Extra Super Avana

Two jobs in one tablet

Each half of this tablet has its own job. Avanafil, at 200mg, handles the erection: it is a PDE5 inhibitor, like sildenafil and tadalafil, and lets the blood vessels of the penis widen when you are aroused. Dapoxetine, at 60mg, handles timing: as a serotonin reuptake inhibitor it slows the ejaculation reflex, so sex can last longer. Arousal still has to be there for the tablet to do anything.

Taking it for an evening

One tablet, swallowed whole with water, an hour or two before sex. The gap is there because the two medicines run on different clocks: avanafil starts within about 15 minutes, dapoxetine builds over one to three hours. Heavy, fatty food slows avanafil. Do not take a second tablet for 24 hours. Keep the blisters dry.

What you may notice

Avanafil mostly causes headache, flushing and a blocked nose, with the odd spell of dizziness. Dapoxetine adds nausea, loose stools, poor sleep and more headaches. Standing up quickly can leave you light-headed on either ingredient.

Two problems call for emergency care. One is priapism, an erection still rigid four hours later. The other is sight that vanishes suddenly, in one eye or both. Neither is common.

Extra Super Avana or Super Avana?

The two drugs are the same; only the avanafil amount changes. Super Avana pairs avanafil 100mg with dapoxetine 60mg, while this tablet doubles the avanafil to 200mg. Both are used when needed rather than on a fixed daily schedule.

Medicines to avoid combining

Nitrates for angina, riociguat and the poppers sold as amyl or butyl nitrite can make blood pressure fall steeply when taken with avanafil. Ketoconazole and similar antifungals, along with some antibiotics, slow the breakdown of avanafil, which strengthens its side effects. Dapoxetine must never be combined with an MAOI antidepressant, and St John's wort alongside it can bring on serotonin syndrome: shivering, agitation, fever and stiff, jerking muscles.