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Sephira Med Centres

Scan · vardenafil

Can Levitra 2.5-20 mg be used in severe liver disease?

Medically reviewed by Dr. Yuki Tanaka, MD - Clinical pharmacology, Toronto

Last reviewed · 3 min read · Updated

Bone review card, cobalt edge, lime chip: liver stone, empty tablet space

No. Child-Pugh C is an off. Vardenafil has not been evaluated in severe hepatic impairment, and the U.S. label says do not use Levitra 2.5-20 mg there. Moderate impairment (Child-Pugh B) starts at 5 mg and must not exceed 10 mg. After a 10 mg dose in those volunteers, Cmax rose 130% and AUC rose 160% versus healthy controls. Mild impairment (Child-Pugh A) rose Cmax 22% and AUC 17%; no adjustment. Dialysis is a different off on the same special-population page.

What start does Child-Pugh B use?

A starting dose of 5 mg is recommended. The maximum dose must not exceed 10 mg.

That 10 mg ceiling is not the usual adult 20 mg ceiling. Do not climb past it because a review praised 20.

Dialysis is a separate off

Do not use vardenafil in patients on renal dialysis. It has not been evaluated there.

CLcr 30-80 mL/min needs no adjustment. CLcr under 30 showed AUC 20-30% higher in volunteers, still not the dialysis off. Keep those rows apart.

Child-Pugh A numbers

Mild impairment raised Cmax 22% and AUC 17% after 10 mg. No dosage adjustment is necessary.

Mild is not moderate. Do not borrow the B ceiling for an A chart unless the clinician has another reason.

How much did 10 mg rise in moderate impairment?

In volunteers with Child-Pugh B, Cmax after 10 mg was 130% higher and AUC was 160% higher than in healthy controls.

Those percents are why the start drops and the ceiling stops at 10 mg. This room will not add a second PK cascade.

Alpha-blocker 5 mg is not liver math

A 5 mg vardenafil start next to a stable alpha-blocker is blood-pressure math. It is not Child-Pugh B.

That pair lives on the alpha-blocker scan. Age 65's 5 mg lives on the age scan.

Is Child-Pugh C allowed?

No. Do not use vardenafil hydrochloride in severe hepatic impairment. The drug was not evaluated in that group.

A forum average of 10 mg does not rewrite that off. The prescriber who owns the liver chart has to see the row.

Sources

  1. DailyMed vardenafil hydrochloride tablets, setid d2dce236-257e-44b6-93a9-9f0280257c6a

Checked against the current label and reviewed by Dr. Yuki Tanaka. See Scan, Tag, Board-check, Post.

Board thread

Answers follow the U.S. Levitra label.

Garth K., Eringate On dialysis three times a week. Friday Levitra?

Board reply

Do not use vardenafil on renal dialysis. The drug was not studied in that group, and dialysis is not expected to clear it faster.

Reed N., Mount Dennis Cirrhosis, Child-Pugh C last year. Is 2.5 mg a workaround?

Board reply

No. Severe hepatic impairment is an off, not a 2.5 mg bargain. 2.5 mg exists for CYP3A4 inhibitors. Ask hepatology and the prescriber who would have written ED therapy.

Ines P., Lawrence Park Child-Pugh B. Can I go to 20 mg if 10 mg feels weak?

Board reply

The moderate-impairment ceiling is 10 mg. Twenty milligrams is the usual adult maximum, not this row. Do not climb it at home.