> ## Documentation Index > Fetch the complete documentation index at: https://docs.hi-doctor.ai/llms.txt > Use this file to discover all available pages before exploring further. # Spedra (avanafil) usage guide > Practical dosing guide for Spedra (avanafil): timing before sex, contraindicated combinations, blood-pressure effects and urgent warning signs. Spedra (avanafil) is taken on demand, before sexual activity, rather than as a daily tablet. Correct timing and avoiding contraindicated combinations matter more with this medicine than remembering a daily dose. ## How to use Two things decide whether a dose is safe and useful: the timing, and what else is in your system. The usual starting dose is 100 mg. Depending on response and tolerability, the prescriber may choose 50 mg or 200 mg. Take no more than once per day, and remember that sexual stimulation is required. Never take avanafil with nitrates, nitric-oxide donors, riociguat, or another erectile-dysfunction medicine. Strong CYP3A4 inhibitors are also contraindicated; some moderate inhibitors require no more than 100 mg every 48 hours. ## Dose schedule Before each dose, check for any new heart, blood-pressure, prostate, antifungal, antibiotic, or HIV medicines. Food can delay onset, so use the timing agreed with your prescriber. After several correctly timed attempts, review efficacy and effects with the prescriber — do not repeat the dose on the same day or move to 200 mg without approval. ## What has been reported | Category | What has been reported | | ---------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Common effects | Headache, flushing, and nasal congestion are common. Dizziness, back pain, indigestion, or visual symptoms can also occur. | | Blood-pressure effects | Avanafil can lower blood pressure, especially with alpha-blockers, other blood-pressure medicines, or substantial alcohol. Sit or lie down if light-headed, and seek advice for fainting. | Seek urgent care for an erection lasting 4 hours or longer, sudden loss of vision or hearing, chest pain, collapse, or a severe allergic reaction. Contact your doctor for marked dizziness, fainting, palpitations, or a headache that is severe or persistent, or if the prescribed dose does not give a satisfactory response after several correctly timed attempts. ## Storage Keep in the original package, away from moisture and direct heat, and out of children's reach. Follow the temperature limit on your pack and do not use it after the expiry date. ## What to expect Avanafil is designed for on-demand use and may act within the prescribed pre-sex window, but timing is not a guarantee of response. It requires stimulation and does not address every cause of erectile dysfunction — review several correctly used doses with the doctor. ## Related reading For EU authorisation history and the trial evidence behind avanafil, see the [avanafil](/library/medicines/avanafil) medicine page. See [erectile dysfunction](/library/conditions/erectile-dysfunction) for how the underlying condition is assessed, and [safety](/essentials/safety) for how doctor review works. ## Start a consultation Answer the sexual health questionnaire and a registered doctor reviews it. They decide whether treatment is appropriate, which one, and at what dose — and declining is a normal outcome. See [what it costs](/essentials/pricing) and [how the review works](/essentials/how-it-works). This page is reference information, not medical advice and not a prescription. Whether a medicine is appropriate for you is decided by a registered doctor after reviewing your consultation.