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Androgen deprivation therapy may also prolong the QT/QTc interval.

Leuprolide; Norethindrone: (Moderate) Consider

whether

Both therapeutic and supratherapeutic doses of vardenafil produce an increase in QTc interval.

Androgen deprivation therapy may also prolong the QT/QTc interval.

Levofloxacin: (Moderate) Levofloxacin should be used cautiously with other agents, such as vardenafil, that may prolong the QT interval or increase the risk of torsade de pointes (TdP). Both therapeutic and supratherapeutic doses of vardenafil produce an increase in QTc interval.

Levofloxacin has been associated with a risk of QT prolongation and TdP.

Although extremely rare, TdP has been reported during postmarketing surveillance of levofloxacin. Levomethadyl: (Severe) Concomitant administration of levomethadyl and vardenafil may cause additive QT prolongation and/or torsades de pointes.

Levomethadyl is contraindicated in combination with other agents that may prolong the QT interval. Lithium: (Moderate) Lithium should be used cautiously and with close monitoring with vardenafil as concurrent use may increase the risk of QT prolongation. Vardenafil is also associated with QT prolongation. Therapeutic (10 mg) and supratherapeutic (80 mg) doses of vardenafil produce an increase in QTc interval (e.g., 4 to 6 msec calculated by individual QT correction). Lofexidine: (Major) Monitor ECG if lofexidine is coadministered with vardenafil due to the potential for additive QT prolongation.

Both therapeutic and supratherapeutic doses of vardenafil produce an increase in QTc interval.

Lomefloxacin: (Moderate) Lomefloxacin has been associated with QT prolongation and infrequent cases of arrhythmia.

Other medications which may prolong the QT interval, such as vardenafil, should be used cautiously when given concurrently with lomefloxacin.

Long-acting beta-agonists: (Moderate) Therapeutic (10 mg) and supratherapeutic (80 mg) doses of vardenafil produce an increase in QTc interval (e.g., 4 to 6 msec calculated by individual QT correction). The effect of vardenafil on the QT interval should be considered when prescribing the drug. Drugs with a possible risk for QT prolongation that should be used cautiously with vardenafil include the beta agonists.

Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses and/or when associated with hypokalemia.

Loperamide: (Moderate) Consider the potential for additive QT effects if vardenafil is administered with loperamide. Both therapeutic and supratherapeutic doses of vardenafil produce an increase in QTc interval.

At high doses, loperamide has been associated with serious cardiac toxicities, including syncope, ventricular tachycardia, QT prolongation, torsade de pointes (TdP), and cardiac arrest.

Loperamide; Simethicone: (Moderate) Consider the potential for additive QT effects if vardenafil is administered with loperamide.

Both therapeutic and supratherapeutic doses of vardenafil produce an increase in QTc interval. At high doses, loperamide has been associated with serious cardiac toxicities, including syncope, ventricular tachycardia, QT prolongation, torsade de pointes (TdP), and cardiac arrest.

Lopinavir; Ritonavir: (Major) Coadministration of ritonavir with vardenafil results in a 20% decrease in ritonavir AUC and a 49-fold increase in vardenafil AUC.

Substantially increased vardenafil plasma concentrations may result in increased associated adverse events including hypotension, syncope, visual changes, and prolonged erection. If coadministered, use vardenafil at reduced doses of no more than 2.5 mg every 72 hours with increased monitoring for adverse reactions.

Vardenafil orally disintegrating tablets provide increased exposure as compared to the regular tablets; therefore, use of the orally disintegrating tablets with ritonavir is not recommended. In addition, both ritonavir and vardenafil are associated with QT prolongation;

concomitant

(Major) Particular caution should be used when prescribing phosphodiesterase type 5 (PDE5) inhibitors to patients receiving lopinavir; ritonavir (Kaletra). Coadministration of lopinavir; ritonavir (Kaletra) with these drugs is expected to substantially increase their plasma concentrations and may result in increased associated adverse events including hypotension, syncope, visual changes, and prolonged erection. If coadministered, use vardenafil at reduced doses of 2.5 mg every 72 hours with increased monitoring for adverse reactions.

In addition, QT prolongation in patients taking lopinavir; ritonavir has been reported.

Coadministration of lopinavir; ritonavir with other drugs that prolong the QT interval, such as vardenafil, may result in additive QT prolongation. Lorcaserin: (Major) Lorcaserin is a serotonin 2C receptor agonist, and priapism is a potential effect of 5-HT2C receptor agonism. Because there is little experience with the combination of lorcaserin and medications indicated for erectile dysfunction (e.g., phosphodiesterase inhibitors), combined use should be approached with caution. Lumacaftor; Ivacaftor: (Moderate) Lumacaftor; ivacaftor may reduce the efficacy of vardenafil by decreasing its systemic exposure. Vardenafil is primarily metabolized by CYP3A4, and lumacaftor is a strong CYP3A inducer. Macimorelin: (Major) Avoid concurrent administration of macimorelin with drugs that prolong the QT interval,

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Sufficient washout time of drugs that are known to prolong the QT interval prior to administration of macimorelin is recommended. Treatment with macimorelin has been associated with an increase in the corrected QT (QTc) interval.

Both therapeutic and supratherapeutic doses of vardenafil produce an increase in QTc interval.

Maprotiline: (Moderate) Use vardenafil with caution in combination with maprotiline due to increased risk of QT prolongation.

Both therapeutic and supratherapeutic doses of vardenafil produce an increase in QTc interval.

Maprotiline has been reported to prolong the QT interval, particularly in overdose or with higher-dose prescription therapy (elevated serum concentrations). Cases of long QT syndrome and torsade de pointes (TdP) tachycardia have been described with maprotiline use, but rarely occur when the drug is used alone in normal prescribed doses and in the absence of other known risk factors for QT prolongation.