Nitroglycerin Spray and Avanafil: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Avanafil
Nitroglycerin Spray
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Potentiation of hypotensive effects
Interaction Deep Dive
Consistent with its known effects on the nitric oxide/cyclic guanosine monophosphate (cGMP) pathway, avanafil has been shown to potentiate the hypotensive effects of nitrates. Because of the potential for excessive hypotension , the concomitant use of avanafil and organic nitrates in any form, either regularly or intermittently, is contraindicated. Avanafil 200 mg caused a clinically significant reduction in standing systolic blood pressure (-30 mmHg or greater) when given prior to a single dose of nitroglycerin 0.4 mg SL in a clinical trial with healthy volunteers. If nitrate administration is deemed medically necessary for a life-threatening condition, at least 12 hours should elapse between the last dose of avanafil and nitrate administration, and the patient should be under close medical supervision with appropriate hemodynamic monitoring1.
Why it happens (mechanism)
Increased levels of cyclic guanosine monophosphate (cGMP) from avanafil and nitrates
Literature reports
1 report — tap to read
a) In a randomized, double-blind, placebo-controlled study of healthy volunteers, 30 to 60 years of age administered avanafil 200 mg followed 0.5, 1, 4, 8, or 12 hours later by nitroglycerin 0.4 mg SL, there was a clinically significant decrease in standing systolic blood pressure (BP) (-30 mmHg or greater), which occurred in 28% (n=28) treated with avanafil/nitroglycerin compared with 15% (n=14) in the placebo/nitroglycerin arm. The mean maximum decrease from baseline in sitting systolic/diastolic BP was -21.6/18.2 and the decrease in standing BP was -28/23.5 in the avanafil/nitroglycerin arm compared with a decrease in sitting BP of -13.4/11.8 and standing BP decrease of -21.1/16.5 in placebo/nitroglycerin arm 1.
Common questions
Can I take Nitroglycerin Spray and Avanafil together?
Potentiation of hypotensive effects Always confirm with your pharmacist or prescriber before making any change.
How serious is the Nitroglycerin Spray and Avanafil interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Nitroglycerin Spray or Avanafil need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: STENDRA(R) oral tablets, avanafil oral tablets. Metuchen Pharmaceuticals LLC (per FDA), Freehold, NJ, 2022. DailyMed
Keep reading about Avanafil
Keep reading about Nitroglycerin Spray
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