Five milligrams arrives with an ECG homework list

01The avoid list is shorter than the rumour

US LEVITRA language: consider QT history and QT-prolonging drugs when prescribing. Then the hard line: patients taking Class IA (quinidine, procainamide) or Class III (amiodarone, sotalol) antiarrhythmics, or those with congenital QT prolongation, should avoid LEVITRA.

That is not 'get a Holter and decide at home.' It is a chart screen. Family history of sudden death and a personal long-QT diagnosis belong on the intake, not in a footnote after the first fill.

This desk locked 5 mg because titles needed a mid-start distinct from neighbors. Most men on a clean ECG still see 10 mg as the labelled usual start. Do not copy 5 mg onto a 10 mg script to match our heading.

Staxyn and other orodispersible vardenafil products still carry the QT paragraph. Switching form does not retire amiodarone. The checklist is the molecule, not the imprint. See the onset postscript if the question is film versus ODT timing, not rhythm drugs.

Protein binding is high and the primary metabolite M1 is active. That does not create a home QT score. It is a reminder that exposure can linger while you are still listing evening medicines for the chart.

02Nitrates remain the louder stop

QT homework does not outrank the nitrate contraindication. Organic nitrates and nitric oxide donors stay forbidden. A suitable interval for safe nitrate use after vardenafil has not been defined.

Chest pain after a 5 mg tablet is EMS plus the drug name plus the clock. Do not take a drawer spray 'just this once' because the QT screen was clean.

Alpha-blockers need a stable regimen and the lowest labelled start. That is blood-pressure math, not QT math. Keep both screens on the same form.

03What the moxifloxacin study actually showed

A placebo- and positive-controlled crossover in healthy men gave therapeutic 10 mg and supratherapeutic 80 mg vardenafil, plus sildenafil 50 and 400 mg, plus moxifloxacin 400 mg. Morganroth 2004 is the published cut.

Placebo-corrected QTcF at about one hour: vardenafil 10 mg +8 msec (6 to 9), sildenafil 50 mg +6 msec (5 to 8). Moxifloxacin showed the expected ~8 msec. Absolute QT did not prolong on the PDE5 arms the way people fear from forum headlines.

EMA product information quotes mean QTc increases of 8 msec after 10 mg and 10 msec after 80 mg, and an extra 4 msec when 10 mg was given with gatifloxacin 400 mg. Clinical impact of those small shifts is described as unknown and not generalisable to every patient.

Moxifloxacin was the positive control because it is a known small QT mover. The study design is why the vardenafil paragraph exists: the sponsor measured the class effect instead of pretending it was zero. Small and measured is still a reason to keep congenital long QT and Class IA/III drugs off the combination list.

Forum posts that say 'all PDE5s prolong QT so none are special' skip the labelling difference. Vardenafil is the one whose US PI turned the finding into a named avoid. That is why this checklist is a vardenafil postscript and not a class clone.

04How Stockholm clinic mail documents the screen

One line is enough: 'No congenital LQTS; no IA/III; nitrate screen negative; other QT drugs listed; K+ checked if recent labs exist.' Attach this postscript as patient education.

Do not write 'ECG normal so QT risk zero.' A single clinic ECG does not erase a congenital diagnosis or an amiodarone script. The avoid list is clinical, not a voltage souvenir.

If the only ECG in the chart is five years old and the medicine list has grown, repeat the screen. New sotalol is a new avoid. An old strip does not grandfather the combination.

QT-desk pocket lines

• Congenital long QT or IA/III partner - avoid vardenafil
• Other QT-active drugs - list them, do not guess at home
• Nitrates still louder than the QT paragraph
• 5 mg is the site lock; 10 mg remains the usual labelled start

05Why 5 mg is on this heading at all

Usual labelled start is 10 mg about 60 minutes before activity, then 5 or 20 mg by effect. Age 65 and older: consider 5 mg because Cmax and AUC were 34 and 52 percent higher than in younger men. Child-Pugh B: start 5 mg, maximum 10 mg. Child-Pugh C: not evaluated.

2.5 mg exists for ritonavir (single 2.5 mg in 72 hours) and other potent CYP3A4 stories. That is not this desk's onset lock. See the onset-lead postscript for why 2.5 mg is not the public start.

A clean QT screen does not make 20 mg the first tablet. Titration is still a clinic sentence after a 5 or 10 mg trial.

06Class IA and III partners

Quinidine and procainamide are uncommon in 2026 inboxes, but they still exist. Amiodarone and sotalol are not uncommon. If either Class III agent is on the list, vardenafil is the wrong PDE5 to improvise at home.

Do not stop amiodarone so you can start an ED tablet. Rhythm control wins. Ask cardiology whether a different ED strategy is acceptable. Tadalafil and sildenafil have their own cardiac cautions; they are not automatic safe swaps without a review.

A 'small QT effect' in healthy volunteers is not permission to pair with a Class III drug. The avoid sentence exists because the combination was not a casual add-on in labelling.

07Other QT drugs still need a chart look

Many antidepressants, antipsychotics, and some macrolides prolong QT. The vardenafil PI tells you to consider those combinations. It does not reprint the entire CredibleMeds list. That is why this is a checklist for the visit, not a home scoring app.

Hypokalaemia is named in the European text as a relevant risk factor. A recent low potassium on the lab sheet belongs next to the ECG question.

Additive QT with another QT-active drug showed up in the gatifloxacin post-marketing work. Additive means the second drug is not free. It does not mean every SSRI is an automatic avoid.

Bring the actual blister names, not 'a heart pill' or 'a mood tablet.' Amiodarone hiding as a 'rhythm vitamin' in family language is how checklists fail. Write generic names on the intake. The vardenafil letter can wait until those names are on paper.

08What to say if the chest tightens after 5 mg

Say vardenafil, say the milligram, say the clock. If an ECG tech then asks about QT drugs, list amiodarone, sotalol, and the rest without editing. A clean pre-dose checklist still matters after the fact because it tells the team what was already ruled in or out.

Do not take a nitrate spray in the ambulance bay because the peak 'should have passed.' A suitable interval for nitrates after vardenafil has not been defined. Half-life is four to five hours. The contraindication is not a one-hour rule.

Syncope after a first 5 mg plus an alpha-blocker is blood-pressure math until proven otherwise. The QT paragraph does not retire that story. Stand slowly. Report the faint. The next tablet waits for a review.

Bring the bag to the ward: orange tablets, the vardenafil letter printout if you have one, and this checklist. Staff can read a named avoid faster than they can reconstruct a forum thread. Factual corrections after the fact still go to [email protected]; the ward does not.

09File the checklist, then dose

The small QTc shifts in healthy men are not a reason to panic every 5 mg tablet. The named avoids are a reason to stop before the first swallow.

Checklist filed 21 August 2026. Parent page: vardenafil letter. Onset timing: onset-lead postscript. Factual corrections: [email protected].