Extra Super Avana: Avanafil and Dapoxetine Guide

Extra Super Avana is a prescription combination product marketed for men who have both erectile dysfunction (ED) and premature ejaculation (PE). It contains two medicines with different roles: avanafil helps support an erection during sexual stimulation, while dapoxetine is a short-acting selective serotonin reuptake inhibitor (SSRI) used for PE in countries where it is approved. The manufacturer lists Extra Super Avana as containing avanafil 200 mg plus dapoxetine 60 mg. These are substantial doses: 200 mg is the upper labeled avanafil dose in U.S. prescribing information, while European dapoxetine guidance does not recommend starting treatment at 60 mg. This guide explains how both ingredients work, what clinical evidence says about combining PDE5 inhibitors with dapoxetine, important side effects and interactions, and why regulatory status matters. It is intended to help you understand the medicine rather than decide whether it is personally appropriate for you.

• •What Is Extra Super Avana and What Does It Contain?
• •How Do Avanafil and Dapoxetine Work?
• •What Does the Evidence Say About Using Avanafil and Dapoxetine Together?
• •How Does Extra Super Avana Compare With Single-Ingredient Treatment?
• •What Side Effects and Drug Interactions Matter?
• •How Should You Think About Dosing, Timing, and Regulatory Status?
• •When Should You Seek Medical Advice or Urgent Care?
• •Conclusion
• •Frequently Asked Questions

What Is Extra Super Avana and What Does It Contain?

Extra Super Avana combines avanafil 200 mg with dapoxetine 60 mg in a single tablet, according to its manufacturer.

Avanafil belongs to the phosphodiesterase type 5 inhibitor, or PDE5 inhibitor, class. Dapoxetine belongs to the SSRI class but is formulated for short-acting, on-demand treatment of premature ejaculation rather than routine antidepressant treatment.

The two ingredients address different sexual-health problems.

Avanafil for erectile dysfunction

Avanafil is used to treat erectile dysfunction, meaning persistent difficulty getting or maintaining an erection firm enough for sexual activity. It does not automatically create an erection or increase sexual desire. Sexual stimulation is still necessary for the normal nitric oxide pathway that the medicine supports.

Current U.S. avanafil prescribing information  lists avanafil as a prescription PDE5 inhibitor for ED and describes 50 mg, 100 mg, and 200 mg strengths. The labeled starting dose is generally 100 mg, with adjustment according to response and tolerability.

Dapoxetine for premature ejaculation

Dapoxetine is a short-acting SSRI developed for premature ejaculation. By increasing serotonin activity in parts of the nervous system involved in ejaculation, it can increase the time before ejaculation and improve perceived control in appropriately diagnosed men.

The European Association of Urology guidance on premature ejaculation identifies dapoxetine as an on-demand treatment for PE in many countries and notes that it is not approved for this indication in the United States.

This distinction is important. Approval of one ingredient in a country does not automatically mean that a fixed combination containing that ingredient and another medicine is approved there.

How Do Avanafil and Dapoxetine Work?

The two medicines affect different biological pathways, which is why they may be considered when ED and PE occur together.

How avanafil supports an erection

During sexual stimulation, nitric oxide helps produce cyclic guanosine monophosphate, usually called cGMP. This chemical relaxes smooth muscle in penile blood vessels and allows more blood to enter erectile tissue.

PDE5 normally breaks down cGMP. Avanafil blocks PDE5, allowing cGMP to remain active longer and helping the natural erection process work more effectively.

Avanafil therefore supports erectile response; it does not treat every possible cause of sexual difficulty. ED can be associated with cardiovascular disease, diabetes, medications, hormonal conditions, psychological factors, or other underlying health issues, so persistent symptoms deserve medical assessment.

How dapoxetine affects ejaculation

Dapoxetine reduces the reuptake of serotonin, increasing its activity between nerve cells involved in ejaculation. Unlike many SSRIs prescribed daily for depression, dapoxetine has pharmacokinetic properties designed for on-demand use.

Randomized trials reviewed by the European Association of Urology found improvements in intravaginal ejaculatory latency time, ejaculatory control, distress, and sexual satisfaction with approved dapoxetine regimens. Common treatment-related effects included nausea, headache, dizziness, and diarrhea.

Extra Super Avana does not represent one drug doing two jobs. It combines a PDE5 inhibitor acting mainly on the erectile blood-flow pathway with an SSRI acting on neural pathways involved in ejaculation. That also means the tablet carries precautions and interaction risks from both drug classes.

What Does the Evidence Say About Using Avanafil and Dapoxetine Together?

There is evidence supporting the broader concept of combining dapoxetine with a PDE5 inhibitor in selected men, particularly when ED and PE coexist. However, evidence about PDE5 inhibitors as a class should not automatically be interpreted as proof that every fixed-dose commercial combination has the same evidence base.

A randomized phase III trial involving 495 men with PE and concomitant ED evaluated dapoxetine in men already receiving stable PDE5-inhibitor treatment. At the study endpoint, average ejaculation latency was longer with dapoxetine than placebo, and patient-reported measures also improved. Treatment-emergent adverse events occurred more often with dapoxetine.

The clinical trial of dapoxetine with PDE5-inhibitor therapy  therefore provides evidence for concurrent treatment in a defined population, but it did not specifically establish that Extra Super Avana's fixed 200 mg/60 mg formulation is the best regimen for every patient.

A more recent systematic review and meta-analysis of five randomized trials found that dapoxetine plus a PDE5 inhibitor improved ejaculation-latency and sexual-satisfaction measures compared with dapoxetine alone. However, combination treatment produced more headache, flushing, and nasal congestion, and substantial statistical heterogeneity was present for some outcomes.

Clinical guidance also emphasizes diagnosing the problem correctly. For acquired premature ejaculation, an underlying condition such as ED should be addressed rather than assuming that ejaculation delay alone is the answer.

How Does Extra Super Avana Compare With Single-Ingredient Treatment?

A combination tablet can appear convenient, but fixed doses remove some of the flexibility clinicians normally have when adjusting two medicines separately.

Extra Super Avana compared with its individual active ingredients

Treatment	Main purpose	Dose context from authoritative sources	Important practical point
Extra Super Avana	Marketed for combined ED and PE	Manufacturer lists avanafil 200 mg + dapoxetine 60 mg	Both doses are fixed together, so one ingredient cannot be reduced independently
Avanafil alone	Erectile dysfunction	U.S. label lists 50, 100, and 200 mg; 100 mg is the usual starting dose	Dose can normally be adjusted according to response, interactions, and tolerability
Dapoxetine alone	Premature ejaculation where approved	European information includes 30 mg and 60 mg; treatment should not start at 60 mg	Allows assessment of tolerability before considering the higher dose
PDE5 inhibitor + dapoxetine prescribed separately	Coexisting ED and PE in selected patients	Regimens depend on the individual medicines and jurisdiction	Separate prescribing provides greater dose flexibility and medication-review opportunities

Sources: manufacturer composition information, current U.S. avanafil labeling, EMA dapoxetine information, and EAU guidance.

For some men, treating one condition may also change how the other is experienced. Anxiety about maintaining an erection, for example, can affect sexual timing and confidence. That is one reason guidelines recommend assessing ED and PE rather than simply assuming that everyone reporting both symptoms needs a two-drug tablet.

What Side Effects and Drug Interactions Matter?

Extra Super Avana can cause adverse effects associated with either avanafil or dapoxetine. Some overlap—particularly dizziness and blood-pressure effects—can be clinically important.

Possible effects associated with avanafil

Commonly reported PDE5-inhibitor effects include headache, flushing, nasal congestion, and related vasodilatory symptoms. More serious but less common concerns include prolonged erection, sudden vision changes, sudden hearing loss, and excessive blood-pressure reduction.

An erection lasting more than four hours requires urgent medical attention because prolonged priapism can damage penile tissue.

Possible effects associated with dapoxetine

Dapoxetine commonly causes effects such as nausea, headache, dizziness, diarrhea, and sometimes sleepiness or fatigue. A particularly important concern is fainting or near-fainting associated with a fall in blood pressure when standing.

Alcohol can increase dizziness, drowsiness, slowed reactions, and the risk of injury from fainting with dapoxetine. European product information advises avoiding alcohol when taking it.

Medicines that can create dangerous interactions

Avanafil must not be combined with nitrate medicines used for angina, such as nitroglycerin, because the combination can produce a dangerous blood-pressure drop. U.S. labeling also contraindicates its use with guanylate cyclase stimulators such as riociguat or vericiguat.

Strong CYP3A4 inhibitors can markedly affect avanafil exposure. The current U.S. label says avanafil should not be used with strong inhibitors such as ketoconazole, ritonavir, clarithromycin, and several related medicines.

Dapoxetine has a separate interaction profile. European Medicines Agency dapoxetine safety information warns against concurrent use with MAO inhibitors, other antidepressants, lithium, linezolid, St John's wort, tramadol, and several migraine medicines, among other interacting drugs.

Important dos and don'ts before using an avanafil-dapoxetine combination

Situation	Do	Don't
Nitrate medicine for chest pain	Tell the prescriber you use nitrates before taking any ED medicine	Do not combine nitrates with avanafil
Antidepressants or other serotonergic medicines	Have the complete medicine list reviewed for dapoxetine interactions	Do not add dapoxetine to antidepressant therapy without medical assessment
Blood-pressure or prostate medicines	Ask about additive dizziness or low blood pressure	Do not assume an over-the-counter or online sexual-health product is interaction-free
Alcohol	Discuss alcohol use and follow the local dapoxetine information	Avoid alcohol with dapoxetine because fainting and impairment risks can increase
Strong CYP3A4 inhibitors	Check prescription, antifungal, antibiotic, and HIV medicines	Do not use avanafil with contraindicated strong CYP3A4 inhibitors
Another ED medicine	Tell the prescriber about sildenafil, tadalafil, vardenafil, avanafil, or similar products	Do not stack multiple PDE5 inhibitors unless specifically directed by a qualified clinician

Sources: DailyMed avanafil labeling and EMA dapoxetine product information.

How Should You Think About Dosing, Timing, and Regulatory Status?

Extra Super Avana should not be approached as a general self-dosing product simply because its two ingredients are familiar medicines.

The manufacturer currently identifies the formulation as avanafil 200 mg plus dapoxetine 60 mg. By comparison, U.S. avanafil labeling generally starts treatment at 100 mg and permits adjustment to 50 mg or 200 mg according to efficacy and tolerability.

European dapoxetine information uses 30 mg as the recommended starting dose and states that treatment should not be initiated at 60 mg. The higher 60 mg dose has a greater incidence and severity of adverse effects.

That comparison does not mean a specific individual should split, substitute, reduce, or change the combination independently. Fixed-dose tablets can have formulation characteristics that make unsupervised alteration inappropriate.

Regulatory status depends on the country

Avanafil is FDA-approved in the United States for erectile dysfunction, and an FDA-listed first generic avanafil product was approved in 2024. Dapoxetine, however, is not approved for PE in the United States, although it is approved in multiple other countries.

For U.S. readers, that means the fact that avanafil is FDA-approved should not be interpreted as FDA approval of Extra Super Avana or of dapoxetine. Patients in other countries should similarly check the authorization status of the specific product and manufacturer with their national medicines regulator or pharmacist.

When Should You Seek Medical Advice or Urgent Care?

A medical review is appropriate before using an ED or PE medicine when symptoms are new, persistent, worsening, or accompanied by other health problems. ED can sometimes be an early marker of vascular disease, while PE may be lifelong or may develop in association with ED, prostatitis, thyroid problems, anxiety, or other factors.

Seek urgent medical attention if you develop:

• An erection lasting longer than four hours.

• Chest pain, severe dizziness, fainting, or significant shortness of breath during sexual activity.

• Sudden loss or major reduction of vision.

• Sudden hearing loss or marked hearing changes.

• Collapse, seizure-like symptoms, or repeated fainting.

• Severe agitation, confusion, fever, tremor, or other concerning symptoms after combining dapoxetine with medicines affecting serotonin.

People with significant heart disease, very low blood pressure, serious liver or kidney disease, a history of fainting, or multiple interacting medicines need particularly careful assessment. Sexual activity itself can also pose cardiovascular stress for some people, so treatment for ED is not appropriate when a clinician has advised against sexual activity because of heart disease.

Conclusion

Extra Super Avana combines avanafil for erectile dysfunction with dapoxetine for premature ejaculation, but the convenience of one tablet also combines the precautions of both medicines. Its marketed 200 mg/60 mg formulation contains the upper labeled avanafil dose and a dapoxetine dose that European guidance does not use as the starting dose.

Regulatory status also varies substantially by country, particularly because dapoxetine is not approved in the United States. If you are considering Extra Super Avana, have your health conditions and complete medication list reviewed by a qualified healthcare professional or pharmacist before use. This guide provides general education and does not replace individualized medical advice.

Frequently Asked Questions

1. Is Extra Super Avana FDA-approved in the United States?

Do not assume that it is an FDA-approved U.S. combination product. Avanafil is FDA-approved for erectile dysfunction, but dapoxetine is not approved for premature ejaculation in the United States. Product authorization should always be checked for the specific country and formulation.

2. What is in Extra Super Avana?

The manufacturer lists Extra Super Avana as containing avanafil 200 mg plus dapoxetine 60 mg per tablet. Avanafil targets erectile function, while dapoxetine is intended to delay ejaculation in men diagnosed with premature ejaculation where the medicine is approved.

3. Does Extra Super Avana increase sexual desire?

No, neither ingredient is primarily a libido-enhancing medicine. Avanafil supports the physical erection response when sexual stimulation occurs, while dapoxetine modifies serotonin signaling involved in ejaculation. Persistent loss of sexual desire may have other medical or psychological causes that deserve assessment.

4. Can Extra Super Avana be taken with nitroglycerin?

No. Avanafil and nitrate medicines such as nitroglycerin can interact to cause a potentially dangerous fall in blood pressure. Tell healthcare professionals about recent PDE5-inhibitor use if you develop chest pain so they can choose appropriate emergency treatment.

5. Can dapoxetine be taken with antidepressants?

Not without specific medical review. European dapoxetine information lists several antidepressants and other serotonin-related medicines among combinations that should not be taken together because clinically important interactions can occur. Give your prescriber or pharmacist a complete medication and supplement list.

6. Is the avanafil-dapoxetine combination better than either medicine alone?

It depends on the diagnosed conditions. Research suggests dapoxetine plus a PDE5 inhibitor can improve some outcomes in selected men with PE and ED, but combination treatment can also increase adverse effects. Individual diagnosis, dose requirements, interactions, and regulatory status still matter.