avanafil, Stendra (cont.)

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Avanafil exaggerates the increases in heart rate and lowering of blood pressure caused by nitrates, for example, nitroglycerin, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), and nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating heart pain (angina). In patients who take nitrates for angina, avanafil could cause heart pain or possibly even a heart attack by exaggerating the increase in heart rate and the lowering of blood pressure. Therefore, avanafil should not be used with nitrates. If nitrates must be administered to a patient who has taken avanafil, at least 12 hours should elapse after the last dose of avanafil before administering the nitrates. Avanafil also exaggerates the blood pressure lowering effects of some alpha-blocking drugs for example, terazosin (Hytrin) that primarily are used for treating high blood pressure or enlargement of the prostate. Individuals who take these alpha-blockers should be on a stable dose of the alpha-blocker before avanafil is started. In such situations, avanafil should be started at the 50 mg dose. If the patient is already taking avanafil, the alpha-blocker should be started at the lowest dose.

Avanafil and alcohol both lower blood pressure. Therefore, combining avanafil with alcohol may cause excessive drops in blood pressure and cause dizziness, headaches, and increased heart rate.

Avanafil should not be combined with other PDE5 inhibitors used for treating impotence, for example, vardenafil (Levitra) or sildenafil (Viagra, Revatio).

PREGNANCY: Avanafil is not approved for use in women.

NURSING MOTHERS: Avanafil is not approved for women and has not been evaluated in women who are breastfeeding.



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