Vardenafil and Nitroglycerin Spray: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Vardenafil
Nitroglycerin Spray
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Potentiation of hypotensive effects
Interaction Deep Dive
The concomitant administration of vardenafil with nitrates (either regularly and/or intermittently) and nitric oxide donors is contraindicated. The blood pressure lowering effects of sublingual nitroglycerin 0.4 mg taken 1 and 4 hours after vardenafil and increases in heart rate when taken at 1, 4 and 8 hours were potentiated by vardenafil 20 mg in healthy middle-aged subjects. These effects were not observed when vardenafil 20 mg was taken 24 hours before the nitroglycerin. Potentiation of the hypotensive effects of nitrates for patients with ischemic heart disease has not been evaluated. A suitable time interval following vardenafil dosing for the safe administration of nitrates has not been determined12.
Why it happens (mechanism)
Increased levels of cyclic guanosine monophosphate (cGMP) from vardenafil and nitrates
Literature reports
1 report — tap to read
a) In a study involving 18 healthy middle-aged subjects, blood pressure and heart rate response to sublingual nitroglycerin 0.4 mg was evaluated following pretreatment with vardenafil 20 mg. Vardenafil 20 mg caused an additional time-related reduction in blood pressure and increase in heart rate in association with nitroglycerin administration. The blood pressure effects were observed when vardenafil 20 mg was dosed 1 or 4 hours before nitroglycerin and the heart rate effects were observed when vardenafil 20 mg was dosed 1, 4 or 8 hours before nitroglycerin. Additional blood pressure and heart rate changes were not detected when vardenafil 20 mg was dosed 24 hours before nitroglycerin 12.
Common questions
Can I take Vardenafil and Nitroglycerin Spray together?
Potentiation of hypotensive effects Always confirm with your pharmacist or prescriber before making any change.
How serious is the Vardenafil and Nitroglycerin Spray interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Vardenafil or Nitroglycerin Spray need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (2)
- Product Information: LEVITRA(R) oral tablets, vardenafil HCl oral tablets. Bayer Health Care Pharmaceuticals Inc (per FDA), Whippany, NJ, 2023. DailyMed
- Product Information: STAXYN(R) oral disintegrating tablets, vardenafil HCl oral disintegrating tablets. GlaxoSmithKline (per FDA), Research Triangle Park, NC, 2023. DailyMed
Keep reading about Vardenafil
Keep reading about Nitroglycerin Spray
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