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study this dose produced an AUC value for unbound vardenafil 200 fold greater than AUC in humans at the MRHD of 20 mg There was no effect on sperm motility or morphology after single 20 mg oral doses of vardenafil in healthy volunteers Pregnancy Nursing Mothers and Pediatric Use Levitra is not indicated for use in women newborns or children Vardenafil was secreted into the milk of lactating rats at concentrations approximately 10-fold greater than found in the plasma Following a single oral dose of 3 mg kg of the administered dose was excreted into the milk within 24 hours It is not known if vardenafil is excreted in human breast milk Pregnancy Category B No evidence of specific potential for teratogenicity embryotoxicity or fetotoxicity was observed in rats and rabbits that received vardenafil at up to 18 mg kg day during organogenesis This dose is approximately 100 fold rat and 29 fold rabbit greater than the AUC values for unbound vardenafil and its major metabolite in humans given the MRHD of 20 mg In the rat pre-and postnatal development study the NOAEL no observed adverse effect level for maternal toxicity was 8 mg kg day Retarded physical development of pups in the absence of maternal effects was observed following maternal exposure to 1 and 8 mg kg possibly due to vasodilatation and or secretion of the drug into milk The number of living pups born to rats exposed pre- and postnatally was reduced at 60 mg kg day Based on the results of the pre- and postnatal study the developmental NOAEL is less than 1 mg kg day Based on plasma exposures in the rat developmental toxicity study 1 mg kg day in the pregnant rat is estimated to produce total AUC values for unbound vardenafil and its major metabolite comparable to the human AUC at the MRHD of 20 mg There are no adequate and well-controlled trials of vardenafil in pregnant women Geriatric Use Elderly males age 65 years and older have higher vardenafil plasma concentrations than younger males years mean Cmax and AUC were 34 and 52 higher respectively see CLINICAL PHARMACOLOGY Pharmacokinetics in Special Populations and DOSAGE AND ADMINISTRATION Phase 3 clinical trials included more than 834 elderly patients and no differences in safety or effectiveness of Levitra or 20 mg were noted when these elderly patients were compared to younger patients However due to increased vardenafil concentrations in the elderly a starting dose of 5 mg Levitra should be considered in patients 65 years of age Adverse Reactions Levitra was administered to over 4430 men mean age 56 range 18-89 years 81 White 6 Black 2 Asian 2 Hispanic and 9 Other during controlled and uncontrolled clinical trials worldwide Over 2200 patients were treated for 6 months or longer and 880 patients were treated for at least 1 year In placebo-controlled clinical trials the discontinuation rate due to adverse events was for Levitra compared to for placebo When Levitra was taken as recommended in placebo-controlled clinical trials the following adverse events were reported see Table 5 Table 5 Adverse Events Reported By 2 of Patients Treated with Levitra and More Frequent on Drug than Placebo in Fixed and Flexible Dose Randomized Controlled Trials of 5 mg 10 mg or 20 mg Vardenafil Adverse Event Percentage of Patients Reporting Event Placebo N 1199 Levitra N 2203 Flexible dose studies started all patients at Levitra 10 mg and allowed decrease in dose to 5 mg or increase in dose to 20 mg based on side effects and efficacy All the events listed in the above table were deemed to be adverse drug reactions with the exception of accidental injury Headache Flushing

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