Three original drugs arrived in this class, and the third is the one people know least about.
Vardenafil is somewhat less affected by a meal than sildenafil, and it is more potent per milligram — which is why the numbers on the box look smaller.
Without prescription, plain packaging. One heart rhythm caution worth reading.
A question that comes up constantly, and the answer is straightforward.
Vardenafil is more potent per milligram than sildenafil. A smaller amount produces a comparable effect.
So comparing the numbers on two different boxes tells you nothing useful. They are different molecules with different potencies, and the figures are not interchangeable.
People sometimes conclude a vardenafil tablet must be weaker because the number is lower. It is not.
Where it has an edge
Two practical differences from sildenafil.
Food matters less. Not nothing — a very heavy fatty meal still slows it — but considerably less than with sildenafil, where a large dinner can push the onset back by an hour.
It is more selective for its target. Which in practice means fewer visual effects. The blue tinge and light sensitivity associated with sildenafil are less common here, because vardenafil has less action on the related enzyme in the retina.
The duration is comparable to sildenafil's — several hours, not the day-and-a-half of tadalafil.
The mechanism
Arousal releases nitric oxide into the erectile tissue. That triggers a messenger molecule which relaxes the smooth muscle around the small arteries there.
Blood flows in. The filling tissue presses on the veins that drain it, so the blood stays.
PDE5 breaks that messenger down, which ends the erection normally. Vardenafil blocks PDE5.
Arousal remains the starting point. The drug prevents an ending; it does not create a begining.
When other options have not worked
Worth knowing, because people assume all three are interchangeable.
They are closely related but not identical, and individual response genuinely varies. Someone who got a poor result from one of the others may do well on this.
So a disappointing experience with one molecule is not a verdict on the whole class. It is worth trying a different one before concluding nothing works.
Though before switching, check the conditions were fair: enough time, not much alcohol, no enormous meal, actual arousal, and more than one attempt.
Taking it
Around thirty minutes to an hour beforehand.
A very heavy fatty meal will still slow it somewhat.
Once in twenty-four hours.
Keep alcohol modest.
No grapefruit juice.
Nitrates: the one hard stop
This is the single line on the page with no room for interpretation.
Glyceryl trinitrate, isosorbide mononitrate, isosorbide dinitrate, nicorandil — anything taken for angina, including the spray carried for emergencies.
Together they can drop blood pressure to a dangerous level. Not mild dizziness. Circulatory collapse.
The same applies to amyl nitrite used recreationally, sold as poppers. That combination reaches emergency departments more often than anyone admits.
If you take anything in that group, this is out. No exceptions, no gap, no half tablet.
The heart rhythm point, specific to vardenafil
This distinguishes vardenafil from the others in the class and it is worth knowing.
It has a modest effect on the electrical recovery time of the heart — what is measured as the QT interval. On its own that is not usually a problem.
It becomes one in combination with other medicines that do the same thing, because the effects add.
Certain heart rhythm medicines, including amiodarone, sotalol and quinidine
Some antipsychotics
Certain antibiotics, particularly some macrolides and quinolones
Some antifungals
A few antidepressants
A known long QT interval, or a family history of sudden unexplained death, means this molecule is not the right choice. One of the alternatives is.
Who should not take it
Recent heart attack or stroke
Unstable angina
Severe heart failure
Uncontrolled or very low blood pressure
Severe liver or kidney disease
Retinitis pigmentosa
Previous sudden vision loss from optic nerve ischaemia
Known long QT interval
Alpha blockers for prostate enlargement combine to lower blood pressure further, so that pairing needs arranging.
Possible side effects
Headache
Flushing
Nasal congestion
Indigestion
Dizziness
Back ache
Two things that need help immediately
An erection lasting more than four hours. Not something to wait out — after several hours the tissue begins to sustain permanent damage.
Sudden loss of vision or hearing, one side or both. Stop and get seen urgently.
Both rare. Both measured in hours.
Ordering without prescription: how it works
Keeping some at home is the main reason men order this online rather than asking across a counter.
Pick the strength and the pack size, put in a delivery address, confirm. Couple of minutes, any time of day, no queue and no conversation across a counter.
It goes out in plain packaging. No pharmacy name on the outside, nothing that hints at what is inside. How long delivery takes depends on where the parcel is headed.
On price it comes down to strength and pack size. Larger packs generaly work out better per unit.
Prices sit below a UK high street counter for an unglamorous reason: no rent in a good location, no counter staff, no window display. Most of the range is generic as well. That saving goes to you.
