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Vardenafil, the active ingredient in Zhewitra 20 mg, works by inhibiting the action of phosphodiesterase type 5 (PDE5), an enzyme that regulates blood flow in the penis. Under normal conditions, sexual stimulation leads to the release of nitric oxide, which increases cGMP levels and causes blood vessels to dilate. PDE5 breaks down cGMP, limiting blood flow. By blocking PDE5, Vardenafil helps maintain higher cGMP levels, ensuring improved blood flow and an erection.