MACROLIDES AND PHOSPHODIESTERASE TYPE-5 INHIBITORS - SILDENAFIL OR VARDENAFIL

Erythromycin and clarithromycin increase the AUC of sildenafil by 2- to 3-fold. It seems likely that telithromycin will interact similarly. Erythromycin increases the AUC of vardenafil 4-fold; it seems likely that clarithromycin and telithromycin will interact similarly.
Dosing guidance is given as follows: Sildenafil for erectile dysfunction - consider a starting dose of 25 mg. Sildenafil for pulmonary hypertension - with erythromycin 20 mg twice daily erythromycin (UK advice. US states no dose reduction necessary). Recommended dose with clarithromycin or telithromycin 20 mg once daily. However, note that erythromycin had a greater effect than clarithromycin in the studies. Vardenafil - the dose of vardenafil should not exceed 5 mg in 24 hours with erythromycin (UK and US). The dose of vardenafil should not exceed 2.5 mg in 24 hours with clarithromycin (US).
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