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PDE5 inhibitors are first-line agents for ED according to guidelines. Although associated with high rates of success, approximately 35% of ED patients fail to respond to PDE5 inhibitor therapy. A course of an alternate PDE5 inhibitor may be considered if a patient does not respond to a PDE5 inhibitor trial; a treatment failure may be deemed after at least 4 unsuccessful trials. Patients refractory to PDE5 inhibitors should be counseled on appropriate use, potentially modifiable factors (e.g. hormonal abnormalities, food or drug interactions, lack of adequate sexual stimulation, heavy alcohol use, and the patient's relationship with his partner), and the risks and benefits of other therapies. Second-line treatment options include intracavernous injection and intra-urethral therapy. Follow-up visits for ED patients, regardless of therapy, are necessary to determine whether therapy continues to be effective and whether cardiovascular health has significantly changed. A single dose of 2.5 mg PO should not be exceeded in a 72-hour period. A single dose of 2.5 mg PO should not be exceeded in a 24-hour period. A single dose of 5 mg PO should not be exceeded in a 24-hour period. If the patient is also taking an alpha-blocker, the initial dose should be 2.5 mg PO. 10 mg PO, taken approximately 60 minutes before sexual activity (Max dose: 10 mg/day PO). Patients requiring a lower dose of vardenafil should use the film-coated tablets. Do not use the orally disintegrating tablets with concomitant moderate or potent CYP3A4 inhibitors (e.g., ritonavir, indinavir, atazanavir, saquinavir, clarithromycin, ketoconazole, itraconazole, erythromycin). Vardenafil 10 mg orally disintegrating tablets provide higher systemic exposure compared to vardenfil 10 mg film-coated tablets, and these dosage forms are not interchangeable. PDE5 inhibitors are first-line agents for ED according to guidelines. Although associated with high rates of success, approximately 35% of ED patients fail to respond to PDE5 inhibitor therapy. A course of an alternate PDE5 inhibitor may be considered if a patient does not respond to a PDE5 inhibitor trial; a treatment failure may be deemed after at least 4 unsuccessful trials. Patients refractory to PDE5 inhibitors should be counseled on appropriate use, potentially modifiable factors (e.g. hormonal abnormalities, food or drug interactions, lack of adequate sexual stimulation, heavy alcohol use, and the patient's relationship with his partner), and the risks and benefits of other therapies. Second-line treatment options include intracavernous injection and intra-urethral therapy. Follow-up visits for ED patients, regardless of therapy, are necessary to determine whether therapy continues to be effective and whether cardiovascular health has significantly changed. For orally disintegrating tablets (e.g., Staxyn), 10 mg/day PO. For orally disintegrating tablets (e.g., Staxyn), 10 mg/day PO. Patients with mild hepatic impairment (Child-Pugh class A): No dose adjustment is required. Patients with moderate hepatic impairment (Child-Pugh class B): Decrease starting dose to 5 mg/day PO using the regular tablets; the maximum dose should not exceed 10 mg/day PO. Do not use vardenafil orally disintegrating tablets in patients with moderate hepatic impairment. Patients with severe hepatic impairment (Child-Pugh class C): Do not use. CrCl 30 mL/minute or more: No dosage adjustments are needed. Hemodialysis Do not use vardenafil in patients requiring dialysis; vardenafil has not been studied in these patients. Vardenafil is administered orally approximately 1 hour before expected intercourse. Orally disintegrating tablets: Place on tongue where tablet will disintegrate. Administer immediately upon removal from blister packaging. Levitra: - Store at 77 degrees F; excursions permitted to 59-86 degrees F Staxyn: - Store at 77 degrees F; excursions permitted to 59-86 degrees F. Vardenafil is contraindicated in patients with a known hypersensitivity to any component of the tablet. The safety and efficacy of combinations of vardenafil with other treatments for erectile dysfunction have not been studied. Therefore, the use of such combinations is not recommended. The safe and effective use of vardenafil in combination with other agents for treating erectile dysfunction has not been studied. Therefore, the use of such combinations is not recommended. Vardenafil is contraindicated in patients who lady era for sale near me are currently on nitrate/nitrite therapy. Consistent with its known lady era for sale near me effects on the nitric oxide/cGMP pathway, vardenafil may potentiate the hypotensive effects of organic nitrates and nitrites. Patients receiving nitrates in any form are not to receive vardenafil. This includes any patient who receives intermittent nitrate therapies. It is unknown if it is safe for patients to receive nitrates once vardenafil has been administered. A suitable time interval following vardenafil dosing for safe administration of nitrates or nitric oxide donors has not been determined. Vardenafil tablets are not recommended in patients with severe hepatic disease (Child-Pugh class C) or end stage renal disease requiring dialysis (severe renal impairment or renal failure). There are no controlled clinical studies on the safety and efficacy of vardenafil in these patients; therefore, vardenafil use is not recommended until further information is available. Patients with moderate hepatic impairment require a reduction in the starting lady era for sale near me dose of the regular tablets and a lower maximum dosage (see Indications/Dosage). Patients with mild hepatic impairment or mild to moderate renal impairment do not require adjustments in the vardenafil regular tablet dosage. The concomitant use of certain potent hepatic cytochrome P450 3A4 inhibitors may result in a requirement to adjust the vardenafil dosage (see Dosage and Drug Interactions). Vardenafil orally disintegrating tablets provide increased exposure as compared to the regular tablets; therefore, the orally disintegrating tablets should not be used in patients with moderate or severe hepatic disease (Child-Pugh class B or C) or in patients on hemodialysis. Patients who require lower doses of vardenafil should use the regular tablets.
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