 mg because concentrations are higher, not because the trials failed.
Moderate hepatic impairment (Child-Pugh B) after 10 mg: Cmax +130%, AUC +160%. Start 5 mg. Do not exceed 10 mg. Severe hepatic impairment was not evaluated. Mild impairment was a smaller bump (Cmax +22%, AUC +17%).
Alpha-blocker: start 5 mg film after the man is stable on the blocker. Do not start Staxyn in that setting. Men who already used film tablets may switch to ODT later if the prescriber says so. A time gap between the two vasodilators is still wise.
Twenty milligrams is the ceiling, and it is the dose that should make everyone say the QT line again. The 80 mg QT arm existed to cover concentrations seen when 5 mg meets ritonavir 600 mg twice daily. If ritonavir is on the list, 20 mg is not the next step. The interaction section is.
Who a 5 mg tablet actually fits
A 5 mg film start is a reasonable fit when
- Clean QT line, no Class IA or III antiarrhythmic
- No nitrate, no riociguat
- Age 65-plus, or moderate hepatic impairment, or stable alpha-blocker - labeled 5 mg starts
- Willing to keep a high-fat meal off the first test
- Needs film 5 mg, not Staxyn 10 ODT
- Accepts a 4-5 hour half-life, not a 36-hour weekend
A 5 mg start fits the man whose QT line is clean, who is not on a nitrate, and who needs a short clock without sildenafil's stronger PDE6 tint story. It also fits age 65 and over, moderate hepatic impairment, and a stable alpha-blocker - those are labeled 5 mg starts, not Helion inventions.
It does not fit congenital long QT. It does not fit amiodarone, sotalol, quinidine, or procainamide. It does not fit a man who wants 36 hours from one tablet. It does not fit someone who will start on Staxyn because swallowing is hard and then need 5 mg - ODT cannot do 5 mg.
Four major fixed-dose trials enrolled 2431 men aged 20 to 83 (mean 57) on 5, 10, and 20 mg. Two trials were general ED. One was diabetes. One was post-prostatectomy. Doses were taken without regard to meals. Primary looks were at 3 months on IIEF-EF, SEP2, and SEP3.
I use those trials to say 5 mg is a studied strength, not a courtesy dose. I do not use them to promise a percentage I cannot see on the page in front of me. If a shop site quotes a precise SEP3 for 5 mg without naming the trial, treat that number as unverified.
The matching analysis - who a Levitra 5 mg start actually fits - is the longer version of this section. The ED work-up still comes first if nobody has taken a blood pressure or a medication list.
After the screen, one film tablet a day
If the QT line is clean and the first 5 mg was fasted and short, 10 mg is the labeled next rung. If 10 mg is short and the screen still holds, 20 mg is the ceiling. Say the QT line again before 20 mg. Do not use Staxyn to invent those steps.
If the first 5 mg met a high-fat meal, repeat 5 mg on a quieter plate before you step. A 18 to 50% Cmax cut is enough to make a real dose look empty. A second tablet the same night is still once-per-day math gone wrong.
Chest pain after any dose: name vardenafil, the milligrams, and the hour. Nitrates stay banned. An erection past 4 hours is urgent. Sudden vision or hearing loss is a stop. Those lines are class rules, not Levitra folklore.
Clock, Hold, Trace, Sign: clock is the 60-minute median and the 4 to 5 hour half-life. Hold is nitrates, riociguat, and the QT stop list. Trace is age, liver, CYP3A4, and film versus ODT. Sign is the ten-count 5 mg fill.
Do not retire an antiarrhythmic or a nitrate from this page. Take the list to the clinician who will sign. The consult below is how I talk through a 5 mg start, not a standing order for 20 mg.
Straight talk
Your questions, answered plainly
Answered by Dr. Sofia Brandt, MD · Urology & sexual medicine
Vardenafil questions start with the QT line more often than men expect. Then come 5 mg versus the leaflet's 10 mg, Staxyn versus film, and whether dinner wrecked the first tablet. I keep nitrates in the first minute of every answer. A clean QT does not reopen a nitrate drawer.
No. Amiodarone is a Class III antiarrhythmic. The label says patients on Class IA or Class III drugs, or with congenital long QT, should avoid vardenafil. Five milligrams does not carve out an exception. I will not write it.
The thorough QT study in 59 men put QTcF at +8 ms on 10 mg and +10 ms on 80 mg. Moxifloxacin 400 mg sat in the same range on that correction. A later 44-man study found +5 ms on 10 mg, and gatifloxacin added to that. I do not need a larger number to respect a named stop.
If he still wants a PDE5 tablet, the conversation moves to sildenafil 25 mg or tadalafil 20 mg with his cardiologist, and only after nitrates are also off the list. Those two do not carry this same QT chapter. They still drop blood pressure.
Quinidine, procainamide, and sotalol are the same stop. If the antiarrhythmic is the one that keeps him alive, we do not trade it for an erection tablet. That is the whole point of screening before the first film.
The leaflet says start at 10 mg. Why is this page locked on 5 mg?
Because the leaflet's usual start is 10 mg, and the leaflet's own fine print already sends a lot of men to 5 mg. Age 65 and over: Cmax +34%, AUC +52%. Moderate hepatic impairment after 10 mg: Cmax +130%, AUC +160%. Stable alpha-blocker: start 5 mg film. Helion uses 5 mg as the first tablet for everyone on this readout so the QT line is said before 10 or 20.
Four major trials still studied 5 mg, 10 mg, and 20 mg in 2431 men. Five milligrams is a real rung. If a fasted 5 mg is clearly short and the QT screen holds, 10 mg is the labeled next step. Twenty milligrams is the ceiling, and I say the QT line again before I write it.
Staxyn 10 mg is not the way to skip 5 mg. ODT raises AUC about 44% versus 10 mg film in healthy men. It is the wrong product if you needed a low start. It is also the wrong product on an alpha-blocker.
The matching page is who a Levitra 5 mg start actually fits. If he wanted a first tablet without a QT chapter, sildenafil 25 mg is the other low start on this site.
Can he use Staxyn 10 instead of a 5 mg film tablet?
Not as a substitute. Staxyn 10 mg ODT is not interchangeable with Levitra 10 mg film, and it certainly is not interchangeable with 5 mg film. In healthy men the ODT raised Cmax 15% and AUC 44% versus the 10 mg film. That is more parent, not a clever 5 mg.
ODT goes on the tongue, no liquid, straight from the blister. Median Tmax is 1.5 hours. Half-life is about 4 to 6 hours. Men who need 5 mg or 20 mg need film. Men on an alpha-blocker must not start on Staxyn.
I use ODT when a man already tolerated film, wants 10 mg, and has trouble swallowing a tablet with water. I do not use it to dodge a 5 mg start or to dodge the QT screen. The warning is on the ODT label too.
If the window tries to fill Staxyn against a 5 mg script, send it back. The ten-count 5 mg fill on this page is film. The quote card is built for that strength. A 10 mg ODT board is a different conversation.
He took 5 mg after a burger and said it did nothing. Next step?
Repeat 5 mg away from a high-fat meal before you step. Food-effect work cut Cmax by 18% to 50%. That range is wide enough to empty a first test. Fasted Tmax is a median 60 minutes. Give the tablet that hour, once.
Do not take a second 5 mg the same night. Once per day is the cap. A staggered 10 mg after a burger is a bad experiment and a worse QT story. If the fasted repeat is short and the screen is clean, 10 mg is the labeled next rung.
Look at the list before you blame the 5 mg tablet. Ritonavir can stretch half-life to 26 hours and multiply Cmax. That man should not be on a casual 5 mg, let alone a step-up. Inducers can do the opposite and make any rung look dead.
If he will not control dinner and he wants a long window, tadalafil 20 mg is the clock that does not move with food. If he wants another short, food-sensitive start without the QT chapter, sildenafil 25 mg is the other option. Nitrates veto all three.
He is 68, on tamsulosin, QT is fine. Is 5 mg the right first film?
Yes. Age 65 and over is a labeled 5 mg consideration because AUC is about 52% higher. A stable alpha-blocker is a labeled 5 mg film start. Those two facts stack. I still want him stable on tamsulosin before the first vardenafil tablet.
Do not start him on Staxyn. ODT is the wrong first product on an alpha-blocker. If he later does well on 10 mg film, a switch to ODT can be discussed. That is not night one.
Moderate hepatic impairment would also lock 5 mg and cap him at 10 mg. I want that history, not a shrug. Nitrates still veto the class. If he has a spray, we stop and talk to cardiology even though the QT line is clean.
Night-time standing to void is when a two-vasodilator mix becomes a fall. I say that before I sign. The ED work-up is also worth a pass if nobody has taken a pressure or a full list yet. A clean QT is necessary. It is not the whole work-up.
Treat every answer here as general teaching, not a decision made for the individual who wrote in. What is right for you turns on your history, your bloods and the rest of your medicine list — and that is a conversation for a prescriber who can see all of it at once.
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