Formulary
Avanafil: Indications, Dosing, Side Effects and Interactions
Avanafil clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Avanafil: Indications, Dosing, Side Effects and Interactions
Avanafil clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Erectile dysfunction**
- **Adult** (By Mouth): Initially 100 mg, to be taken approximately 15-30 minutes before sexual activity, then adjusted according to response to 50-200 mg (max. per dose 200 mg), to be taken as a single dose as needed; maximum 1 dose per day.
**Erectile dysfunction in patients on alpha-blocker therapy**
- **Adult** (By Mouth): Initially 50 mg, to be taken approximately 15-30 minutes before sexual activity, then adjusted according to response to 50-200 mg (max. per dose 200 mg), to be taken as a single dose as needed; maximum 1 dose per day.
Cautions
Active peptic ulceration; anatomical deformation of the penis (e.g. angulation, cavernosal fibrosis, Peyronie's disease); bleeding disorders; cardiovascular disease; left ventricular outflow obstruction; predisposition to priapism (e.g. in sickle-cell disease, multiple myeloma, or leukaemia) Cautions, further information Elderly For phosphodiesterase type-5 inhibitors, Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate in severe heart failure characterised by hypotension i.e. systolic blood pressure less than 90 mmHg, or concurrent nitrate therapy for angina (risk of cardiovascular collapse).
Contraindications
Avoid if systolic blood pressure below 90 mmHg (no information available); blood pressure >170/100 mmHg; hereditary degenerative retinal disorders; history of non-arteritic anterior ischaemic optic neuropathy; life-threatening arrhythmia in previous 6 months; mild to severe heart failure; patients in whom vasodilation or sexual activity are inadvisable; recent history of myocardial infarction; recent history of stroke; recent unstable angina
Side effects
Common or very common Headaches; nasal complaints; vasodilation Uncommon Asthenia; dizziness; drowsiness; dyspnoea exertional; gastrointestinal discomfort; muscle complaints; nausea; pain; palpitations; respiratory disorders; vision blurred; vomiting Rare or very rare Akathisia; angina pectoris; chest pain; diarrhoea; dry mouth; emotional disorder; gastritis; genital pruritus; gout; haematuria; hypertension; increased risk of infection; influenza like illness; insomnia; penis disorder; peripheral oedema; rash; seasonal allergy; sexual dysfunction; tachycardia; urinary frequency increased; weight increased
Interactions
**Severe interactions:**
- In a patient who has taken avanafil within 12 hours, where nitrate administration is deemed medically necessary in a life-threatening situation, the likelihood of a significant and potentially...
- Patients with left ventricular outflow obstruction (e.g.
- There was a statistically significant difference in maximum decrease from baseline in supine diastolic blood pressure with enalapril and avanafil only, which returned to baseline 4 hours after the...
- In a single-dose three-way crossover design study evaluating healthy subjects, the mean maximum reduction in diastolic blood pressure was significantly greater following avanafil administered in...
- Based on these data avanafil is not anticipated to have a significant effect on other medicinal products metabolised by these enzymes.
**Other interactions (37):**
- Potential for pharmacodynamic interactions with avanafil Nitrates Avanafil was shown to augment the hypotensive effects of nitrates compared to placebo in healthy subjects.
- This is thought to result from the combined effects of nitrates and avanafil on the nitric oxide/cGMP pathway.
- Medicinal products reducing systemic blood pressure As a vasodilator, avanafil may reduce systemic blood pressure.
- One episode of "syncope" was observed in placebo and one episode on 100 mg of avanafil in phase III clinical trials.
- Alpha-blockers Haemodynamic interactions with doxazosin and tamsulosin were studied in healthy subjects in a two-period crossover-design trial.
- In patients receiving stable doxazosin treatment, the placebo-subtracted mean maximum decreases in standing and supine systolic blood pressure following avanafil dosing were 2.5 mmHg and 6.0 mmHg,...
Hepatic impairment
Manufacturer advises avoid in severe impairment. Dose adjustments Manufacturer advises use lowest effective initial dose in mild to moderate impairment and adjust according to tolerance.
Renal impairment
Avoid if creatinine clearance less than 30 mL/minute. M See Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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