Spedra dosage: a guide to the 50 mg, 100 mg and 200 mg strengths
- The three strengths and when each is taken
- Who may be started on 50 mg
- Why Spedra is limited to once a day
- How food and alcohol affect it
- What to do if it doesn't work, or after a wrong or extra dose
- How dose adjustments are decided
Spedra strengths and when to take them
Spedra is taken as needed before sexual activity, not every day.
| Strength | When it's used | Timing before sex |
|---|---|---|
| 50 mg | A lower dose if 100 mg is too strong, or a starting dose for some men | About 30 minutes |
| 100 mg | The licensed starting dose | About 15 to 30 minutes |
| 200 mg | The maximum dose, if 100 mg isn't effective enough | About 15 to 30 minutes |
The 15 to 30 minute window comes from the 100 mg and 200 mg SmPCs. The patient information leaflet (PIL) gives about 30 minutes for 50 mg.
Good to know
Spedra only helps you get an erection if you're sexually stimulated, as the PIL points out. It doesn't cause an erection on its own.
When might you start on 50 mg?
You might start on 50 mg if you already take an alpha blocker, such as doxazosin or tamsulosin. Alpha blockers and avanafil can both lower blood pressure, so the SmPC advises being stable on your alpha blocker first, then starting Spedra at the lowest dose of 50 mg.
You might also move to 50 mg later if your prescriber decides 100 mg was too strong for you, as the PIL describes.
Some other medicines don't call for a 50 mg start, but they do change your dose limits because they slow CYP3A4, the enzyme that breaks down avanafil:
- Moderate CYP3A4 inhibitors, such as erythromycin, diltiazem, verapamil and fluconazole. The SmPC caps the dose at 100 mg, with at least 48 hours between doses
- Strong CYP3A4 inhibitors, such as ketoconazole, itraconazole, clarithromycin and ritonavir. Spedra must not be taken with these
How often can you take Spedra?
No more than once a day, whichever strength you take, according to the SmPC.
The SmPC doesn't state a single reason for the limit, but two points in it are relevant. Avanafil has a terminal half-life of approximately 6 to 17 hours, so your body is still clearing a dose well after you take it. When healthy volunteers took single doses of up to 800 mg, side effects were similar in type but more frequent and more severe.
Important !
- Don't take a second tablet the same day, even if the first doesn't seem to work
- Don't take two tablets together for a stronger effect
- Don't take Spedra with any organic nitrate or nitric oxide donor, such as amyl nitrite, or with riociguat. The SmPC lists both as contraindications
Do food and alcohol affect how Spedra works?
Food
You can take Spedra with or without food, but a meal may slow it down, according to the PIL. After a high-fat meal, the SmPC reports avanafil took on average 1.25 hours longer to reach its peak blood level, and at 200 mg that peak was 39% lower. The total amount absorbed didn't change.
Grapefruit juice
Grapefruit juice can raise the amount of avanafil in your body, so skip it for 24 hours beforehand.
Alcohol
Alcohol with avanafil can make low blood pressure more likely, according to the SmPC. You might notice dizziness on standing, a headache or a pounding heartbeat. It can also make it harder to get an erection.
What if Spedra doesn't seem to work?
Spedra doesn't work every time. In the trials summarised by NICE, 100 mg led to successful intercourse in 57.1% of attempts in men without diabetes or a prostatectomy, compared with 27% on placebo. Results were lower in men with diabetes and after prostatectomy.
A heavy meal, alcohol, not waiting long enough or a lack of sexual stimulation can all make a difference. If it still isn't working, don't take an extra tablet or raise the dose yourself. Your prescriber can decide whether 200 mg is right for you.
Missed dose, wrong dose or taking too much
Missed dose
You only take Spedra when you need it, so there's no missed dose to make up. Just take it next time as prescribed.
Wrong or extra dose
If you've taken a higher strength than prescribed, or a second tablet the same day, contact your prescriber straight away. The PIL warns you may get more side effects than usual, and they may be worse.
Warning !
How dose adjustments are decided
According to the SmPC, your prescriber can raise the 100 mg starting dose to 200 mg or lower it to 50 mg, depending on how well it works for you and how well you tolerate it.
Your other medicines and your health matter too. The SmPC rules Spedra out in some situations, including severe kidney or liver impairment, a heart attack or stroke in the last 6 months, and blood pressure below 90/50 mmHg or above 170/100 mmHg. So tell your prescriber about every medicine you take, including anything from a pharmacy.
Reporting side effects
If you get any side effects, talk to your prescriber or pharmacist. You can also report suspected side effects through the MHRA Yellow Card scheme.
Final thoughts
Spedra comes in 50 mg, 100 mg and 200 mg, and you'll usually start on 100 mg, taken about 15 to 30 minutes before sex, once a day at most. Some medicines lower or cap your dose, a heavy meal can slow it down and alcohol can lower your blood pressure. If your dose needs to change, that's your prescriber's call.
FAQ
What is the starting dose of Spedra?
100 mg, taken as needed approximately 15 to 30 minutes before sex. Men on an alpha blocker start on 50 mg.
Can I start on 200 mg of Spedra?
No. The SmPC sets 100 mg as the starting dose, and any increase is your prescriber's decision.
Can I take Spedra twice in one day?
No. The maximum is once a day.
Do I need to take Spedra every day?
No. It's taken as needed before sexual activity.
Can I drink alcohol with Spedra?
Alcohol can increase the chance of low blood pressure and may reduce your ability to get an erection. Speak to your prescriber if you're unsure.
The DoktorABC medical advisory board
Dr. Roland Ruiken
Medical advisor, Norway
Dr. Viktor Simunovic
Medical advisor, Croatia