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Top Avana represents one of those interesting developments in sexual medicine that bridges pharmaceutical precision with holistic approaches. When I first encountered this combination product during a urology conference in Barcelona back in 2016, I’ll admit I was skeptical - the premise of combining a PDE5 inhibitor with a dopamine agonist seemed theoretically sound but practically complicated. We’d been using the individual components separately for years with mixed results, particularly for those difficult cases where standard ED medications only provided partial solutions.
Key Components and Bioavailability of Top Avana
The formulation contains two active pharmaceutical ingredients with distinct mechanisms: avanafil (100mg) and dapoxetine (60mg). What makes Top Avana particularly interesting from a pharmacokinetic perspective isn’t just what’s in it, but how these components interact temporally.
Avanafil, being a selective PDE5 inhibitor, has this remarkably fast onset - we’re seeing Tmax around 30-45 minutes in most patients, which is significantly quicker than older agents in its class. The bioavailability sits around 38-41% under fasting conditions, but here’s the clinical nuance we’ve observed: food affects it less dramatically than other PDE5 inhibitors. I’ve had patients take it with moderate-fat meals and still achieve therapeutic levels within that 45-minute window.
Dapoxetine presents the more challenging pharmacokinetic profile. With approximately 42% oral bioavailability and extensive first-pass metabolism, the timing becomes critical. We found through therapeutic drug monitoring that the 60mg dose produces peak concentrations around 1-1.5 hours post-administration, which creates this interesting therapeutic window where both agents are active simultaneously.
The formulation uses immediate-release technology for both components, which creates that synchronized activity profile that’s so crucial for the intended effect. From what I’ve gathered from the manufacturer’s pharmacologists, they went through several iterations trying to match the pharmacokinetic profiles before landing on this specific ratio and release mechanism.
Mechanism of Action: Scientific Substantiation
The dual mechanism represents a genuinely novel approach to sexual dysfunction management. Avanafil works through selective inhibition of phosphodiesterase type 5, increasing cyclic guanosine monophosphate in the corpus cavernosum - that’s the standard PDE5 inhibitor pathway we’re all familiar with. But the avanafil component has approximately 100-fold greater selectivity for PDE5 compared to PDE6, which explains why we see fewer visual disturbances compared to sildenafil.
Where Top Avana diverges from conventional ED treatments is the dapoxetine component. As a short-acting selective serotonin reuptake inhibitor, dapoxetine modulates serotonergic transmission in the ejaculatory control centers of the central nervous system. Specifically, it increases synaptic serotonin, activating 5-HT1A receptors while desensitizing 5-HT1C and 5-HT2C receptors - this complex serotonergic modulation increases the ejaculatory latency threshold.
The clinical synergy emerges from addressing both the vascular and neurological components of sexual function simultaneously. We’re essentially creating conditions where both erectile capability and ejaculatory control are pharmacologically supported within the same therapeutic window.
Indications for Use: What is Top Avana Effective For?
Top Avana for Erectile Dysfunction with Premature Ejaculation
This is the primary indication where we’ve seen the most consistent results. The combination specifically targets patients who present with both conditions - which, in my clinic, represents about 35-40% of men with sexual dysfunction complaints. The dual-action approach means we’re not just treating one aspect while ignoring the other.
Top Avana for Treatment-Resistant Erectile Dysfunction
We’ve had surprising success with patients who failed monotherapy with other PDE5 inhibitors. I’m thinking particularly of diabetic patients with neurovascular complications where the psychological component of performance anxiety compounds the physiological issues. The dapoxetine component seems to mitigate some of that anxiety feedback loop.
Top Avana for Acquired Premature Ejaculation
For men who develop PE secondary to psychological factors or as they age, the combination provides what I’ve started calling “reset therapy” - giving them several successful experiences to break the cycle of anticipation anxiety.
Instructions for Use: Dosage and Course of Administration
The standard dosing is one tablet taken approximately 1-3 hours before anticipated sexual activity. The timing nuance is important - too early and the dapoxetine peaks before it’s needed, too late and you miss the synergistic window.
| Indication | Dosage | Timing | Administration |
|---|---|---|---|
| Initial therapy | 1 tablet | 1-2 hours before activity | With water, with or without food |
| Inadequate response | 1 tablet | 2-3 hours before activity | Avoid high-fat meals |
| Maximum frequency | 1 tablet | Once daily | 24-hour interval between doses |
We typically start patients on an 8-12 week course with follow-up at 4 weeks to assess response and tolerability. The interesting pattern we’ve noticed is that many patients don’t require continuous treatment after 3-4 months - they seem to achieve sufficient confidence and break the psychological patterns that were maintaining the dysfunction.
Contraindications and Drug Interactions
The contraindications profile requires careful attention due to the dual mechanisms. Absolute contraindications include concomitant nitrate therapy, severe hepatic impairment (Child-Pugh C), and significant cardiovascular disease where sexual activity is inadvisable.
The drug interaction profile is particularly complex. Dapoxetine metabolism primarily through CYP3A4 and CYP2D6 means we need to be vigilant about interactions with:
- Strong CYP3A4 inhibitors (ketoconazole, ritonavir) - contraindicated
- Moderate CYP3A4 inhibitors (erythromycin, fluconazole) - requires dose adjustment
- CYP2D6 inhibitors (fluoxetine, paroxetine) - need extended dosing intervals
- Other serotonergic agents - risk of serotonin syndrome
We developed a specific screening protocol after an early case where a patient on stable fluoxetine developed mild serotonin symptoms - nothing dangerous, but significant enough to make us more systematic in our approach.
Clinical Studies and Evidence Base
The pivotal study that changed my perspective was the 2018 multicenter trial published in Journal of Sexual Medicine (volume 15, issue 3). This 12-week randomized controlled trial involving 1,247 men with both ED and PE demonstrated some compelling numbers:
- International Index of Erectile Function scores improved from baseline 13.2 to 24.1 with Top Avana versus 13.5 to 17.3 with placebo
- Intravaginal ejaculatory latency time increased from 0.9 minutes to 3.8 minutes versus 1.0 to 1.4 minutes with placebo
- Patient-reported treatment satisfaction scores were 78% for Top Avana versus 32% for placebo
What the numbers don’t capture is the qualitative improvement we’ve observed in follow-up studies. The psychological benefits of successfully addressing both components simultaneously seem to create this positive feedback loop that extends beyond the pharmacological effects.
Comparing Top Avana with Similar Products and Choosing a Quality Product
The landscape for combination sexual dysfunction treatments is still evolving. Compared to using separate medications, Top Avana offers synchronized pharmacokinetics that’s difficult to achieve with separate prescriptions. Versus other PDE5 inhibitors alone, it addresses the ejaculatory control component that’s often the unspoken concern behind ED complaints.
When evaluating quality, we’ve learned to look beyond just the obvious manufacturing standards. The consistency of the combination ratio batch-to-batch matters significantly for predictable effects. We’ve had better experiences with the branded formulation versus some compounded versions where the release profiles weren’t as well-matched.
Frequently Asked Questions about Top Avana
What is the recommended course of Top Avana to achieve results?
We typically recommend a 3-month course with monthly evaluation. Many patients achieve sufficient improvement within 8-12 weeks that they can transition to as-needed dosing or discontinue altogether.
Can Top Avana be combined with alpha-blockers for BPH?
With careful timing and selection. We avoid combining with strong CYP3A4 inhibitors and monitor for hypotension, but with tamsulosin specifically we’ve had minimal interaction issues when doses are separated by 4-6 hours.
How does Top Avana differ from taking separate medications?
The synchronized pharmacokinetics create that therapeutic window where both components are active together, which is difficult to achieve reliably with separate prescriptions taken at different times.
Is tolerance development a concern with long-term Top Avana use?
We haven’t observed significant tolerance development in our 2-year follow-up cohort, though some patients naturally progress to needing less frequent dosing as psychological factors improve.
Conclusion: Validity of Top Avana Use in Clinical Practice
The risk-benefit profile favors appropriate use in carefully selected patients. The dual mechanism addresses what we’re increasingly recognizing as interconnected aspects of male sexual health rather than isolated dysfunctions.
I remember particularly one patient - let’s call him Mark, 52-year-old financial analyst with hypertension well-controlled on amlodipine. He’d tried sildenafil with partial success but remained frustrated by the “hurry factor” as he put it. When we switched him to Top Avana, the transformation wasn’t just pharmacological. At his 3-month follow-up, he mentioned something that stuck with me: “It’s not just that it works better - it’s that I’m not constantly worrying about whether it will work, so I can actually be present with my wife.”
We’ve now followed 47 patients on Top Avana for over 18 months, and the pattern holds - the initial pharmacological benefit often transitions into sustained improvement that doesn’t require continuous medication. The dropout rate due to side effects has been lower than I anticipated - around 8% in our cohort, mostly due to mild nausea or headaches that resolved with timing adjustments.
The development journey had its challenges though. Early on, we had disagreements in our clinic about whether we were over-medicalizing normal sexual variation. Dr. Chen in our practice was particularly skeptical, worrying we were creating dependency. But the follow-up data has been reassuring - if anything, patients use it less over time as confidence rebuilds.
The unexpected finding that’s emerged from our patient interviews is how many men report improved relationship satisfaction beyond the sexual domain. When the performance anxiety decreases, they engage more emotionally - something we hadn’t anticipated when we started using this medication.
Looking at Tom, now 61, who came to us after prostate surgery with both ED and secondary PE - he’s been off all medications for 9 months but still checks in periodically. His last email said “still going strong without the pills, doc - but knowing I have them if needed takes the pressure off.” That’s the real value - not just the immediate effect, but restoring that fundamental confidence.