Issues for surgery
Risk of hypotension if continued.
Risk of QT-interval prolongation if continued (see Interactions with common anaesthetic agents and Interactions with other common medicines used in the perioperative period).
Advice in the perioperative period
Elective surgery
Advise patient not to take the day prior to and the day of procedure.
Emergency surgery
Follow the advice as for elective surgery. If dose(s) taken prior to admission, monitor BP.
Post-operative advice
Hold whilst inpatient.
Interactions with common anaesthetic agents
Hypotension
PDE5 inhibitors can increase the risk of hypotension when used concomitantly with inhalational or intravenous anaesthetics.
QT-interval prolongation
See also Interactions with other common medicines used in the perioperative period.
Vardenafil has some risk for prolonging the QT-interval. Co-administration of vardenafil with medicines known to prolong the QT-interval must be based on a careful assessment of the potential risks and benefits for each patient since the risk of torsade de pointes may increase.
Anaesthetic agents that may be used in the perioperative period that are known to, or predicted to, prolong the QT-interval include:
- desflurane, isoflurane, sevoflurane – avoid
- thiopental*
*monitor ECG if concurrent use unavoidable; if risk factors for QT-prolongation are also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia) use greater caution
Interactions with other common medicines used in the perioperative period
Hypotension
PDE5 inhibitors can increase the risk of hypotension when used concomitantly with the antiemetics droperidol and prochlorperazine.
QT-interval prolongation
See also Interactions with common anaesthetic agents.
Vardenafil has some risk for prolonging the QT-interval. Co-administration of vardenafil with medicines known to prolong the QT-interval must be based on a careful assessment of the potential risks and benefits for each patient since the risk of torsade de pointes may increase.
Medicines that may be used in the perioperative period that are known to, or predicted to, prolong the QT-interval include:
- ciprofloxacin*
- clarithromycin* (see also below)
- domperidone – avoid
- droperidol – avoid
- erythromycin (particularly intravenous)* (see also below)
- granisetron – avoid if risk factors
- haloperidol – avoid
- loperamide (increased risk with high doses)*
- ondansetron – avoid
- prochlorperazine (theoretical risk)*
*monitor ECG with concurrent use if risk factors for QT-interval prolongation also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia).
Hypokalaemia
Corticosteroids may cause hypokalaemia, increasing risk of torsade de pointes, which may be additive to effects of vardenafil – monitor serum potassium closely with prolonged use.
Macrolides
Clarithromycin and erythromycin are predicted to increase the exposure to PDE5 inhibitors due to inhibition of CYP3A4.
Whilst single surgical prophylactic doses should not pose a problem, consult product literature for recommendations regarding dose adjustments and monitor closely should continued post-operative treatment be required.
Further information
None relevant.
References
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com (Accessed on 20th September 2023)
Baxter K, Preston CL (eds), Stockley’s Drug interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com (Accessed on 20th September 2023)
Summary of Product Characteristics – Vardenafil 10mg tablets. Rivopharm Ltd. Accessed via www.medicines.org.uk 20th September 2023 [date of revision of the text May 2023]