Vardenafil

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(Vardenafil) Here Quick Reference

IUPAC Name
piperazine,1-[[3-(1,4-dihydro-5-methyl-4-oxo-7-propylimidazo[5,1- f ][1,2,4]triazin-2-yl)-4-ethoxyphenyl]sulfonyl]-4-ethyl-, mono-hydrochloride
Chemical Information
Empirical Formula	C23H32N6O4S•HCl•3H2O
Molecular Weight	579.1
General Drug Information
Classification	Phosphodiesterase-5 Enzyme Inhibitor (PDE5)
Schedule	Legend
How Supplied	Oral Tablets: 2.5, 5, 10, 20 mg
Trade Names	Levitra®
Pregnancy Category	B
Breast Feeding	Excretion into breast milk unknown/not indicated for use in women
Generic Availability	Generic Not Available
Patent Expiration Date	May 1, 2019
Administration Information
Route(s)	Oral
Method(s)	Take this medicine 60 minutes prior to sexual activity
Pharmacokinetic Information
Absorption	F = 15%
	Cmax = Cmax reduce by 18-50% by high-fat meals
	tmax = 30 to 120 minutes
Distribution	Vd = 208 L
	Protein binding = 95%
Metabolism	CYP3A4, CYP3A5, and CYP2C9 to M1 metabolite
Excretion	t1/2 = 4-5 hours
	Feces (91% to 95% as metabolites); urine (2% to 6%)

Contents 1 Brand/Trade Names of Drug 2 Generic Name of Drug 3 Description 4 Mechanism of action 5 Time Required for Therapeutic Response 6 Pharmacokinetics 6.1 Absorption 6.2 Distribution 6.3 Metabolism 6.4 Excretion 7 Special Population Pharmacokinetics 8 Indications 8.1 FDA Approved Indications 8.2 Non-FDA Approved Indications 9 Dosage 10 Administration 11 Monitoring Parameters 12 Contraindications/Precautions 12.1 Contraindications 12.2 Warnings 12.3 Precautions 12.4 Pregnancy indications 12.5 Breast-feeding indications 13 Drug-Drug Interactions 14 Drug-Food-Herb Interactions 15 Adverse Reactions/Side Effects 16 Overdosage Measures 17 Product Information and Distribution 18 Pharmacogenomic information 19 Patient Information 20 References 21 PUBMED References 21.1 Efficacy Trial Articles 21.2 Therapeutic Class Comparison Trial Articles 21.3 Pharmacokinetics Articles 21.4 Drug Interaction Articles 22 Images 23 External Links

Brand/Trade Names of Drug

Levitra®

Generic Name of Drug

Vardenafil (var DEN a fil) Click Here

Description

Vardenafil is a selective phosphodiesterase-5 enzyme inhibitor (PD5) similar to sildenafil and tadalafil, administered orally for the treatment of erectile dysfunction (ED). Vardenafil and tadalafil are more selective compared to sildenafil for PDE5 than PDE6, which is present in the retina, which would explain the higher case reports of visual adverse events associated with sildenafil. Most selective of the current PDE5 inhibitors for PDE5 receptors. It was FDA approved for treatment of ED in 2003.^{[1] [2]}

Mechanism of action

Penile erection is a hemodynamic process initiated by the relaxation of smooth muscle in the corpus cavernosum and its associated arterioles. During sexual stimulation, nitric oxide is released from nerve endings and endothelial cells in the corpus cavernosum. Nitric oxide activates the enzyme guanylate cyclase resulting in increased synthesis of cyclic guanosine monophosphate (cGMP) in the smooth muscle cells of the corpus cavernosum. The cGMP in turn triggers smooth muscle relaxation, allowing increased blood flow into the penis, resulting in erection. The tissue concentration of cGMP is regulated by both the rates of synthesis and degradation via phosphodiesterases (PDEs). The most abundant PDE in the human corpus cavernosum is the cGMP specific phosphodiesterase type 5 (PDE5); therefore, the inhibition of PDE5 enhances erectile function by increasing the amount of cGMP. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 has no effect in the absence of sexual stimulation. ^[3]

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Time Required for Therapeutic Response

• Initial: ~1 hour ^[3]
• Maximum: ~4 hours^[3]

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Pharmacokinetics

Absorption

Following oral administration, vardenafil is rapidly absorbed with absolute bioavailability of approximately 15%. In the fasted state, the Cmax of a single dose of 20 mg of vardenafil is reached between 30 minutes and 2 hours in healthy male volunteers. Administration with high-fat meals caused a reduction in Cmax by 18 to 50%.

Distribution

Vardenafil shows extensive tissue distribution with a mean steady-state volume of distribution (V_ss) of 208 L. Vardenafil and its major circulating metabolite, M1, are highly bound to plasma proteins; 95%. This protein binding is reversible and independent of total drug concentrations.

Metabolism

Vardenafil is metabolized predominantly by hepatic enzyme CYP3A4, and to a lesser extent CYP 3A5 and CYP2C isoforms. Vardenafil undergoes desethylation at the piperzine moiety, forming its major circulating metabolite, M1. M1 is subject to further metabolism. The plasma concentration of M1 is approximately 26% that of the parent compound. This metabolite shows a phosphodiesterase selectivity profile similar to that of vardenafil and an in vitro inhibitory potency for PDE5 28% of that of vardenafil. Therefore, M1 accounts for approximately 7% of total pharmacologic activity.

Excretion

The total body clearance of vardenafil is 56 L/h, and the terminal half-life of vardenafil and its primary metabolite (M1) is approximately 4 to 5 hours. Vardenafil is excreted as metabolites predominantly in the feces (91-95%) and to a lesser extend in the urine (2-6%).

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Special Population Pharmacokinetics

• Renal insufficiency

In the moderate (ClCr = 30 to 50 ml/min) or severe (ClCr <30 ml/min) renal impairment groups, the AUC of vardenafil was 20 to 30% higher compared to that observed in a control group with normal renal function (ClCr >80ml/min).

• Hepatic insufficiency

In volunteers with mild hepatic impairment (Child-Pugh A), the Cmax and AUC following a 10mg vardenafil dose were increased by 22% and 17%, respectively, compared to healthy control subjects. In volunteers with moderate hepatic impairment (Child-Pugh B), the Cmax and AUC following a 10mg vardenafil dose was increased by 130% and 160%, respectively, compared to healthy control subjects. Consequently, a starting dose of 5mg is recommended for patients with moderate hepatic impairment, and the maximum dose should not exceed 10mg. Vardenafil has not been evaluated in patients with severe (Child-Pugh C) hepatic impairment.

• Hemodialysis

Vardenafil pharmacokinetics have not been evaluated in patients requiring renal dialysis.

• Geriatric

In a healthy volunteer study of elderly males (≥65 years) and younger males (18-45 years), mean Cmax and AUC were 34% and 52% higher, respectively, in the elderly males. Thus it is recommended that the starting dose of vardenafil 5mg in patients ≥65 years of age should be considered.

• Pediatric

Vardenafil trials were not conducted in the pediatric population.

• Gender

Vardenafil is only indicated for males.

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Indications

FDA Approved Indications

• Erectile Dysfunction ^{[4] [5] [6] [7] [8] [9] [10]}

Non-FDA Approved Indications

• Raynaud's Phenomenon ^[11]

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Dosage

• Erectile Dysfunction
  • Maintenance Dose: 2.5 to 20 mg/day

• Maximum Dosage Limits
  • Adults: 20 mg/day
  • Elderly: 20 mg/day

• Dosage Adjustment
  • Renal insufficiency: No dose adjustment needed for patients Clcr <30 ml/min. Vardenafil has not been evaluated in patients on renal dialysis.
  • Hepatic insufficiency:
    • Mild Hepatic Impairment: No dose adjustment is necessary.
    • Moderate Hepatic Impairment: Initial dose of 5 mg is recommended; maximum dose should not exceed 10 mg.
    • Severe Hepatic Impairment: Vardenafil has not been study in patients with severe hepatic impairment.
  • Hemodialysis: Vardenafil pharmacokinetics have not been evaluated in patients requiring renal dialysis.
  • Geriatric: Initial dose of 5 mg should be considered in patients ≥ 65 years of age.
  • Pediatric: Vardenafil trials were not conducted in the pediatric population. Not indicated for this patient population.
  • Gender: Only recommended for male patients.

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Administration

• Route: Oral
• Method: Swallow tablet followed by a drink of water.
• Special considerations: Should be taken ~1 hour prior to sexual activity.

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Monitoring Parameters

• Laboratory monitoring not necessary.
• Monitor for response and adverse reactions.

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Contraindications/Precautions

Contraindications

• Vardenafil has shown to potentiate the hypotensive effects of nitrates, and its administration in patients who are using nitrates of any form, either regularly and/or intermittently, is contraindicated. Following a 20 mg of vardenafil, no changes in blood pressure and heart rate were detected 24 hours prior to nitroglycerin 0.4 mg sublingually in a study conducted in 18 healthy male subjects. Results of the study would suggest that a minimum of 24 hours must pass before administration of nitrates in situations deemed medically necessary.
• Vardenafil is contraindicated for patients with a known hypersensitivity to vardenafil or any component of the tablet.

Warnings

• FDA notified healthcare professionals of updated labeling for Cialis®, Levitra®, and Viagra® to reflect a small number of post-marketing reports of sudden vision loss, attributed to NAION (non arteritic ischemic optic neuropathy), a condition where blood flow is blocked to the optic nerve. FDA advises patients to stop taking these medicines, and call a doctor or healthcare provider right away if they experience sudden or decreased vision loss in one or both eyes. Patients taking or considering taking these products should inform their health care professionals if they have ever had severe loss of vision, which might reflect a prior episode of NAION. Such patients are at an increased risk of developing NAION again. At this time, it is not possible to determine whether these oral medicines for erectile dysfunction were the cause of the loss of eyesight or whether the problem is related to other factors such as high blood pressure or diabetes, or to a combination of these problems.

FDA Medwatch

• Cardiovascular Effects
  • General: In men with certain underlying cardiovascular conditions, treatment for erectile dysfunction, including vardenafil is not recommended; there is a degree of cardiac risk associated with sexual activity.
  • Left Ventricular Outflow Obstruction: Patients with left ventricular outflow obstruction (e.g. aortic stenosis) can be sensitive to the vasodilating affects of PDE5 inhibitors.
  • Vardenafil can decrease supine blood pressure in healthy male patients by 7 mmHg in systolic and 8 mmHg in diastolic due to its systemic vasodilatory properties. Caution in patients with underlying cardiovascular diseases which can be adversely affected.
• Concomitant therapy with potent CYP 3A4 Inhibitors
• Patient populations not studied in clinical trials; Due to the lack of controlled clinical data on the safety and efficacy of vardenafil in the following patients, it is not recommended until further information is available, as per manufacturer.
  • Patients with unstable angina; hypotension (resting systolic blood pressure of <90mmHg); uncontrolled hypertension (>170/110 mmHg); recent history (within 6 months) of stroke, life-threatening arrhythmia, or MI; severe cardiac failure
  • Severe hepatic impairment
  • End-stage renal disease requiring dialysis
  • Known hereditary degenerative retinal disorders, including retinitis pigmentosa

Precautions

• Alpha-blockers: caution with co-administration with PDE5 inhibitors; both agents are vasodilators with blood-pressure lowering effects. When used in combination, potential for additive effect on significantly lowering blood pressure leading to symptomatic hypotensiion (e.g. fainting, lightheadedness, dizziness).
• Hepatic Insufficiency
• Renal Insufficiency
• Patients with congenital or acquired QT prolongation and on therapy with Class IA or Class III antiarrhythmic agents should avoid taking vardenafil.
• Vardenafil should be used with caution in patients with anatomical deformation of the penis, or in patients who have conditions which may predispose them to priapism; sickle cell anemia, multiple myeloma, or leukemia

Pregnancy indications

• Pregnancy category: B Vardenafil is not indicated for use in women, newborns, or children.

• Teratogenicity: There are no adequate and well-controlled trials of vardenafil in pregnant women.

Breast-feeding indications

• Secretion into breast milk: It is not known if vardenafil is excreted in human breast milk.

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Drug-Drug Interactions

Vardenafil Drug/Drug Interaction Chart

Severity Level	Increased Effect/Toxicity	Decreased Effect
4	Organic Nitrates[3]	Not known
3	Protease Inhibitors[3] Alpha1-Blockers[3] [12] Antifugal Agents(Imidazole)[3] Macrolide Antibiotics[3]CYP 3A4 Inhibitors[3]	Not known
2	Not known	CYP 3A4 Inducers[3]
1	Not known	Not known

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Drug-Food-Herb Interactions

Atorvastatin Drug/Food/Herb Interaction Chart

Severity Level	Increased Effect/Toxicity	Decreased Effect
4	Not known	Not known
3	Not known	High-Fat Meals [3]
2	Grapefruit Juice [3]	Not known
1	Not known	Not known

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Adverse Reactions/Side Effects

Vardenafil was administered to over 4430 men (mean age 56, range 18-89 years; 81% White, 6% Black, 2% Asian, 2% Hispanic and 9% Other) during controlled and uncontrolled clinical trials worldwide. Over 2200 patients were treated for 6 months or longer, and 880 patients were treated for at least 1 year. In placebo-controlled clinical trials, the discontinuation rate due to adverse events was 3.4% for Vardenafil compared to 1.1% for placebo.^[3]

Atorvastatin Adverse Reactions Chart

Incidence	Body System	Adverse Reactions
> 10 %	All	Headache(15%), Flushing(11%)
2-10%	CNS	Dizziness(2%)
	GI	Dyspepsia(4%), Nausea(2%)
	Respiratory	Rhinitis(9%), Sinusitis(3%)
	Misc	Accidental Injury(3%), Flu Syndrome(3%), Increased Creatine Kinase(2%)
< 2%	All	abnormal ejaculation, abnormal liver function tests, abdominal pain, abnormal vision, anaphylactic reaction, angina pectoris, arthralgia, asthenia, back pain, blurred vision, changes in color vision, chest pain, chromatopsia, conjunctivitis, diarrhea, dim vision, dry mouth, dyspnea, dysphagia, epistaxis, esophagitis, eye pain, face edema, gastritis, gastroesophageal reflux, GGTP increased, glaucoma, hypertension, hypertonia, hypesthesia, hypotension, insomnia, laryngeal edema, myalgia, myocardial infraction, myocardial ischemia, neck pain, non-arteritic anterior ischemia optic neuropathy, pain, painful erection, palpitation, paresthesia, pharyngitis, photophobia, photosensitivity reaction, postural hypotension, priapism, prolonged erection, pruritus, rash, somnolence, sweating, syncope, tachycardia, tinnitus, vertigo, vomiting, and watery eyes.

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Overdosage Measures

A maximum dose of 120 mg vardenafil was administered to eight healthy male volunteers. The majority of these patients experienced reversible back pain, myalgia, and/or “abnormal vision”. In cases of overdose, standard supportive measures should be taken as required.

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Product Information and Distribution

Vardenafil Product Availability Information

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage	Markings
Levitra[3]	Bayer	Oral Tablets	2.5 mg	30	00085-1923-01	15-30°C (59-86°F)	BAYER/2.5
			5 mg	30	00085-1945-01		BAYER/5
			10 mg	30	00085-1901-01		BAYER/10
			20 mg	30	00085-1934-01		BAYER/20

• Manufacturers/Distributors
  • Manufactured by: Bayer
  • Marketed by: GlaxoSmithKline
  • Distributed and Marketed by: Schering-Plough

• Inactive ingredients

Microcrystalline Cellulose, Crospovidone, Colloidal Silicon Dioxide, Magnesium Stearate, Hypromellose, Plyethylene Gycol, Titanium Dioxide, Yellow Ferric Oxide, and Red Ferric Oxide

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Pharmacogenomic information

Vardenafil Pharmacogenomic Information

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Patient Information

• May be taken with or without food.
• Avoid high-fat meals; onset of action occurs faster with an empty stomach.
• Should be taken approximately 60 minutes before sexual activity.
• Sexual stimulation is required for an erection to occur after taking vardenafil.
• Patients should be advised to contact their healthcare provider for dose modification if they are not satisfied with the quality of their sexual performance with vardenafil or in the case of an unwanted effect.
• Vardenafil offers no protection against sexually transmitted diseases.
• In the event that an erection persists longer than 4 hours, the patient should seek immediate medical assistance. If untreated promptly, it may result in irreversible damage to the erectile tissue.
• Side effects are usually mild and transient-headache, flushing, gastrointestinal upset
• Avoid use with nitrates. A minimum of 24 hours must pass before administration of nitrates in situations deemed medically necessary.

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References

1. ↑ Shabsigh R. Seftel AD. Rosen RC. Porst H. Ahuja S. Deeley MC. Garcia CS. Giuliano F. Review of time of onset and duration of clinical efficacy of phosphodiesterase type 5 inhibitors in treatment of erectile dysfunction. Urology. 68(4):689-96, 2006 Oct.
2. ↑ Setter SM. Iltz JL. Fincham JE. Campbell RK. Baker DE. Phosphodiesterase 5 inhibitors for erectile dysfunction. Annals of Pharmacotherapy. 39(7-8):1286-95, 2005 Jul-Aug.
3. ↑ ^{3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13} Levitra® [Package Insert]. West Haven, CT: Bayer Pharmaceuticals Corporation, 2005.
4. ↑ Porst H, Rosen R, Padma-Nathan H, Goldstein I, Giuliano F, Ulbrich E, et al. The efficacy and tolerability of vardenafil, a new, oral, selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at-home clinical trial. Int J Impot Res. 2001 Aug;13(4):192-9.
5. ↑ Hatzichristou D, Montorsi F, Buvat J, Laferriere N, Bandel TJ, Porst H, et al. The efficacy and safety of flexible-dose vardenafil (levitra) in a broad population of European men. Eur Urol. 2004 May;45(5):634-41; discussion 41.
6. ↑ Potempa AJ, Ulbrich E, Bernard I, Beneke M, Vardenafil Study G, Potempa A-J, et al. Efficacy of vardenafil in men with erectile dysfunction: a flexible-dose community practice study. Eur Urol. 2004 Jul;46(1):73-9.
7. ↑ Hellstrom WJ, Gittelman M, Karlin G, Segerson T, Thibonnier M, Taylor T, et al. Sustained efficacy and tolerability of vardenafil, a highly potent selective phosphodiesterase type 5 inhibitor, in men with erectile dysfunction: results of a randomized, double-blind, 26-week placebo-controlled pivotal trial. Urology. 2003 Apr;61(4 Suppl 1):8-14.
8. ↑ Mirone V. Palmieri A. Cucinotta D. Parazzini F. Morelli P. Bettocchi C. Fusco F. Montorsi F. Flexible-dose vardenafil in a community-based population of men affected by erectile dysfunction: a 12-week open-label, multicenter trial. Journal of Sexual Medicine. 2(6):842-7, 2005 Nov.
9. ↑ Stark S. Sachse R. Liedl T. Hensen J. Rohde G. Wensing G. Horstmann R. Schrott KM. Vardenafil increases penile rigidity and tumescence in men with erectile dysfunction after a single oral dose. European Urology. 40(2):181-8; discussion 189-90, 2001 Aug.
10. ↑ Stief C. Porst H. Saenz De Tejada I. Ulbrich E. Beneke M. Vardenafil Study Group. Sustained efficacy and tolerability with vardenafil over 2 years of treatment in men with erectile dysfunction. International Journal of Clinical Practice. 58(3):230-9, 2004 Mar.
11. ↑ Caglayan E. Huntgeburth M. Karasch T. Weihrauch J. Hunzelmann N. Krieg T. Erdmann E. Rosenkranz S. Phosphodiesterase type 5 inhibition is a novel therapeutic option in Raynaud disease. Archives of Internal Medicine. 166(2):231-3, 2006 Jan 23.
12. ↑ Auerbach SM, Gittelman M, Mazzu A, Cihon F, Sundaresan P, White WB, et al. Simultaneous administration of vardenafil and tamsulosin does not induce clinically significant hypotension in patients with benign prostatic hyperplasia. Urology. 2004 Nov;64(5):998-1003.

PUBMED References

Efficacy Trial Articles

1. Stark S. Sachse R. Liedl T. Hensen J. Rohde G. Wensing G. Horstmann R. Schrott KM. Vardenafil increases penile rigidity and tumescence in men with erectile dysfunction after a single oral dose. European Urology. 40(2):181-8; discussion 189-90, 2001 Aug.
2. Mirone V. Palmieri A. Cucinotta D. Parazzini F. Morelli P. Bettocchi C. Fusco F. Montorsi F. Flexible-dose vardenafil in a community-based population of men affected by erectile dysfunction: a 12-week open-label, multicenter trial. Journal of Sexual Medicine. 2(6):842-7, 2005 Nov.
3. Valiquette L. Young JM. Moncada I. Porst H. Vezina JG. Stancil BN. Edmunds K. Montorsi F. Vardenafil Study Group. Sustained efficacy and safety of vardenafil for treatment of erectile dysfunction: a randomized, double-blind, placebo-controlled study. Mayo Clinic Proceedings. 80(10):1291-7, 2005 Oct.
4. Hellstrom WJ, Gittelman M, Karlin G, Segerson T, Thibonnier M, Taylor T, et al. Sustained efficacy and tolerability of vardenafil, a highly potent selective phosphodiesterase type 5 inhibitor, in men with erectile dysfunction: results of a randomized, double-blind, 26-week placebo-controlled pivotal trial. Urology. 2003 Apr;61(4 Suppl 1):8-14.
5. Potempa AJ. Ulbrich E. Bernard I. Beneke M. Vardenafil Study Group. Efficacy of vardenafil in men with erectile dysfunction: a flexible-dose community practice study. European Urology. 46(1):73-9, 2004 Jul.
6. Caglayan E. Huntgeburth M. Karasch T. Weihrauch J. Hunzelmann N. Krieg T. Erdmann E. Rosenkranz S. Phosphodiesterase type 5 inhibition is a novel therapeutic option in Raynaud disease. Archives of Internal Medicine. 166(2):231-3, 2006 Jan 23.
7. Stief C. Porst H. Saenz De Tejada I. Ulbrich E. Beneke M. Vardenafil Study Group. Sustained efficacy and tolerability with vardenafil over 2 years of treatment in men with erectile dysfunction. International Journal of Clinical Practice. 58(3):230-9, 2004 Mar.

Therapeutic Class Comparison Trial Articles

1. Tolra JR. Campana JM. Ciutat LF. Miranda EF. Prospective, randomized, open-label, fixed-dose, crossover study to establish preference of patients with erectile dysfunction after taking the three PDE-5 inhibitors. Journal of Sexual Medicine. 3(5):901-9, 2006 Sep.
2. Rubio-Aurioles E. Porst H. Eardley I. Goldstein I. Vardenafil-Sildenafil Comparator Study Group. Comparing vardenafil and sildenafil in the treatment of men with erectile dysfunction and risk factors for cardiovascular disease: a randomized, double-blind, pooled crossover study. Journal of Sexual Medicine. 3(6):1037-49, 2006 Nov.

Pharmacokinetics Articles

1. Klotz T. Sachse R. Heidrich A. Jockenhovel F. Rohde G. Wensing G. Horstmann R. Engelmann R. Vardenafil increases penile rigidity and tumescence in erectile dysfunction patients: a RigiScan and pharmacokinetic study. World Journal of Urology. 19(1):32-9, 2001 Feb.
2. Stark S. Sachse R. Liedl T. Hensen J. Rohde G. Wensing G. Horstmann R. Schrott KM. Vardenafil increases penile rigidity and tumescence in men with erectile dysfunction after a single oral dose. European Urology. 40(2):181-8; discussion 189-90, 2001 Aug.

Drug Interaction Articles

1. Auerbach SM, Gittelman M, Mazzu A, Cihon F, Sundaresan P, White WB, et al. Simultaneous administration of vardenafil and tamsulosin does not induce clinically significant hypotension in patients with benign prostatic hyperplasia. Urology. 2004 Nov;64(5):998-1003.
2. Rajagopalan P. Mazzu A. Xia C. Dawkins R. Sundaresan P. Effect of high-fat breakfast and moderate-fat evening meal on the pharmacokinetics of vardenafil, an oral phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction. Journal of Clinical Pharmacology. 43(3):260-7, 2003 Mar.
3. Wensing G, Bauer R, Unger S, Rohde G, Heinig R. Simultaneous administration of vardenafil and alcohol does not result in a pharmacodynamic or pharmacokinetic interaction in healthy male subjects. Int J Clin Pharmacol Ther. 44(5):216-24. 2006 May.

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Images

Vardenafil Tablets

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External Links

• Manufacturers/Distributors
  • Manufactured by: Bayer
  • Marketed by: GlaxoSmithKline
  • Distributed and Marketed by: Schering-Ploung

• Patient information pages

Levitra

• Healthcare professional information pages

Levitra Healthcare Professional information; Levitra Package Insert

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