01 Twenty milligrams and a median sixty-minute peak
Peak plasma after a 20 mg dose is the reason this leaf exists. In healthy volunteers, maximum levels after a single 20 mg Levitra tablet usually arrive between 30 minutes and 2 hours, median 60 minutes, when the stomach is empty. Absolute bioavailability is only about 15%.
For most patients the recommended start is still 10 mg, taken about 60 minutes before sexual activity, then raised to 20 mg or cut to 5 mg by effect and side effects. Maximum frequency is one tablet per day. Sexual stimulation is required.
Virena locks 20 mg because the SERP page is the fast-peak ceiling, not the 2.5 mg starter. The onset margin explains why 2.5 mg is the wrong first story: see Levitra 20 mg peak notes, not 2.5 first. The QT screen before that 20 mg swallow is the QT margin.
Staxyn, the 10 mg orodispersible tablet, is a different product with different food rules. It is not this film-coated 20 mg NDC.
02 Nitrates at 24 hours, and alpha-blockers that share a Tmax
Nitrates and nitric-oxide donors are contraindicated. In healthy middle-aged men, 20 mg Levitra potentiated the blood-pressure drop from 0.4 mg sublingual nitroglycerin at 1 and 4 hours, and heart-rate rises at 1, 4, and 8 hours. Those extra effects were not seen when 20 mg was taken 24 hours before the nitroglycerin. Potentiation in men with ischemic heart disease was not studied. The contraindication still stands. This leaf uses 24 hours as the practical interval from that healthy-volunteer design, not as permission to keep a spray 'for Sunday.'
Riociguat is contraindicated. Poppers count.
Alpha-blockers can share a peak. When vardenafil and terazosin were timed to hit Tmax together, standing hypotension was common enough that one study arm stopped early. Separating Tmax by 6 hours was quieter. Dizziness clustered on the simultaneous-peak days. Counseling is: stable alpha-blocker first, lowest effective vardenafil, and do not chase a 20 mg peak on top of a same-hour alpha dose without a plan.
Common reactions include headache, flushing, rhinitis, and dyspepsia. Sudden vision or hearing changes: stop. Erection past 4 hours: emergency care.
| Hold or pair | What the Levitra label actually measured |
|---|---|
| Nitroglycerin 0.4 mg SL | Extra BP drop at 1 and 4 h after vardenafil 20 mg |
| 24 h after 20 mg | Those extra NTG effects were not observed in healthy men |
| QT at 1 h (10 mg) | Fridericia QTc +8 msec vs placebo |
| QT at 1 h (80 mg) | Fridericia QTc +10 msec vs placebo |
| Terazosin + vardenafil | More standing hypotension when Tmax coincided |
03 Where a 20 mg ten-count is written
Written cash for vardenafil 20 mg × 10 is a GoodRx Levitra row dated 6 July 2026. Staxyn ODT is not that NDC and is not priced here.
Harris Teeter, Albertsons, Kroger, and Safeway are the official pharmacy links on this leaf. Virena does not dispense.
Generic vardenafil 20 mg x 10, GoodRx Levitra table, 06 July 2026.
Generic vardenafil 20 mg, ten tablets, the Virena Levitra ceiling lock, August 2026. GoodRx Levitra table lists 20 mg x 10 at $573.78 average retail and $44.21 with a coupon (06 July 2026). Staxyn ODT is not this tablet NDC. Virena does not dispense.
04 QT caution belongs before the 20 mg tablet
QT caution belongs before the 20 mg tablet, not as a footnote after flushing. A single-dose crossover in 59 healthy men (45-60 years) measured QT at 1 hour, near peak. Vardenafil 10 mg raised Fridericia QTc by 8 msec versus placebo (90% CI 6 to 9). An 80 mg dose (four times the highest recommended tablet) raised Fridericia QTc by 10 msec (8 to 11). Moxifloxacin 400 mg, the active control, raised it 8 msec. Heart rate rose about 5 to 6 beats per minute.
The insert tells patients with congenital QT prolongation, and patients on class IA or class III antiarrhythmics, to avoid Levitra. A postmarketing combination study showed an additive QT effect when vardenafil was paired with another QT-prolonging drug.
This is a screen, not a panic. Therapeutic 10 mg and the supratherapeutic 80 mg produced QTc shifts in the same small band as moxifloxacin in that design. The clinical rule is still avoidance in the named groups, not a home ECG app as a substitute for a history.
The longer QT walk-through is the Levitra 20 mg QT margin. Bring the antiarrhythmic list to the visit that first writes 20 mg.
05 Why 20 mg is a ceiling and not a first swallow
Raising to 20 mg is a labelled option after 10 mg was tried. It is not a shortcut because a friend 'needed the strong one.' Elderly men (≥65 years) had mean Cmax 34% higher and AUC 52% higher than men 18 to 45. The US label asks clinicians to consider a 5 mg start in that age band. Phase 3 still enrolled hundreds of older men; age is a start-low cue, not an automatic ban on later 20 mg.
Moderate hepatic impairment after 10 mg raised exposure enough that the dose should not exceed 10 mg. Severe hepatic impairment is outside routine use. Renal cuts exist on the insert for certain creatinine bands; the clinician reads the current row rather than a remembered blog number.
Potent CYP3A4 inhibitors rewrite 20 mg completely. Ketoconazole 400 mg daily with vardenafil points to a 2.5 mg single dose. Ritonavir with 5 mg vardenafil multiplied exposure so hard that the label's ceiling becomes a single 2.5 mg dose in a long interval (often 72 hours). Erythromycin 500 mg three times daily with 5 mg vardenafil: do not exceed a single 5 mg tablet in 24 hours. A 20 mg ceiling tablet in those combinations is the wrong object.
If 20 mg is written, keep the once-daily cap. A second 20 mg at 3 hours because the first peak 'missed' is not on the insert.
Levitra 20 mg fast-peak lock
06 Fasted Tmax versus a high-fat Cmax cut
Fasted Tmax is the fast-peak story. High-fat meals in two food-effect studies cut vardenafil Cmax by 18% to 50%. The label still allows Levitra with or without food. That is the same pattern as sildenafil's permission-plus-delay, with a wider Cmax haircut on some meals.
If the point of choosing 20 mg was a reliable hour, a heavy plate works against that point. Lighten the meal or take the tablet before the rich courses. Do not answer a blunted Cmax with a second 20 mg.
Volume of distribution is about 208 L. Protein binding is about 95% for parent and the M1 metabolite. M1 circulates at about 26% of parent and accounts for roughly 7% of pharmacologic activity. Terminal half-life for vardenafil and M1 is about 4 to 5 hours. Clearance is about 56 L/h. Metabolites leave mostly in feces (about 91% to 95%) and little in urine (about 2% to 6%).
That 4-5 hour half-life is closer to sildenafil than to tadalafil's 17.5 hours. Do not borrow Cialis's 36-hour weekend story for a Levitra 20 mg night.
| Absorption | Rapid. 20 mg fasted Tmax 30 minutes to 2 hours (median 60). High-fat Cmax cut 18-50%. Bioavailability ~15%. |
|---|---|
| Distribution | Vss about 208 L. ~95% protein bound. Tiny semen recovery (0.00018% of a 20 mg dose at 1.5 hours). |
| Metabolism | Mainly CYP3A4, with CYP3A5 and CYP2C. Active M1 from piperazine desethylation. |
| Excretion | T½ about 4-5 hours. Feces 91-95%, urine 2-6%. |
07 Counseling the 60-minute hour without a stopwatch fight
Counseling the 60-minute hour without a stopwatch fight means saying median, not magic. Fasted Tmax after 20 mg is 30 minutes to 2 hours. Couples who treat 60 minutes as a guarantee will call a 40-minute attempt a failed tablet and a 90-minute peak 'late.' Both can be inside the labelled range.
Stimulation is required on the insert. A quiet room and a phone will make any strength look slow. That sentence belongs next to the hour, not in a footnote.
High-fat Cmax cuts of 18% to 50% are why a restaurant 20 mg can feel weaker than a fasted 10 mg. Compare nights with the plate named, or the comparison is noise.
Headache, flushing, rhinitis, and dyspepsia show up often enough to mention in the same visit as the hour. They are not proof that 20 mg is working and not a reason to take a second tablet. Sudden vision or hearing change is a stop. An erection past 4 hours is emergency care.
If the household wanted Sunday leftover, say so before 20 mg is written. Half-life 4 to 5 hours will not reprint Cialis's 36-hour window. The two-evening 10 mg margin is that clock. If the household wanted 50-100 mg after a plate, stay on the sildenafil leaf.
Priapism risk rises with sickle-cell disease, myeloma, leukemia, or a penile deformity. Those facts belong in the first minute of the visit that first writes 10 mg, not after a 20 mg ceiling is already in the pocket. Adcirca or Revatio already on the list is a class-stack stop, not a reason to add a 'fast peak' 20 mg on Friday.
08 Film-coated 20 mg is not the orodispersible 10 mg
Film-coated 20 mg is swallowed with or without food. Staxyn ODT 10 mg dissolves on the tongue without liquid and should be taken without food or liquid in the mouth, immediately from the blister. Swapping those instructions is a product error, not a preference.
Generic vardenafil 20 mg tablets follow the film-coated clock on this leaf. If the box says orodispersible, stop using these paragraphs.
Do not combine Levitra with Cialis, Viagra, or a tadalafil-sildenafil export combo. One PDE5 pathway at a time. The binding sheet that sets Cialis against Viagra, and then parks 20 mg vardenafil as the third clock, is the how to take Cialis versus Viagra sheet.
Priapism risk rises if there is a sickle-cell, myeloma, or leukemia background, or a penile deformity. Those are visit facts, not footnotes you skip because 20 mg 'is only timing.'
09 Hepatic cuts and elderly starts before anyone chases 20 mg
Hepatic impairment after a 10 mg vardenafil dose already raises exposure. Moderate impairment is a 10 mg ceiling on the insert, not a 20 mg fast-peak night. Severe hepatic disease sits outside routine use. Do not treat 'I want the hour' as a reason to ignore that row.
Elderly men (≥65 years) showed mean Cmax 34% higher and AUC 52% higher than men 18 to 45. The US label asks clinicians to consider a 5 mg start. Phase 3 still enrolled hundreds of older men, so age is a start-low cue, not an automatic lifetime ban on later 20 mg after a fair 10 mg hour.
Renal rows exist on the current insert for certain creatinine bands. The clinician reads today's table. A remembered blog number is not a substitute. Hemodialysis timing does not turn 20 mg into a casual Saturday tablet.
Indinavir and ritonavir both multiply vardenafil. Ritonavir 600 mg twice daily with 5 mg Levitra produced exposure so high that the labelled answer is a single 2.5 mg dose in a long interval, often 72 hours. A 20 mg ceiling tablet does not belong in that sentence. Erythromycin 500 mg three times daily with 5 mg vardenafil: do not exceed a single 5 mg tablet in 24 hours.
Cimetidine 400 mg twice daily did not change vardenafil AUC or Cmax in the labelled pair. That negative finding is useful. It does not clear ketoconazole, itraconazole, or grapefruit as 'also fine.' Bring the antifungal name, not a guess.
10 Fast-peak notes to take into the visit
Say 20 mg only if 10 mg already had a fair hour. Say QT drugs in the first sentence. Say the last nitrate time in the second.
If you wanted a tablet that ignores dinner, 20 mg vardenafil is a weaker match than daily or PRN tadalafil. If you wanted 50-100 mg after a plate, stay with the sildenafil after-food leaf.
Do not raise yourself from 10 mg to 20 mg by email. Elise dated this vardenafil leaf on 21 August 2026. [email protected] is for page errors, not a peak request.
If the household wanted a tablet that ignores dinner and can still cover Sunday, this 20 mg hour is the wrong object. Half-life 4 to 5 hours will not reprint tadalafil's 36-hour window. If the household wanted 50-100 mg after a plate, the sildenafil after-food leaf is the tighter match. Bring QT drugs, nitrates, and the last 10 mg timing to the visit that would write 20 mg. France emergencies stay 15 or 112. Write those 10 mg minutes on the same slip as the QT list. Do not borrow a 20 mg tablet from a previous bottle the week an azole starts.
A labelled cimetidine pair left vardenafil AUC and Cmax unchanged. That negative finding is useful next to ketoconazole and ritonavir, which do change the milligram. Name the antifungal. Do not assume every stomach tablet is cimetidine.
| INN | vardenafil |
|---|---|
| Brand on this leaf | Levitra (film-coated) |
| US tablet strengths | 2.5, 5, 10, 20 mg |
| Virena SERP lock | 20 mg fast peak |
| Mean t½ | About 4-5 hours |
| Nitrate practical hold | 24 hours in the healthy 20 mg + NTG study |