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Avanafil, sold under the brand name Stendra, is a medication used to treat erectile dysfunction. It's always essential to consult a healthcare professional or pharmacist before combining medications, including Avanafil, with others. However, here are some general interactions to be aware of:

Nitrates: Avanafil should not be taken with any form of nitrate medication, as this combination can lead to a severe drop in blood pressure, which can be dangerous. Nitrates are often prescribed for chest pain (angina) and include medications like nitroglycerin.

Alpha-blockers: Combining avanafil with alpha-blockers can also cause a significant drop in blood pressure. Alpha-blockers are sometimes used to treat high blood pressure or prostate enlargement. If taking both, the lowest effective dose should be used, and the patient should be closely monitored.

Other erectile dysfunction medications: Avana use of Avanafil with other drugs used to treat erectile dysfunction, such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra), is not recommended due to the increased risk of side effects and a severe drop in blood pressure.

CYP3A4 inhibitors: Avanafil is primarily metabolized by the liver enzyme CYP3A4. Medications that inhibit this enzyme can increase the levels of avanafil in the body, potentially leading to an increased risk of side effects. Examples of CYP3A4 inhibitors include some antibiotics, antifungals, and HIV protease inhibitors.

CYP3A4 inducers: Conversely, medications that induce the activity of CYP3A4 can decrease the levels of avanafil in the body, reducing its effectiveness. Examples of CYP3A4 inducers include rifampin and certain antiepileptic drugs.

Alcohol: Drinking alcohol in excess while taking avanafil can increase the risk of certain side effects such as dizziness, headache, and low blood pressure.

Grapefruit juice: Grapefruit juice can increase the levels of avanafil in the body by inhibiting the enzyme CYP3A4. This can increase the risk of side effects. It's generally advised to avoid consuming grapefruit or grapefruit juice while taking avanafil.

Always inform your healthcare provider about all medications, supplements, and herbal remedies you are taking before starting avanafil to ensure safe and effective treatment. They can provide personalized advice based on your medical history and current medications.