Avaforce D (Avanafil/Dapoxetine)

This is a fixed-dose combination of two separate medicines.

The combination is not approved by the FDA, EMA, or MHRA.

Dapoxetine has never received FDA approval in the United States.

Dapoxetine is approved in many other countries for premature ejaculation.

The recommended dapoxetine starting dose is 30 mg, not 60 mg.

This product delivers 60 mg from the first tablet.

60 mg should follow a trial of 30 mg in most men.

Both drugs lower blood pressure. Fainting risk is combined.

Dapoxetine is an SSRI with mental health contraindications.

Those contraindications are listed in section 5a. Read them fully.

Use this product only if a doctor prescribes this exact combination.

Avaforce D is a combination tablet with two active ingredients.

It contains avanafil, a PDE-5 inhibitor for erectile dysfunction.

It also contains dapoxetine, a short-acting SSRI for premature ejaculation.

It is intended for men who have both conditions together.

Avanafil helps achieve and maintain a firm erection.

Dapoxetine helps delay ejaculation during intercourse.

Avanafil is a newer, highly selective PDE-5 inhibitor.

It acts faster than older drugs in its class.

Dapoxetine is designed for on-demand use, not daily dosing.

It leaves the body quickly compared with regular antidepressants.

The tablet is swallowed whole with water.

It is taken only when needed, before sexual activity.

Avanafil works only during sexual stimulation.

It does not increase sexual desire or libido.

The product offers no protection against HIV or other STIs.

Avaforce D is intended for adult men aged 18 to 64.

Women and anyone under 18 must not use it.

Sexual stimulation triggers nitric oxide release in penile tissue.

Nitric oxide activates an enzyme called guanylate cyclase.

This enzyme raises cyclic guanosine monophosphate (cGMP) levels.

cGMP relaxes smooth muscle in the corpus cavernosum.

Relaxed muscle lets penile arteries widen and fill with blood.

Expanding tissue compresses the veins, trapping blood inside.

An enzyme called PDE-5 normally breaks cGMP down.

Avanafil blocks PDE-5, so cGMP stays elevated longer.

Blood flow is therefore maintained during sexual activity.

It targets PDE-5 far more precisely than older drugs. It affects PDE-6 in the eye much less. Visual side effects are therefore less common.

Ejaculation is controlled by a spinal reflex.

Serotonin signalling in the brain and spinal cord regulates this reflex.

Nerve cells release serotonin, then reabsorb it quickly.

Dapoxetine blocks the serotonin transporter that reabsorbs it.

Serotonin therefore stays active in the synapse longer.

Increased serotonin signalling raises the ejaculatory threshold.

This delays the ejaculation reflex during intercourse.

Dapoxetine is absorbed and cleared rapidly.

This makes it suitable for on-demand use only.

Avanafil works best 15 to 30 minutes before sex. Dapoxetine works best 1 to 3 hours before sex. A single tablet cannot optimise both. Taking it about 1 hour beforehand is the usual compromise.

Drink a full glass of water with the tablet. This reduces fainting risk from dapoxetine.

Not applicable. This medicine is used only as needed.

Your doctor should reassess after about 4 weeks or 6 doses.

Take the tablet exactly as your doctor prescribed.

Swallow the tablet whole with a full glass of water.

Do not chew, crush, or split the tablet.

Take it approximately 1 hour before planned sexual activity.

Stay well hydrated before and after the dose.

It may be taken with or without food.

Avoid heavy or high-fat meals for faster onset.

Avoid alcohol completely on dosing days.

Sexual stimulation is required for the erection effect.

Take no more than one tablet in 24 hours.

Do not combine it with any other ED or PE medicine.

Sit or lie down immediately if you feel faint.

Avoid situations where fainting could cause injury.

Do not drive or operate machinery after dosing.

Do not share your tablets with anyone else.

Attend your doctor’s review appointment as arranged.

Take any nitrate medicine in any form.

Nitrates include glyceryl trinitrate and isosorbide mononitrate or dinitrate.

This covers nitrate sprays, patches, and sublingual tablets.

Take nicorandil, a nitrate-like anti-anginal medicine.

Use amyl nitrite or butyl nitrite recreationally (“poppers”).

Take riociguat or another guanylate cyclase stimulator.

Have had a heart attack or stroke within 6 months.

Have unstable angina or angina during sexual intercourse.

Have severe low blood pressure below 90/50 mmHg.

Have severe uncontrolled high blood pressure.

Have retinitis pigmentosa or another inherited retinal disease.

Have previously lost vision from non-arteritic anterior ischaemic optic neuropathy (NAION).

Have any significant heart valve disease.

Have heart failure classified as NYHA class II, III, or IV.

Have a heart conduction disorder, such as AV block.

Have sick sinus syndrome or a pacemaker for conduction problems.

Have significant ischaemic heart disease.

Have any history of fainting or syncope.

Have a history of mania, hypomania, or bipolar disorder.

Have moderate or severe depression, treated or untreated.

Take a monoamine oxidase inhibitor (MAOI) now or recently.

Have taken an MAOI within the past 14 days.

Take thioridazine, or took it within 14 days.

Take any SSRI, SNRI, or tricyclic antidepressant.

Stopped such an antidepressant less than 14 days ago.

Take lithium, tryptophan, or St John’s Wort.

Take linezolid, tramadol, or a triptan migraine medicine.

Have moderate or severe liver impairment.

Are allergic to avanafil, dapoxetine, or any excipient.

Have been advised to avoid sexual activity for cardiac reasons.

Are aged under 18 or over 64.

Are a woman or a child.

Nitrates plus avanafil can cause a fatal drop in blood pressure. Never combine them.

Wait 14 days after stopping an MAOI or SSRI before using dapoxetine. Wait 7 days after stopping dapoxetine before starting one. Combining them can cause serotonin syndrome, which can be fatal.

Any heart disease, arrhythmia, or heart rhythm irregularity.

A previous heart attack, stroke, or bypass surgery.

High blood pressure or low blood pressure.

Dizziness on standing up, or orthostatic hypotension.

Any episode of fainting, however long ago.

Any mental health condition, including anxiety or depression.

Any past thoughts of self-harm or suicide.

A family history of bipolar disorder.

Epilepsy or any seizure disorder.

Liver disease or hepatitis of any type.

Kidney disease or reduced kidney function.

Any eye disease or sudden vision loss previously.

Hearing loss, tinnitus, or other ear disorders.

Sickle cell anaemia, leukaemia, or multiple myeloma.

Any bleeding disorder, or use of blood thinners.

An active or recent stomach ulcer.

A penile deformity such as Peyronie’s disease or angulation.

A previous prolonged or painful erection.

Glaucoma or raised eye pressure.

Diabetes, especially if poorly controlled.

A history of alcohol or recreational drug use.

Recent or planned surgery, including dental procedures.

Alcohol with dapoxetine is a serious combination. It significantly raises the risk of fainting and injury. Do not treat this as optional advice.

A doctor has prescribed this exact combination for me.

I have discussed my mental health history with my doctor.

I have no history of fainting or heart rhythm problems.

I take no antidepressant of any kind.

I stopped any MAOI or SSRI more than 14 days ago.

I take no tramadol, lithium, or St John’s Wort.

I have taken no nitrate medicine in 24 hours.

I have not used poppers or amyl nitrite.

I take no ketoconazole, itraconazole, ritonavir, or clarithromycin.

I have taken no other ED or PE medicine today.

I have not taken a dose in the last 24 hours.

I have drunk no alcohol today.

I will drink a full glass of water with the tablet.

I will not drive or operate machinery afterwards.

I am aged between 18 and 64.

The blister is sealed and the expiry date valid.

I know the emergency warning signs listed below.

All nitrates: glyceryl trinitrate, isosorbide mononitrate, isosorbide dinitrate.

Nicorandil, a nitrate-like anti-anginal medicine.

Amyl nitrite and butyl nitrite (“poppers”).

Riociguat and other soluble guanylate cyclase stimulators.

MAOIs: phenelzine, tranylcypromine, isocarboxazid, moclobemide, selegiline.

SSRIs: fluoxetine, sertraline, paroxetine, citalopram, escitalopram.

SNRIs: venlafaxine, duloxetine.

Tricyclic antidepressants: amitriptyline, imipramine, clomipramine.

Thioridazine and other antipsychotics affecting heart rhythm.

Lithium, tryptophan, and St John’s Wort.

Linezolid, an antibiotic with MAOI activity.

Tramadol and other serotonergic painkillers.

Triptans: sumatriptan, rizatriptan, and similar migraine drugs.

Potent CYP3A4 inhibitors: ketoconazole, itraconazole, ritonavir, telithromycin, nefazodone.

Other PDE-5 inhibitors: sildenafil, tadalafil, vardenafil.

Other dapoxetine products or any other PE treatment.

Recreational drugs, especially MDMA, cocaine, and amphetamines.

Alpha-blockers: tamsulosin, doxazosin, alfuzosin, terazosin.

Moderate CYP3A4 inhibitors: erythromycin, fluconazole, diltiazem, verapamil.

Blood pressure medicines, including diuretics and calcium channel blockers.

Warfarin and other anticoagulants.

NSAIDs and aspirin, due to bleeding risk with SSRIs.

Any medicine affecting heart rhythm or the QT interval.

Rifampicin, an antibiotic used for tuberculosis.

Carbamazepine, phenytoin, and phenobarbital.

Fainting, blackout, or loss of consciousness.

Severe dizziness where you cannot stay standing.

A very slow or irregular heartbeat.

Chest pain, pressure, or tightness during or after sex.

Pain spreading to the jaw, neck, or left arm.

An erection lasting longer than 4 hours (priapism).

A painful erection that will not subside.

Sudden loss of vision in one or both eyes.

Sudden decrease or loss of hearing.

Swelling of the face, lips, tongue, or throat.

Widespread rash with blistering or peeling skin.

A seizure or convulsion.

Signs of stroke: sudden weakness, slurred speech, facial droop.

Agitation, confusion, or restlessness.

Muscle twitching, stiffness, or loss of coordination.

Rapid heartbeat with high blood pressure.

Heavy sweating with fever or shivering.

Severe diarrhoea with nausea and vomiting.

New or worsening thoughts of suicide or self-harm.

Sudden severe low mood or hopelessness.

Unusually elevated mood, racing thoughts, or reckless behaviour.

Tell emergency staff what you have taken. Name both avanafil and dapoxetine. They must not give you nitrate medicines. Untreated priapism can cause permanent erectile damage within hours.

Treats erectile dysfunction and premature ejaculation in one tablet.

Removes the need to time two separate medicines.

Avanafil is a newer, highly selective PDE-5 inhibitor.

Its selectivity means fewer visual side effects than older drugs.

Avanafil can act within 15 to 30 minutes alone.

Dapoxetine is designed specifically for on-demand use.

It clears the body faster than standard antidepressants.

Both components are used only when needed.

Manufactured under regulated pharmaceutical quality standards.

Cost-effective compared with buying two branded products.

The fixed combination is not approved by major regulators.

The 60 mg dapoxetine dose skips the recommended 30 mg trial step.

A single tablet cannot optimise timing for both drugs.

Dapoxetine adds fainting risk that avanafil alone does not carry.

Dapoxetine adds significant mental health contraindications.

Its interaction list is far longer than for sildenafil products.

It is unsuitable for men over 64.

You have erectile dysfunction without premature ejaculation.

You have premature ejaculation without erectile dysfunction.

You have never trialled dapoxetine at 30 mg.

You need different dose adjustments for each condition.

You have any cardiac or mental health history listed above.

Combination products suit men with both conditions and no contraindications. Only your doctor can confirm whether that describes you.

Store below 30°C in a cool, dry place.

Protect tablets from direct sunlight and heat.

Keep tablets sealed in the original blister until use.

Do not store in the bathroom or near a sink.

Moisture and humidity can degrade the tablets.

Do not transfer tablets into unlabelled containers.

Do not freeze or refrigerate this product.

Keep it out of the sight and reach of children.

Accidental ingestion by a child is a medical emergency.

Check the expiry date printed on the pack.

Never use tablets after the expiry date.

Discard damaged, cracked, or discoloured tablets.

Dispose of unused medicine through a pharmacy take-back scheme.

Do not flush tablets or throw them in household waste.

This content is for information only. It is not medical advice. Avaforce D is a prescription-only medicine. This fixed-dose combination is not approved by the FDA, EMA, or MHRA. Dapoxetine is not approved in the United States. Use this product only under a qualified doctor’s supervision and direction. Always read the manufacturer’s package insert before use. Consult your doctor or pharmacist about your specific condition and dose.