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Database of Antiretroviral Drug Interactions

Interactions with Vardenafil and Antiretrovirals

Antiretroviral (ARV)Dose of ARVDose of VardenafilEffect on ARV LevelsEffect on Vardenafil LevelsPotential Clinical EffectsMechanism of InteractionManagement
Darunavir161
(DRV)(Prezista)
---Not studied; may increase vardenafil levelsIncreased vardenafil effects (eg, hypotension, priapism)Inhibition of CYP450 3A4 by darunavir/ritonavir

Initiate vardenafil at 2.5 mg QD; adjust dose as indicated; not recommended to exceed 2.5 mg in 72 hour period

Elvitegravir/cobicistat727
(Genvoya, Stribild)
--No effect expectedNot studied; may increase vardenafil levelsPossible increased vardenafil effects (e.g. hypotension, priapism) Inhibition of CYP450 3A4 by cobicistat

Initiate vardenafil 2.5 mg every 72 hours and monitor for adverse effects

Elvitegravir/ritonavir-boosted protease inhibitor727
--No effect expectedNot studied; may increase vardenafil levelsPossible increased vardenafil effects (e.g. hypotension, priapism)Inhibition of CYP450 3A4 by ritonavir

Initiate vardenafil 2.5 mg every 72 hours and monitor for adverse effects

Indinavir16
(IDV)(Crixivan)
800 mg Q8H10 mg x 1 doseNot studiedVardenafil AUC: increased 16-fold; Cmax: increased 7-fold; half-life: increased 2-foldIncreased vardenafil effects (eg, hypotension, nausea, priapism, syncope)Inhibition of CYP450 3A4 by indinavir

Consider initiating vardenafil at lower dose and titrate to effect. Dose should not exceed 2.5 mg in any 24 hour period.

Lopinavir/ritonavir78
(LPV/r)(Kaletra)
---Not studied; may increase vardenafil levelsIncreased vardenafil effects (eg, hypotension, priapism)Inhibition of CYP450 3A4 by lopinavir/ritonavir

Initiate vardenafil at 5 mg QD; adjust dose as indicated; not recommended to exceed 20 mg in a 48 hour period

Ritonavir741
(RTV)(Norvir)
600 mg BID5 mg daily-Vardenafil AUC increased 49-fold; Cmax increased 13-fold. T1/2 increased to 26 hours.Increased tadalafil effectsInhibition of CYP3A4

Initiate (and do not exceed) vardenafil 2.5 mg every 72 hours and monitor for adverse effects

"-" indicates that there are no data available
 16:Crixivan [package insert]. Whitehouse Station, NJ: Merck & Co., Inc.; Oct 2005.
 78:Kaletra [package insert]. North Chicago, IL: Abbott Laboratories; Oct 2005.
 161:Prezista [package insert]. Raritan, NJ: Tibotec Therapeutics Inc.; April 2010.
 727:Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf.
 741:Levitra [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; Sept 2016