Sildenafil (Viagra) and tadalafil (Cialis) get most of the attention, but vardenafil, first sold as Levitra, is a well-established ED medicine in its own right. It works in the same way as the other two. The differences are practical: timing, food, the forms it comes in, and a few safety points.
What vardenafil is
Vardenafil is a PDE5 inhibitor, like sildenafil and tadalafil. It helps blood flow into the penis when you are sexually aroused; it does not cause an erection on its own1. The original brand, Levitra, comes as film-coated tablets (5, 10 and 20 mg) and as a 10 mg tablet that dissolves in the mouth1. Generic vardenafil is widely available, under names such as Vilitra and Zhewitra.
Was vardenafil discontinued? No. Levitra is still authorised in the European Union1, and current US labels exist for generic vardenafil2. A second Bayer brand of the same medicine, Vivanza, was withdrawn in Europe3, which may be where the idea comes from.
Vardenafil vs sildenafil vs tadalafil at a glance
| Vardenafil (Levitra) | Sildenafil (Viagra) | Tadalafil (Cialis) | |
|---|---|---|---|
| When to take | About 25 to 60 minutes before sex1 | About 1 hour before; anywhere from 30 minutes to 4 hours4 | Before sex; can help for up to 36 hours5 |
| Peak level in the blood | Usually 30 minutes to 2 hours (typically 1 hour)2 | 30 minutes to 2 hours (typically 1 hour)4 | 30 minutes to 6 hours (typically 2 hours)5 |
| Half-life (time for the level to halve) | About 4 to 5 hours2 | About 4 hours4 | About 17.5 hours5 |
| Food | A high-fat meal may delay it1 | A high-fat meal can delay it by about an hour4 | Not affected5 |
| Usual starting dose | 10 mg2 | 50 mg4 | 10 mg as needed, or 2.5 to 5 mg daily5 |
| Highest licensed dose | 20 mg once a day2 | 100 mg once a day4 | 20 mg once a day5 |
| Daily low-dose option | No | No | Yes5 |
In practice, vardenafil behaves much like sildenafil: a similar wait before sex and a similar time in the body. Tadalafil stands apart because it lasts much longer. For a deeper look at the other two, see sildenafil vs tadalafil.
Is vardenafil stronger than Viagra?
Not in any way that matters to you. A 20 mg vardenafil tablet is not “stronger” than a 100 mg sildenafil tablet just because the numbers differ; each medicine has its own dose range. European urology guidelines say there is no proven difference in how well the different PDE5 inhibitors work6. But they differ in timing, food effects and side effects, so switching is a reasonable step if your first medicine does not suit you. Our guide Viagra not working? covers when to switch.
Doses, and why higher-strength tablets are not “better”
- Licensed range: 5 to 20 mg, with 10 mg the usual starting dose, no more than once a day2.
- Men aged 65 or over have higher blood levels, so a 5 mg starting dose should be considered2.
- Liver or kidney problems may need a lower dose, and vardenafil should not be used with severe liver problems or by people on dialysis2.
- Some other medicines, such as certain HIV medicines, antifungals and antibiotics, raise vardenafil levels and need a lower dose2.
You may see vardenafil tablets sold at 40 mg or 60 mg. These are above the 20 mg licensed maximum2. In studies of high doses, severe back pain was seen when 40 mg was taken twice a day, and most volunteers given a single very high dose had back or muscle pain and vision changes2. A higher number on the pack does not mean a better result.
The dissolve-in-the-mouth tablet
Vardenafil also comes as a 10 mg orodispersible tablet, which you put on your tongue to dissolve without water17. Two points to know:
- It is not interchangeable with the 10 mg film-coated tablet, because it gives higher blood levels7.
- It contains phenylalanine, which matters for people with the inherited condition phenylketonuria (PKU)7.
Side effects
In trials, the most common side effects of vardenafil were headache, flushing, a runny or blocked nose, indigestion and sinusitis, with dizziness and nausea less often2. These are similar to sildenafil’s, although sildenafil is more often linked with a colour tinge to vision, and tadalafil with back and muscle aches45. For a full comparison, see ED medication side effects compared.
Heart rhythm caution. Vardenafil can lengthen the QT interval, a measure of the heart’s electrical cycle. People born with a long QT interval, or taking heart rhythm medicines such as amiodarone, sotalol, quinidine or procainamide, should avoid it2. This is the main safety difference from sildenafil and tadalafil.
The warnings shared by all ED tablets apply too: never with nitrates or riociguat, care with alpha-blockers, get emergency help for an erection lasting more than 4 hours, and stop and seek help for sudden loss of vision or hearing2. See ED pills and your heart.
Who might choose vardenafil
- Men who want a medicine with timing similar to sildenafil but did not get on with sildenafil itself.
- Men who would like a tablet that dissolves on the tongue, without water.
- Not usually men with a long QT interval or on certain heart rhythm medicines, and not those who want a long window of effect, for whom tadalafil may suit better.
Our ED medicines page lists all the options, including Levitra 20 mg. For the fast-acting option, see avanafil vs sildenafil.
Frequently asked questions
Is vardenafil better than sildenafil?
Not on average. Guidelines say there is no proven difference in how well the different ED tablets work. Vardenafil and sildenafil have similar timing; some men prefer one over the other because of side effects or the dissolving tablet.
How fast does vardenafil work?
It is usually taken about 25 to 60 minutes before sex. Blood levels peak at around 1 hour, and a high-fat meal can slow it down.
How long does vardenafil last?
Its half-life is about 4 to 5 hours, similar to sildenafil. It does not cause a lasting erection; it helps when you are aroused during that window.
Is vardenafil better than tadalafil?
Neither is better overall. Tadalafil lasts much longer and is not affected by food, and it can be taken as a low daily dose. Vardenafil is shorter-acting and comes as a dissolving tablet.
Can vardenafil be taken daily?
It is taken as needed, no more than once a day. Among the common ED tablets, only tadalafil has a licensed low daily dose.
Is 40 mg vardenafil safe?
The licensed maximum is 20 mg once a day. Higher-strength tablets are above that limit and bring more side effects without a proven extra benefit.
Sources & references
- European Medicines Agency. Levitra (vardenafil): EPAR summary.
- US National Library of Medicine, DailyMed. Vardenafil tablets prescribing information.
- European Medicines Agency. Vivanza (vardenafil): withdrawn authorisation.
- US National Library of Medicine, DailyMed. Viagra (sildenafil) prescribing information.
- US National Library of Medicine, DailyMed. Cialis (tadalafil) prescribing information.
- European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Management of erectile dysfunction.
- US National Library of Medicine, DailyMed. Vardenafil orally disintegrating tablets prescribing information.
Related reading
- Kamagra vs Viagra
- Can you take Viagra every day?
- ED medicines overview
- Vardenafil medicines
- Sildenafil medicines
- Tadalafil medicines
This content is for informational purposes only and is not medical advice. Do not take more than the licensed dose of any ED medicine, and never take one with nitrates. Used as prescribed by a licensed medical professional.
A. Srinivasan is a licensed clinical pharmacist with 24 years of experience. He holds a B.Pharm and M.Pharm from University of Madras. At OnlineMeds, he reviews medicine and health content to help ensure it is accurate, evidence-based, and easy to understand.