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Alert for Healthcare
Professionals
Vardenafil (marketed as Levitra)
FDA ALERT [7/2005]: FDA has approved new
labeling for Levitra, Viagra, and Cialis regarding postmarketing
reports of vision loss related to NAION (non-arteritic anterior
ischemic optic neuropathy). Most, but not all, of these patients had
underlying anatomic or vascular risk factors for development of
NAION, including: low cup to disc ratio (“crowded disc”), age over
50, diabetes, hypertension, coronary artery disease, hyperlipidemia
and smoking. Given the small number of events, the large number of
users of PDE-5 inhibitors and the fact that this event occurs in a
similar population to those who do not take these medicines, it is
not possible to determine whether these events are related directly
to the use of PDE-5 inhibitors, to the patient’s underlying vascular
risk factors or anatomical defects, to a combination of these
factors, or other factors. We cannot currently draw a conclusion of
cause and effect. FDA will continue to evaluate the issue.
This information reflects FDA’s current
analysis of data available to FDA concerning this drug. FDA intends
to update this sheet when additional information or analyses become
available.
To report any unexpected adverse or serious
events associated with the use of Levitra, please contact the FDA
MedWatch program at 1-800-FDA-1088 or
http://www.fda.gov/medwatch/report/hcp.htm
Recommendations
Physicians should:
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advise patients to stop use of all PDE-5 inhibitors
and seek medical attention in the event of a sudden loss of vision
in one or both eyes. Such an event may be a sign of non-arteritic
anterior ischemic optic neuropathy (NAION), a cause of decreased
vision, which can result in permanent loss of vision.
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discuss with patients the increased risk of NAION in
individuals who have already experienced NAION in one eye, including
whether such individuals could be adversely affected by use of
vasodilators such as PDE-5 inhibitors.
Data Summary
As of May 18, 2005, a total of 43 cases of ischemic
optic neuropathy (ION) among patients using the marketed PDE-5
inhibitors (sildenafil, tadalafil, vardenafil) have been reported to
the FDA’s Adverse Event Reporting System. Since approval, 38 cases
have been identified in association with sildenafil, 4 cases have
been identified in association with tadalafil and one case has been
identified in association with vardenafil. Most of these cases
(25/43) appear to be the non-arteritic anterior ischemic optic
neuropathy (NAION) subtype. Thirty-six of the 43 cases reported
accompanying visual loss, and 26 of these 36 cases reported the
visual loss as continuing or permanent. Most of the patients in
these cases reported vascular risk factors for NAION that overlap
with vascular risk factors for erectile dysfunction (such as age
over 50, low cup to disc ratio, hypertension, diabetes, smoking,
etc), making direct attribution to PDE-5 inhibitors not possible.
However, the clinical attributes of some of the cases (e.g., a
temporal relationship in 19 sildenafil cases, 4 tadalafil cases, and
the one vardenafil case, and the report of recurrent ocular symptoms
that might reflect NAION in five sildenafil cases and one tadalafil
case), raise concern in regard to the role of PDE-5 inhibitors.
One case associated with vardenafil use was reported to FDA in 2004.
A male patient in his mid-50s with no documented hypertension,
diabetes and hyperlipidemia took 10mg vardenafil for the first time
and experienced vision loss in his left eye the next morning. The
patient lost central vision in his left eye, reportedly due to
transient ischemia. It is unknown if the vision loss reversed or
persisted.
FDA is aware of 6 additional cases of vision loss following
vardenafil administration, reported as serious adverse events in the
Bayer Global Drug Safety Database.
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Date created: July 8, 2005, updated November 14, 2007 |
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