Can you take Viagra and Levitra together? No. Both are PDE5 inhibitors, and the product information for each says that combining it with another treatment for erectile dysfunction has not been studied and is not recommended. healthdirect's advice is short: "Do not take sildenafil if you are taking other medicines for ED." Vardenafil, the medicine in Levitra, is available in Australia as a generic; the Levitra brand itself is not on the Australian register.
Why shouldn't Viagra and vardenafil be taken together?
Because they are the same kind of medicine, and neither label backs the pair. Both are PDE5 inhibitors (healthdirect — ED medicines), and their labels use almost the same words. For sildenafil, combinations with "other PDE5 Inhibitors" or "other treatments for erectile dysfunction have not been studied. Therefore the use of such combinations is not recommended" (EMA — Viagra). For Levitra, combinations with "other treatments for erectile dysfunction have not been studied. Therefore, the use of such combinations is not recommended", and its leaflet says: "Do not use Levitra film-coated tablets combined with any other treatment for erectile dysfunction" (EMA — Levitra). In Australia, the Viagra leaflet asks you to check with your doctor if you are "taking or using any other treatment for impotence" (Viagra CMI), and healthdirect gives the rule quoted above (healthdirect — Sildenafil).
Is Levitra available in Australia?
Not under that name. A search of the Australian Register of Therapeutic Goods returns no entry for Levitra. Vardenafil itself is registered, as Vardenafil Apotex and APO-Vardenafil 5, 10 and 20 mg tablets, listed since March 2018 (ARTG search). healthdirect lists it among the four PDE5 inhibitors available in Australia, with sildenafil, tadalafil and avanafil, all on prescription (healthdirect — ED medicines).
What happens if you take Viagra and vardenafil together?
No one has studied it, so no label can say exactly. The labels do show that more medicine of this kind brings more side effects, not a better erection: 200 mg of sildenafil "did not result in increased efficacy", while headache, flushing, dizziness, indigestion, nasal congestion and altered vision became more common (EMA — Viagra). Vardenafil's own side effects are the same family: headache is very common, and dizziness, flushing, a blocked or runny nose and indigestion are common (EMA — Levitra). Each medicine on its own causes a mild, passing drop in blood pressure (EMA — Viagra; EMA — Levitra). An erection lasting more than 4 hours needs the nearest hospital emergency department (healthdirect — Sildenafil). If you think you have taken too much, phone the Poisons Information Centre on 13 11 26, contact your doctor or go to the nearest emergency department (Viagra CMI). Doubling up on Viagra alone is its own question: is it safe to take more than one Viagra?
How long should you wait between Viagra and vardenafil?
No label gives a waiting time, so ask your doctor before switching from one to the other. The labels do say how long each works. Sildenafil usually starts working in 30 to 60 minutes and its effects last up to 4 hours (healthdirect — Sildenafil). With Levitra, an erection is possible "anywhere from 25 minutes up to four to five hours after taking Levitra", and the medicine's half-life is about 4 to 5 hours (EMA — Levitra). Each also has its own limit of one tablet a day (healthdirect — Sildenafil; EMA — Levitra).
If Viagra isn't working, should you try vardenafil instead?
Possibly, but instead of Viagra, not on top of it, and with your doctor, who checks whether the medicine is working and "can adjust the dose if necessary" (healthdirect — ED medicines). Sildenafil usually starts at 50 mg and can go up to 100 mg or down to 25 mg (EMA — Viagra overview); take it about an hour before sex, and it may take longer after a heavy meal (Viagra CMI). Vardenafil starts at 10 mg, taken about 25 to 60 minutes before sex, and can go up to 20 mg or down to 5 mg; a high-fat meal may delay it, and its label says to avoid grapefruit (EMA — Levitra): does grapefruit juice affect Viagra? Neither works without sexual stimulation. How the tablets compare: which erectile dysfunction drug is best?
Does the same apply to Cialis and avanafil?
Yes. The Australian Cialis leaflet lists "other PDE5 inhibitors such as sildenafil" among the medicines that interfere with it (Cialis CMI), and the avanafil leaflet names the other three tablets as treatments not to combine it with (EMA — Spedra). Both labels' reasons for Viagra with Cialis are set out in can you take Viagra and Cialis together?
The short answer
Take one ED medicine at a time. The sildenafil and Levitra labels both advise against combining them, and healthdirect says not to take sildenafil with other ED medicines. If Viagra is not working, a change of dose, timing or medicine is for your doctor to decide, and nitrates for chest pain are never allowed with any of them (healthdirect — ED medicines): why nitroglycerin and Viagra never mix. Every other combination is covered in our guide to taking Viagra or Cialis with other medicines.
