Extra Super Avana is a prescription-only oral pill that combines two active ingredients: Avanafil and Dapoxetine. The single tablet is marketed in a fixed strength of 200 mg Avanafil / 60 mg Dapoxetine.
Because the combination is not listed as a distinct approved product, clinicians must evaluate the two components individually and decide whether the fixed-dose tablet is appropriate for a given patient.
Avanafil belongs to the phosphodiesterase-type 5 (PDE5) inhibitor family. By blocking the PDE5 enzyme in penile smooth muscle, it prevents the breakdown of cyclic guanosine monophosphate (cGMP). Elevated cGMP leads to smooth-muscle relaxation, increased arterial inflow, and erection in response to sexual stimulation. Avanafil has a rapid onset of action (as early as 15 minutes) and a relatively short duration compared with some older PDE5 inhibitors.
Dapoxetine is a selective serotonin reuptake inhibitor (SSRI) formulated for on-demand use. It modestly increases serotonin levels in the central nervous system, which enhances the ejaculatory latency time. Because dapoxetine is rapidly cleared (half-life ≈ 1.5 hours), it is taken only a short time before anticipated sexual activity, minimizing systemic exposure.
When taken together, the tablet aims to address two separate aspects of male sexual function:
The pharmacologic actions are independent; no known synergistic effect exists beyond the convenience of a single tablet.
Because the combined formulation does not have a distinct marketing authorization, its use relies on the individual approvals of avanafil and dapoxetine. Clinicians may prescribe the combination off-label when both conditions coexist, provided that all safety criteria for each component are satisfied.
At present, no peer-reviewed clinical trials or practice guidelines endorse the use of a combined avanafil/dapoxetine tablet for any indication beyond the separate treatment of ED and PE. Consequently, the fixed-dose product is considered off-label for simultaneous management of both conditions.
Off-label use requires individualized risk assessment and close monitoring by a qualified healthcare professional.
(Reported in ≥ 1 % of users of either component)
These effects are usually mild, transient, and resolve without intervention. If they persist or worsen, patients should contact their prescriber.
Any of these symptoms warrants immediate medical attention.
| Interaction Type | Affected Component | Example Interacting Drugs | Clinical Impact | ||-||--| | CYP3A4 inhibitors | Avanafil | Ketoconazole, itraconazole, clarithromycin | Increases avanafil plasma concentration → higher risk of hypotension and priapism. | | Nitrates | Avanafil | Nitroglycerin, isosorbide dinitrate | Potent vasodilation → severe hypotension, syncope. | | CYP2D6 / CYP3A4 inhibitors | Dapoxetine | Fluoxetine, paroxetine, quinidine, erythromycin | Raises dapoxetine levels → heightened serotonergic toxicity. | | Serotonergic agents | Dapoxetine | Other SSRIs, SNRIs, tramadol, linezolid, St. John’s wort | Increases risk of serotonin syndrome. | | Alpha-blockers | Avanafil | Doxazosin, tamsulosin | Additive blood-pressure lowering effect. |
Patients should provide a complete medication list-including over-the-counter products and herbal supplements-before initiating therapy.
Important: Do not exceed one tablet in a 24-hour period. Combining with additional doses of either component can increase the risk of adverse events.
If a sexual encounter is not anticipated within the next 24 hours, do not take a make-up dose. Take the next tablet only when planning sexual activity again.
No tapering is required when stopping avanafil. Dapoxetine, being a short-acting SSRI, also does not require gradual withdrawal, but patients may notice a return of premature ejaculation symptoms promptly.
For patients with known cardiovascular disease, periodic cardiology review may be warranted.
This article provides educational information about Extra Super Avana and is not a substitute for professional medical advice. Treatment decisions, including the use of unapproved combinations, must be made under the guidance of a qualified healthcare provider. The content is intended for informational purposes only and does not constitute medical recommendations. Always consult a physician before starting, stopping, or changing any medication regimen.
No. The avanafil component interacts dangerously with nitrates, potentially causing severe hypotension. Patients using any nitrate (e.g., nitroglycerin) should avoid this combination.
Avanafil begins working within 15-30 minutes, while dapoxetine should be taken 1-3 hours beforehand with a light meal. Align the timing so that both agents are active during sexual activity.
Mild, well-controlled hypertension (e.g., < 150/90 mmHg) may be acceptable, but blood pressure should be measured before each dose. Uncontrolled hypertension is a contraindication.
A high-fat meal can delay avanafil absorption, potentially postponing the onset of action. Dapoxetine absorption is improved with food, so a light meal is recommended rather than a heavy, fatty one.
No. Both avanafil and dapoxetine are prescription-only medicines in Hong Kong. Obtaining them without a valid prescription violates local drug regulations.
Seek emergency medical care immediately. Prolonged erections (priapism) can cause permanent tissue damage if not treated promptly.
St John’s wort, an herbal product with serotonergic activity, can increase the risk of serotonin syndrome when combined with dapoxetine. Always disclose supplement use to your prescriber.
Both components can cause dizziness or visual disturbances in some individuals. Assess your own response before driving, especially after the first few doses.
Coverage depends on the individual drug’s inclusion in the Hospital Authority formulary. Since the fixed-dose combination lacks a specific listing, reimbursement is unlikely unless prescribed as separate, individually listed products.
