Getting the 20 mg tablet online
A legal purchase is the prescription, then a pharmacy that is allowed to dispense it. That pharmacy can be one you already use, a mail-order pharmacy, or the pharmacy attached to a telehealth visit. The tablet is the same medicine. What changes online is who receives the prescription and how the bottle reaches you.
A site that skips the prescription
Vardenafil is not an over-the-counter tablet. A page that will ship the 20 mg tablet without a prescription is not a licensed fill. Leave that page. The legal path is a prescription written after someone has evaluated you, then dispensed by a pharmacy that can show it is licensed to do that.
How to check the pharmacy
Confirm the pharmacy before you pay. The FDA program BeSafeRx describes how to check an online pharmacy. The National Association of Boards of Pharmacy keeps a list of pharmacies that have passed its accreditation, and some of those pharmacies use a.pharmacy web address. The board of pharmacy in your state can confirm that a pharmacy holds a license there. If the site will not name the pharmacy, the pharmacist, or the state license, stop and do not send payment.
A licensed clinician can prescribe this tablet after evaluating you, and that visit can happen online where your state's rules and the clinician's judgment allow it. The visit is an evaluation. It is not an automatic approval. The clinician needs your current medicines, your heart history, and whether you use nitrates. A service that will sell the tablet without that evaluation is the no-prescription path, and it is not a legal fill.
Moving a prescription you already have
A pharmacy can ask the pharmacy that holds your prescription to transfer it. You give the new pharmacy the medicine name, your details, and the name of the pharmacy that has the prescription now. The prescription number makes the request easier to match. Refills move with the transfer only when the prescription still has refills left. The two pharmacies complete the transfer. You do not have to use any one website's checkout to ask for it.
Delivery to your home
Many pharmacies ship to a home address, and some local pharmacies deliver. The pharmacy that fills the prescription is the one that can say whether your address is eligible and what the window is. There is no single delivery time that every pharmacy offers. The bottle still comes from the pharmacy that dispensed it.
What the 20 mg tablet costs
No single cash price belongs to this tablet. The amount changes with the pharmacy, the number of tablets, and whether the bottle is the generic or the brand Levitra. The figure that matters is the one that pharmacy shows for your quantity before you pay. Insurance is a second price. The plan's formulary decides whether vardenafil is covered, and many plans treat erectile-dysfunction medicines differently from other prescriptions. A coupon or a membership discount on one website is that website's offer. It is not the price of the medicine. Levitra is the brand name. The 20 mg tablet ordered online is usually the generic, which contains the same active ingredient. Whether a pharmacy can still dispense the brand box is a stock question for that pharmacy. Ask before you pay if the brand itself is what you need.
How blood flow to the penis increases
An erection depends on blood reaching the penis. Vardenafil blocks an enzyme called phosphodiesterase type 5, or PDE5. Blocking that enzyme helps raise cyclic guanosine monophosphate, or cGMP. Higher cGMP relaxes the blood vessels in the penis, and once those vessels relax, more blood can flow in. The extra flow helps a man attain an erection when he is sexually stimulated. During sexual activity, it helps him achieve an erection and maintain it. Without sexual stimulation, the rise in cGMP and the extra blood do not themselves produce the erection.
Taking a dose before sexual activity
Swallow the tablet by mouth with water. The amount, and when a dose is taken, follows the prescription label and the healthcare provider's instructions. Those directions stay in place even when the usual timing is already familiar. When a dose is required, it is usually taken about 1 hour, about 60 minutes, before sexual activity. Take no more than one dose in a day, and no more than one tablet that day. Daily use is typically not recommended. The tablet is for the occasion when it is required, not a dose on ordinary days in a row. A relaxed and comfortable environment can help the effects. A different form may change what this medication treats, so this hour-before timing and this once-a-day limit belong to this tablet and should not be copied onto that other form.
You can take this tablet with food or without it. A heavy, high-fat meal can delay the start, so the effect may arrive later than the usual hour. If the tablet upsets your stomach, taking it with food is a reasonable adjustment. The prescriber's instructions still set the dose.
Grapefruit and alcohol
Grapefruit and grapefruit juice may raise the chance of side effects with this dose. Ask the pharmacist or the prescriber before you combine them, rather than treating a general warning as a personal yes or no. Alcohol can add dizziness, a further drop in blood pressure, and more difficulty getting an erection. If you drink, keep the amount small and notice those effects before you take another dose.
When the effect starts
After the tablet is swallowed, it typically starts working within 60 minutes. Count that time from ingestion, the moment the tablet goes down. That first hour is when to notice the effect beginning. How long the effect then lasts can vary for every person. One person's length is not a guide to the next person's, so there is no single span that fits everyone.
Effects to report soon
Tell the care team as soon as possible if any of these appear. An allergic reaction can show up as a skin rash, itching, or hives, or as swelling of the face, lips, tongue, or throat. Hearing loss and ringing in the ears are reported on that same short timeline. Heart attack signs include pain or tightness in the chest, shoulders, arms, or jaw, along with nausea, shortness of breath, cold or clammy skin, and feeling faint or lightheaded. Heart rhythm changes can look like a fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, or trouble breathing. Low blood pressure can appear as dizziness, feeling faint or lightheaded, or blurry vision. A prolonged or painful erection is reported as soon as possible as well. Stroke signs can be sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, a severe headache, or a change in vision. Sudden vision loss in one or both eyes goes to the care team the same way, as soon as it happens.
Flushing, headache, and nasal symptoms
Flushing, headache, dizziness, and a stuffy or runny nose can occur with this tablet. One of them may show up after a dose, or more than one. A doctor or the care team should hear about them when they persist, when they worsen, or when they are bothersome. Say which effect is lasting, which is getting stronger, and which is hard to live with, so the person hearing it knows what changed.
Overdose risks
An overdose of vardenafil can make severe side effects more likely. The set tied to that extra amount is a severe headache, dizziness, fainting, a prolonged erection known as priapism, and potential cardiovascular issues. Cardiovascular issues are problems that involve the heart and the blood vessels. In this cluster, priapism is the prolonged erection. The condition is more of the medicine than was directed, and the consequence is a higher chance of that severe set. If you took more than directed, contact Poison Control in the United States at 1-800-222-1222. Call 911 if there is chest pain, fainting, trouble breathing, or an erection that is painful and will not go down.
Medicines to keep apart
Some medicines must not be taken with this tablet. Match the names against anything already in use. If one of them is current, the tablet is not added beside it. Do not take this medication with bepridil, cisapride, droperidol, grepafloxacin, methscopolamine nitrate, nitroprusside, pimozide, riociguat, or thioridazine. Do not take it with medicines for fungal infections, including fluconazole, itraconazole, ketoconazole, posaconazole, and voriconazole. Do not take it with medicines for an irregular heartbeat, such as dronedarone. Other medicines for erectile dysfunction sit on the same do-not-take list, including avanafil, sildenafil, and tadalafil. Nitrates carry a blood-pressure consequence on top of that separation. Do not take this tablet with nitrates such as amyl nitrite, isosorbide dinitrate, isosorbide mononitrate, or nitroglycerin. Combining these medicines can lead to a sudden and serious drop in blood pressure. When a nitrate is already in use, this tablet stays out of the combination.
Medicines that may interact
This medication may also interact with antiviral medicines for HIV or AIDS, with certain antibiotics such as erythromycin and clarithromycin, and with medicines for prostate problems. It may interact with other medicines that cause heart-rhythm changes, such as dofetilide and ziprasidone. Certain medicines for high blood pressure may interact as well.
Tell the healthcare provider if you take those blood-pressure medicines, alpha-blockers, or other erectile-dysfunction medicines. The provider can help determine whether vardenafil is safe based on medical history and current medications. Have that talk before starting.
Vardenafil can change the heart's QT interval, the timing of the electrical reset between beats. That is why medicines for an irregular heartbeat stay on the do-not-take list. If you already have a long QT interval, or you take a medicine known to lengthen it, the prescriber needs that fact before this tablet is started. Do not add the tablet beside those medicines to see what happens.
Blood pressure while taking it
Vardenafil can cause a small decrease in blood pressure. For most people, that effect is mild and temporary. That is the usual scale of the change when the tablet is used on its own. The effect can become dangerous if this medication is taken with certain drugs that also lower blood pressure. The added drug is the condition that changes a mild, temporary dip into one that can be dangerous. Heart disease does not have a yes-or-no answer you can apply from the bottle alone. The prescriber evaluates chest pain, a recent heart attack or stroke, and medicines that lower blood pressure, especially nitrates, before this tablet is appropriate. Chest pain during sex is a reason to stop and get emergency help, not a reason to take another dose.
Who needs a different plan
The usual plan for this tablet leaves out four groups: liver disease, kidney impairment, women (including pregnancy and breastfeeding), and children. A person in one of those groups needs the instruction written for that group.
In liver disease, the doctor might monitor liver function and then suggest a lower or adjusted dose. Monitoring means checking how the liver is working, and that check comes before the suggestion. A lower dose or an adjusted dose is what may follow from the check. Change the amount if the doctor suggests it after liver function has been looked at.
People with kidney problems may not be able to metabolize this medication safely or eliminate it safely. Metabolize means break it down in the body. Eliminate means clear it out. When either step is not safe, side effects or complications can follow. A problem with the breakdown or with the clearing is enough to open that risk.
Women, pregnancy, and breastfeeding
Levitra is not recommended for women. There is limited data on its safety during pregnancy and limited data on its safety during breastfeeding. Those gaps leave no clear safety picture for either state. During pregnancy, avoid using medications that a healthcare provider has not prescribed. Starting a medicine without that prescription, this tablet included, is the use that warning is there to prevent.
Talk to the care team about the use of this medication in children, and have that talk before the tablet is given to a child. Special care may be needed. The care team is the group that can say what that care involves for the child in question.
Why size, color, or shape can differ
Generic medications may be manufactured by different companies. Some of those generics vary in size, color, and shape. A tablet from one maker can look unlike a tablet from another and still contain the same active ingredients, because the active ingredients are always the same. A new size, color, or shape can be read as a difference in who made the tablet, while the ingredient that acts stays the same. Bayer HealthCare Pharmaceuticals manufactures Levitra, and the brand tablet contains vardenafil hydrochloride. The imprint on the tablet and the name on the pharmacy label are how you confirm what you were given. If the imprint, the strength, or the name does not match that label, ask the pharmacist before you take it. Do not match the tablet against a picture from a different maker.
Effect compared with Viagra
Levitra (vardenafil) and Viagra (sildenafil) are similarly effective treatments for erectile dysfunction. The points compared are effectiveness, onset, and how long the effect lasts. Effectiveness is how well the treatment works, onset is when the effect starts, and duration is how long it lasts. Individual response can vary across those points. One person may not match another on the effect, the start, or the length. A result in one person does not predict the result in the next.