Avanafil

FDA label

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Renal No adjustment for mild/moderate (CrCl ≥30); do not use in severe renal impairment or on dialysis

Hepatic No adjustment for mild/moderate (Child-Pugh A/B); do not use in severe hepatic impairment

Maximum dosing frequency once per day

Instructions

• Take as needed ~15–30 min before sexual activity; sexual stimulation required
• Maximum once per day; use the lowest effective dose
• With or without food
• Do not use with strong CYP3A4 inhibitors; limit to 50 mg/24h with moderate CYP3A4 inhibitors
• Start at 50 mg in patients on stable alpha-blocker therapy
• If nitrate is medically necessary, wait ≥12 hours after last dose

Contraindications

• Any form of organic nitrate (potentiates hypotension)
• Guanylate cyclase stimulators (e.g., riociguat, vericiguat)

Cautions

• Cardiovascular risk during sexual activity — avoid if sexual activity inadvisable
• Hypotension with alpha-blockers, other antihypertensives, or substantial alcohol
• Prolonged erection/priapism — seek care if erection >4 hours
• Non-arteritic anterior ischemic optic neuropathy (sudden vision loss)
• Sudden decrease or loss of hearing
• Caution in bleeding disorders/active peptic ulcer
• Offers no protection against sexually transmitted diseases

Adverse reactions

• Headache
• Flushing
• Nasal congestion
• Nasopharyngitis
• Back pain

Pregnancy Not indicated for use in females

Lactation Not indicated for use in females