Avarante represents a significant addition to the UK over-the-counter erectile dysfunction treatment landscape. Furthermore, the reclassification of tadalafil 10mg from prescription-only to pharmacy supply provides men with another option that doesn’t require a GP appointment.
Erectile dysfunction is common, affecting approximately:
10% of men in their 40s
30% of men in their 60s
Over 50% of men over 70
Up to 60% of men with diabetes
Substantially more men if you include occasional difficulty alongside persistent problems
Furthermore, ED is significantly underdiagnosed and undertreated because of the perceived stigma and reluctance to discuss the condition. As a result, pharmacy supply through Avarante removes one barrier to accessing effective treatment.
Avarante versus Viagra Connect: how they compare
Both Avarante (tadalafil 10mg) and Viagra Connect (sildenafil 50mg) are pharmacy-only ED treatments from the same manufacturer (Viatris). However, they differ in important ways:
Avarante (tadalafil 10mg):
Mechanism: PDE5 inhibitor
Onset: 30 minutes to 2 hours
Duration: up to 36 hours
Dosing: one tablet at least 30 minutes before sex; not suitable for daily use
Food effect: minimal; can be taken with or without food
Suits: men who want spontaneity, longer windows of opportunity, those who prefer not to plan precise timing
Viagra Connect (sildenafil 50mg):
Mechanism: PDE5 inhibitor
Onset: 30 minutes to 1 hour
Duration: approximately 4 to 6 hours
Dosing: one tablet about 1 hour before sex; can be used up to once daily
Food effect: high-fat meals delay onset; better taken on a relatively empty stomach
Suits: men who want shorter-acting medicine, those for whom planning is easier than spontaneity, those with established response to sildenafil
As a result, the choice between Avarante and Viagra Connect often comes down to lifestyle preferences and individual response. Furthermore, our pharmacist can discuss which would suit you better based on your specific situation.
Avarante versus prescription ED treatments
Several prescription ED treatments are available alongside the OTC options:
Tadalafil tablets (prescription generic): same active as Avarante; available in 2.5mg, 5mg, 10mg, and 20mg; multiple dosing options including daily 2.5mg or 5mg for continuous use
Sildenafil tablets (prescription generic): same active as Viagra Connect; available in 25mg, 50mg, and 100mg; allows dose adjustment based on response
Vardenafil tablets (Levitra and generic): shorter-acting alternative; 5mg, 10mg, and 20mg
Hezkue Oral Spray Sildenafil: newer formulation; first licensed sildenafil oral spray in the UK
Alprostadil products: Viridal Duo, Caverject (intracavernosal injection), MUSE (intraurethral pellet); for men where oral PDE5 inhibitors don’t work or aren’t suitable
Vacuum erection devices: non-medicine option for men preferring physical rather than pharmacological treatment
As a result, the broader prescription ED landscape provides flexibility for individual situations. However, for many men, the OTC convenience of Avarante or Viagra Connect is preferable when these are suitable.
Where Avarante fits in ED treatment
Modern UK approach to ED follows a layered framework:
Lifestyle measures: smoking cessation, weight management, exercise, alcohol moderation, stress management. As a result, these address common contributory factors
Address underlying causes: review medicines that may contribute (some antihypertensives, antidepressants, anti-androgens); investigate cardiovascular, metabolic, or hormonal causes; address relationship or psychological factors
First-line oral medicine: PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil). As a result, oral PDE5 inhibitors are effective in approximately 70 to 80% of men with ED
Second-line treatments: intracavernosal alprostadil (Viridal Duo, Caverject), intraurethral alprostadil (MUSE), vacuum erection devices, oral or topical testosterone if hypogonadism present
Specialist treatments: penile prostheses, vascular surgery for selected patients
Psychological support: where psychogenic factors are prominent or alongside medical treatment
Avarante fits at the first-line oral medicine step. Furthermore, the OTC pharmacy supply makes it accessible without GP appointment for men where this is appropriate.
Who Avarante suits well
Avarante suits adult men who:
Have erectile dysfunction (difficulty achieving or maintaining an erection sufficient for sexual activity)
Are aged 18 and over
Want a longer duration of effect for more spontaneity
Prefer a once-as-needed approach rather than daily medicine
Don’t have contraindications (severe cardiovascular disease, nitrate use, specific other contraindications)
Have had a clear discussion with our pharmacist about their cardiovascular health and other medicines
Want OTC pharmacy access rather than GP prescription
Have realistic expectations about the medicine and the need for sexual stimulation
Who might suit alternatives better
Alternatives may suit men who:
Need a shorter-acting medicine (Viagra Connect sildenafil; takes effect for 4 to 6 hours)
Want daily continuous treatment rather than as-needed dosing (prescription daily tadalafil 2.5mg or 5mg)
Prefer a different format (Hezkue oral spray sildenafil)
Have severe ED not responding to PDE5 inhibitors (alprostadil products: Viridal Duo, Caverject, MUSE; vacuum erection devices; specialist treatments)
Have contraindications to PDE5 inhibitors (severe cardiovascular disease, nitrate medicines, specific eye conditions)
Want GP review of underlying causes before starting treatment
Need investigation of contributing factors (diabetes, hypogonadism, cardiovascular disease)
Courier Pharmacy supply
Avarante 10mg Tablets is a UK Pharmacy (P) medicine. As a result, the supply requires pharmacist assessment but does not require a GP prescription. Our pharmacist will check that Avarante is suitable through a brief consultation.
Key features and specifications
Active ingredient: tadalafil 10mg per tablet
Form: light yellow film-coated round biconvex tablets, 8.1mm diameter, debossed ‘M’ on one side and ‘TL3’ on the other
Pack sizes: 2, 4, or 8 tablets (8-tablet pack typical)
Licensed indication: erectile dysfunction in adult men aged 18 and over
Standard dose: one tablet at least 30 minutes before anticipated sexual activity
Maximum dose frequency: once daily (not designed for daily continuous use)
Onset of action: 30 minutes to 2 hours
Duration of effect: up to 36 hours
Effect on sexual stimulation: tadalafil enhances the response to sexual stimulation but does not cause automatic erections
Legal category: Pharmacy (P) medicine
Supplied by: Courier Pharmacy, UK GPhC-registered, with pharmacist support
Additional information
Pack size
Pack of 2, Pack of 4, Pack of 8
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Avarante is one of the newer additions to the UK over-the-counter erectile dysfunction treatment landscape. Furthermore, it represents an important development: the first tadalafil product to be reclassified from prescription-only to pharmacy supply in the UK. The 36-hour duration of effect gives more spontaneity than shorter-acting alternatives. As a result, Avarante offers a meaningful new option alongside Viagra Connect (sildenafil) for adult men with erection problems.
At Courier Pharmacy, we believe in treatment that fits the person.
That means honest framing of where Avarante fits in the wider erectile dysfunction treatment landscape. Furthermore, it means careful screening to ensure tadalafil is the right choice for your specific situation. This page covers what Avarante is, how it compares to other ED treatments, who it suits, and the safety considerations that matter.
Five key takeaways
Avarante 10mg Tablets is a UK Pharmacy (P) medicine containing tadalafil 10mg per film-coated tablet. As a result, it can be supplied through pharmacist consultation without a prescription, after appropriate safety screening
Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor that enhances the natural erection response to sexual stimulation. Furthermore, sexual stimulation is required for the medicine to work. As a result, Avarante doesn’t cause automatic erections without arousal
Standard dose: one 10mg tablet taken at least 30 minutes before anticipated sexual activity. The effect can last up to 36 hours. As a result, tadalafil is sometimes called the “weekend pill” because of this extended window of effect compared to shorter-acting alternatives
Avarante is for adult men aged 18 and over. Furthermore, several significant cautions and contraindications apply. Specifically: absolutely contraindicated with nitrates (heart medicines containing nitrate); not suitable for men with severe cardiovascular disease; significant interactions with alpha-blockers and CYP3A4 inhibitors
Avarante joins Viagra Connect (sildenafil) as a Pharmacy (P) treatment for ED in the UK. As a result, men can now choose between two distinct OTC options with different durations of action. Both are manufactured by Viatris and require pharmacist assessment for safe supply
Why choose Courier Pharmacy for Avarante
At Courier Pharmacy, our approach starts with a simple idea: treatment should fit the person, not force the person to fit the system.
Dr Ada Jex-Cori
Our service is shaped by the philosophy of Dr Ada Jex-Cori, our brand pharmacist.
Dr Ada represents the spirit of the pharmacy: evidence-led, community-rooted, and willing to challenge the one-size-fits-all approach to medicine.
She is named in honour of three pioneering women in science: Ada Lovelace, the mathematician and visionary; Sophia Jex-Blake, the first female doctor in the UK who fought the medical establishment; and Gerty Cori, the biochemist and Nobel Prize winner.
In our fictional world of Ethrewell, Dr Ada fights against pharma’s standardised approach to medicine. In the real world, she represents what we stand for. Her view is straightforward: you are not broken. The system is. And we are here to change that.
Honest framing of where Avarante fits
Avarante is a genuinely useful new addition to the UK OTC erectile dysfunction landscape. Furthermore, the 36-hour duration of effect gives meaningful advantages over shorter-acting alternatives.
However, Avarante isn’t the right answer for everyone. As a result, we will discuss your situation rather than just selling the product. Specifically:
Whether Avarante or Viagra Connect would suit you better based on your lifestyle and preferences
Whether your ED warrants GP review of underlying causes before starting treatment
Whether you have any cardiovascular risk factors that need consideration
Whether you’re on any nitrate or other contraindicated medicines
Whether prescription tadalafil at a different dose would suit better (2.5mg, 5mg daily, or 20mg as needed)
Whether stronger or different ED treatment would suit your situation
Treatment that fits, not one-size-fits-all
Many online pharmacies dispense ED medicines without thinking through the individual situation. Courier Pharmacy is different.
We think through your situation: your ED pattern, what you’ve already tried, your cardiovascular health, your current medicines, what fits with your lifestyle, and your goals.
Avarante may be the right answer for you. Alternatively, Viagra Connect may suit better. Furthermore, prescription daily tadalafil 2.5mg or 5mg may be more appropriate if you need continuous treatment. Or GP review may be appropriate to identify and address underlying causes of your ED.
ED as a broader health marker
ED can be a marker of broader cardiovascular health issues. As a result, our pharmacist may discuss:
Whether GP review for underlying causes is appropriate alongside ED treatment
Whether other medicines you take may be contributing
Mental health considerations (depression, anxiety, relationship factors)
As a result, treating ED can be an opportunity to improve broader health and wellbeing.
Pharmacist support before and after purchase
Our pharmacist is available to discuss:
Whether Avarante or another ED treatment would suit you best
How to use Avarante for best effect
Managing side effects
Drug interactions and what to be aware of
When to seek GP review or specialist input
Lifestyle interventions that complement medicine treatment
Mental health and relationship considerations
This is free and available before and after purchase.
Care for specific patient groups
We provide tailored support for:
Men experiencing ED for the first time who want to start treatment
Men wanting to switch from sildenafil to tadalafil for longer duration of effect
Men with diabetes where ED is more common and treatment response may differ
Men with cardiovascular disease where careful prescriber assessment is needed
Older men where multiple medicines and comorbidities need consideration
Men with MCAS, CFS, fibromyalgia, or other long-term conditions where men’s health issues overlap with the broader picture
Men whose ED is causing significant relationship or psychological impact
Coordination with your GP and other care
If you have a GP, cardiologist, or other healthcare professional involved in your care, we are happy to coordinate. Furthermore, for men with significant cardiovascular conditions, joined-up care matters.
Trust earned, not claimed
We are GPhC-regulated. Furthermore, we ground our content in NHS, BNF, EMC, and BSSM (British Society for Sexual Medicine) guidance.
We will tell you honestly if Avarante isn’t the right answer for your situation. We would rather give you the right advice than a quick sale.
How to buy Avarante from Courier Pharmacy
Avarante 10mg Tablets is a UK Pharmacy (P) medicine supplied through Courier Pharmacy under pharmacist supervision. The supply does not require a prescription, but the pharmacist will check that the use is appropriate.
How our service works
Add Avarante to your basket and complete the pharmacist consultation. The questions cover your ED pattern, what you’ve tried before, current medicines (especially any nitrate medicines), cardiovascular health, and other relevant medical conditions
Our pharmacist reviews your answers to confirm Avarante is suitable. As a result, if any concerns arise, we will contact you to discuss
Once approved, your order is prepared and dispatched discreetly
Free pharmacist support is available before and after your purchase
When alternatives might suit better
If Avarante isn’t the right product for your situation, we will explain why. Alternatives may include:
Viagra Connect (sildenafil 50mg) if shorter-acting medicine suits your lifestyle better
Hezkue Oral Spray Sildenafil if you prefer an oral spray format or have difficulty swallowing tablets
Prescription daily tadalafil (2.5mg or 5mg) if you need continuous treatment rather than as-needed dosing
Prescription tadalafil at different strengths (5mg, 20mg) if 10mg isn’t the right dose
Prescription sildenafil at different strengths (25mg, 100mg) for dose flexibility
Vardenafil (Levitra) or avanafil (Spedra) for alternative oral PDE5 inhibitors
Viridal Duo, Caverject, or MUSE (alprostadil products) for men where oral PDE5 inhibitors aren’t effective
Vacuum erection devices for non-medicine treatment
GP review for assessment of underlying causes including cardiovascular health, diabetes, hypogonadism
Specialist referral for refractory ED or complex cases
Psychological support or counselling where psychogenic factors are prominent
Our community service
Our free fortnightly drop-in clinics at Insomnia, Derby run every other week from 10am to 12pm.
Healthcare shouldn’t only happen when you’re paying for it. We show up, even when it’s free.
We cover men’s health, ED, premature ejaculation, low testosterone, prostate health, MCAS, CFS, fibromyalgia, allergies, asthma, hair loss, weight management, digestive health, and whatever else people bring through the door. No appointment needed, no charge, no pressure.
Active ingredients
Each Avarante film-coated tablet contains:
Tadalafil 10mg (active ingredient): a phosphodiesterase type 5 (PDE5) inhibitor. Tadalafil works by inhibiting the enzyme PDE5 in the smooth muscle of the corpora cavernosa of the penis. As a result, this enhances the natural erection response to sexual stimulation. Tadalafil has a longer duration of action than other PDE5 inhibitors, with effects lasting up to 36 hours after a single dose
Excipients
Excipients include:
Lactose anhydrous (118.96mg per tablet)
Poloxamer 188
Cellulose microcrystalline (pH101)
Povidone (K-25)
Croscarmellose sodium
Magnesium stearate
Sodium laurilsulfate
Silica colloidal anhydrous
Film coating: hypromellose, lactose monohydrate, triacetin, titanium dioxide (E171), iron oxide yellow (E172), iron oxide red (E172), talc
Excipient considerations
Several considerations apply:
Lactose content: patients with severe lactose intolerance, total lactase deficiency, or glucose-galactose malabsorption should be aware. The total lactose content (anhydrous lactose in the tablet plus lactose monohydrate in the film coating) is approximately 119mg per tablet
Sodium content: each tablet contains less than 1 mmol (23mg) of sodium, so is essentially "sodium-free"
Where Avarante fits in erectile dysfunction treatment
Erectile dysfunction is one of the most common men's health concerns. Furthermore, it has substantial impact on quality of life, relationship satisfaction, and overall wellbeing.
Understanding erectile dysfunction
Erectile dysfunction is the inability to achieve or maintain an erection sufficient for satisfactory sexual activity. Furthermore, it has multiple potential causes:
Medicine-related: some antihypertensives (beta-blockers, thiazide diuretics), some antidepressants (SSRIs), anti-androgens (finasteride, dutasteride, spironolactone), some antipsychotics, some opioids
Lifestyle factors: smoking, excessive alcohol, sedentary lifestyle, obesity, recreational drug use
Combined causes: often multifactorial; not just one issue
As a result, ED may be a symptom of broader health issues worth investigating. Furthermore, addressing underlying causes is often as important as the medicine treatment.
ED as a cardiovascular warning sign
ED can precede cardiovascular disease by 3 to 5 years. As a result, new-onset ED in middle-aged men warrants:
Furthermore, men with ED have approximately a 50% increased risk of cardiovascular events over the next decade compared to men without ED. As a result, ED is not just a sexual health issue but a broader health marker worth taking seriously.
Throughout: psychological support where relevant; relationship counselling where appropriate
Avarante fits at Step 3 — first-line oral PDE5 inhibitor treatment. Furthermore, the pharmacy supply removes one barrier to accessing this treatment.
Treatment expectations
Realistic expectations matter:
PDE5 inhibitors are effective in approximately 70 to 80% of men with ED
Sexual stimulation is required; the medicine doesn't cause automatic erections
The first dose may not work optimally; up to 8 attempts may be needed to assess response
Different PDE5 inhibitors suit different men; switching between them may be worthwhile
Combination with lifestyle changes typically gives better results than medicine alone
Psychological factors often improve once erections become more reliable, even with continued medicine use
When to seek medical assessment
Several situations warrant GP review before continuing self-treatment:
Sudden onset ED (over days to weeks rather than gradual)
ED associated with low libido, fatigue, mood changes (possible hypogonadism)
ED with significant cardiovascular risk factors not yet assessed
ED with chest pain on exertion or other cardiovascular symptoms
ED with neurological symptoms (numbness, weakness, vision changes)
ED with significant prostate symptoms
ED not responding to OTC treatment after appropriate trial
ED with significant depression or anxiety
Persistent erection lasting more than 4 hours (priapism — urgent medical attention needed)
How Avarante works
Tadalafil works as a phosphodiesterase type 5 (PDE5) inhibitor. Furthermore, the mechanism is well-established from decades of clinical use and research.
The normal erection mechanism
During sexual stimulation:
Nerve signals release nitric oxide (NO) in the smooth muscle of the corpora cavernosa (the erection chambers in the penis)
Nitric oxide stimulates production of cyclic guanosine monophosphate (cGMP)
Increased cGMP causes smooth muscle relaxation in the penile blood vessels
Relaxed smooth muscle allows increased blood flow into the corpora cavernosa
The trapped blood produces an erection
After sexual activity, the enzyme PDE5 breaks down cGMP
As cGMP decreases, smooth muscle contracts and blood flows out
The erection subsides
How tadalafil enhances this process
Tadalafil inhibits the PDE5 enzyme. As a result:
Less cGMP is broken down
Higher cGMP levels persist longer
Smooth muscle stays relaxed for longer
Erections become easier to achieve and maintain in response to sexual stimulation
The natural physiological process is enhanced rather than replaced
Critically: tadalafil only works when sexual stimulation triggers the nitric oxide release. As a result, tadalafil does not cause erections without arousal. Furthermore, men taking Avarante still need sexual stimulation for the medicine to be effective.
Why tadalafil lasts longer than sildenafil
Different PDE5 inhibitors have different pharmacokinetic properties:
Sildenafil (Viagra Connect): half-life approximately 4 hours; duration of effect 4 to 6 hours
Tadalafil (Avarante): half-life approximately 17.5 hours; duration of effect up to 36 hours
Vardenafil: half-life approximately 4 to 5 hours; duration of effect 4 to 6 hours
Avanafil: half-life approximately 5 hours; duration of effect 4 to 6 hours but with faster onset
Tadalafil's much longer half-life is the basis for its 36-hour window of effect. Furthermore, this is why tadalafil is sometimes called the "weekend pill" — a Friday evening dose can support sexual activity through to Sunday.
Pharmacokinetics
After oral administration:
Tadalafil is well-absorbed from the GI tract
Peak plasma concentrations occur at 2 hours (with some patients responding within 30 minutes)
Food has minimal effect on absorption; can be taken with or without food
Half-life is approximately 17.5 hours
Metabolised primarily by CYP3A4 enzymes in the liver
Excreted mainly via the faeces; small amount via urine
As a result, CYP3A4 inhibitors and inducers can significantly affect tadalafil levels (see drug interactions section).
Selectivity matters
Tadalafil has good selectivity for PDE5 over other phosphodiesterase enzymes. However, it has some activity at PDE11 (more than some other PDE5 inhibitors), which is thought to contribute to the back and muscle pain side effects more common with tadalafil than sildenafil.
Furthermore, the relative selectivity for PDE5 versus PDE6 (found in the retina) explains why tadalafil has somewhat less effect on colour vision than sildenafil. As a result, the side effect profiles of different PDE5 inhibitors differ slightly.
How to take Avarante
This summary is for reference only. The definitive guide is the patient information leaflet supplied with the product. If you are uncertain about any aspect of use, contact our pharmacist for support.
Standard dosing
Take one Avarante 10mg tablet at least 30 minutes before anticipated sexual activity
Swallow the tablet whole with a glass of water
Can be taken with or without food
Maximum one tablet per 24 hours
Do not take more than one dose in 24 hours
When to take Avarante
Timing flexibility is one of tadalafil's main advantages:
Take at least 30 minutes before anticipated sexual activity
Effect persists for up to 36 hours
As a result, you don't need to time exactly to anticipated sexual activity
Many men take Avarante on Friday evening for a weekend window
The medicine works in response to sexual stimulation throughout the 36-hour window
Sexual stimulation is required
This is critical. Furthermore, Avarante:
Does not cause automatic erections
Requires sexual stimulation (psychological, physical, or both) to produce its effect
Enhances the natural erection response rather than replacing it
Won't help if there's no arousal or sexual interest
As a result, men using Avarante need to allow time for arousal and sexual stimulation. Simply taking the tablet is not enough.
Alcohol
Alcohol can:
Reduce sexual response and contribute to ED
Combined with tadalafil, increase risk of postural hypotension and dizziness
Mask judgment about whether the medicine is working
As a result, limit alcohol intake when using Avarante. Furthermore, heavy alcohol use can worsen ED and reduce the effectiveness of the medicine.
Food
Food has minimal effect on tadalafil absorption. As a result, Avarante can be taken with or without food. Furthermore, this is an advantage over sildenafil, where high-fat meals can significantly delay onset.
First-time use
If this is your first time using a PDE5 inhibitor:
Take the tablet in a relaxed setting where you can take time
Allow at least 30 minutes for the medicine to begin working
Sexual stimulation should be unhurried and natural
Don't expect immediate effects; many men find the first attempt isn't optimal
Up to 8 attempts may be needed to assess true response to the medicine
Contact our pharmacist if you have questions or concerns after first use
If Avarante doesn't work the first time
Several considerations:
Confirm you allowed at least 30 minutes after taking the tablet
Confirm there was adequate sexual stimulation
Confirm alcohol was minimal
Consider whether stress, anxiety, or distraction reduced the effect
Try again on a subsequent occasion under different circumstances
If multiple attempts have not been successful, contact our pharmacist or your GP for review
Furthermore, the SmPC notes that up to 8 attempts may be needed to assess true response to the medicine.
Maximum frequency
One tablet per 24 hours maximum. Furthermore, Avarante is not designed for daily continuous use.
If you find yourself needing PDE5 inhibitor treatment more frequently than 2 to 3 times per week, discuss with our pharmacist or your GP. Furthermore, alternatives may include prescription daily tadalafil 2.5mg or 5mg for continuous use.
Storage
Store at room temperature, in the original packaging, away from heat and moisture. Keep out of sight and reach of children.
Warnings and precautions for Avarante
Absolute contraindications
Avarante must NOT be used in:
Men with known hypersensitivity to tadalafil or any tablet excipient
Men taking any nitrate medicines: glyceryl trinitrate (GTN spray, tablets, patches), isosorbide mononitrate or dinitrate, nicorandil. As a result, combination can cause life-threatening hypotension. This is the most important contraindication
Men taking guanylate cyclase stimulators such as riociguat (used for pulmonary hypertension)
Men taking amyl nitrite or other "poppers" (recreational nitrate inhalants)
Men with severe cardiovascular disease where sexual activity itself would be unsafe (recent heart attack, unstable angina, severe heart failure, severe arrhythmias, severe hypotension or uncontrolled hypertension)
Men with a recent stroke (within 6 months)
Men with non-arteritic anterior ischaemic optic neuropathy (NAION) — a rare condition causing sudden vision loss
Men with hereditary degenerative retinal disorders (rare conditions including some forms of retinitis pigmentosa)
Men with severe lactose intolerance, total lactase deficiency, or glucose-galactose malabsorption (because of the lactose content)
Men under 18 years of age
Women (this product is for adult men only)
The nitrate interaction (most important safety point)
Combining tadalafil with any nitrate medicine can cause severe, prolonged hypotension. Furthermore, this can be life-threatening.
Amyl nitrite and other recreational nitrate inhalants ("poppers")
Critical rules:
Never take Avarante if you currently take any nitrate medicine
If you have angina that may need GTN spray during physical activity (including sex), Avarante is generally not suitable
If a man on Avarante develops chest pain, tell paramedics or emergency staff about the tadalafil use — GTN should generally be avoided for at least 48 hours after the last tadalafil dose
Cardiovascular considerations
Sexual activity carries a small inherent cardiovascular risk. Furthermore, this is similar to the cardiovascular demands of climbing two flights of stairs.
Men with significant cardiovascular disease should discuss with their GP or cardiologist before using Avarante. Specifically:
Recent myocardial infarction (within 90 days)
Unstable angina or angina with sexual activity
Heart failure (NYHA Class 2 or above)
Significant cardiac arrhythmias
Recent stroke (within 6 months)
Severe or uncontrolled hypertension
Significant hypotension
Alpha-blocker interaction
Alpha-blockers used for blood pressure or prostate symptoms can cause postural hypotension when combined with tadalafil:
Alfuzosin (Xatral)
Doxazosin
Tamsulosin
Terazosin
Prazosin
Indoramin
If you take an alpha-blocker, you should be stable on the alpha-blocker treatment before initiating tadalafil. Furthermore, our pharmacist will discuss this with you. As a result, in some cases, your GP review of the alpha-blocker dose may be appropriate before starting Avarante.
CYP3A4 inhibitor interactions
Tadalafil is metabolised by CYP3A4. As a result, CYP3A4 inhibitors can significantly increase tadalafil levels.
Strong CYP3A4 inhibitors warranting caution:
Ritonavir (HIV medicine)
Ketoconazole (antifungal)
Itraconazole (antifungal)
Clarithromycin (antibiotic)
Erythromycin (antibiotic)
Cimetidine (some H2 antagonists)
Grapefruit juice (in large amounts)
As a result, men taking these medicines should consult their physician before taking Avarante. Furthermore, a lower dose may be more appropriate, which would require prescription rather than pharmacy supply.
Other significant interactions
Other PDE5 inhibitors (sildenafil, vardenafil, avanafil): don't combine; overdose risk
Alpha-blockers: dose adjustments may be needed (see above)
Antihypertensives in general: additive blood pressure lowering; usually clinically acceptable but worth monitoring
Priapism (prolonged erection)
Rarely, PDE5 inhibitors can cause prolonged erections (priapism) lasting more than 4 hours. Furthermore, this is a medical emergency. As a result:
Seek immediate medical attention if you have an erection lasting longer than 4 hours
Don't wait to see if it resolves
Untreated priapism can cause permanent damage to the penile tissue
Risk is higher in men with sickle cell disease, leukaemia, multiple myeloma, or anatomical penile abnormalities
Vision changes
Tadalafil can cause vision changes:
Mild blurred vision or change in light perception
Rarely, more significant vision changes
Very rarely, non-arteritic anterior ischaemic optic neuropathy (NAION) causing sudden vision loss in one or both eyes
If you experience sudden vision changes, stop taking Avarante and seek urgent medical attention. Furthermore, NAION is more common in men with diabetes, hypertension, hyperlipidaemia, smoking, age over 50, or a "crowded optic disc".
Hearing changes
Rarely, PDE5 inhibitors have been associated with sudden hearing loss or tinnitus. As a result, if you develop sudden hearing changes, stop taking Avarante and seek medical attention.
Hepatic and renal impairment
Avarante should be used with caution in:
Significant hepatic impairment: lower dose or alternative may be appropriate
Severe renal impairment: lower dose may be appropriate
Driving and operating machinery
Tadalafil can occasionally cause dizziness or vision changes. As a result, men taking Avarante should be cautious about driving and operating machinery until they know how the medicine affects them personally.
Sexual activity safety
Sexual activity carries a small inherent cardiovascular risk. Furthermore, if you experience chest pain, severe shortness of breath, or other significant symptoms during sexual activity:
Stop the activity
Seek medical attention urgently
Tell paramedics or emergency staff that you have taken tadalafil
Critically: GTN spray should generally NOT be used during the 48 hours after a tadalafil dose due to the nitrate contraindication
Side effects of Avarante
Avarante is generally well-tolerated at standard doses. Furthermore, side effects are usually mild and transient.
Common side effects (up to 1 in 10 men)
Headache (the most common side effect)
Flushing (redness or warmth in the face, neck, or chest)
Indigestion or heartburn
Back pain
Muscle aches (especially leg muscle pain)
Nasal congestion (blocked or runny nose)
Nausea
Dizziness
These effects often improve with continued use. Furthermore, they reflect the medicine's effects on smooth muscle elsewhere in the body in addition to the penis.
Less common side effects (up to 1 in 100 men)
Mild blurred vision or change in colour perception
Increased heart rate
Palpitations
Hypotension or postural hypotension
Hypertension
Nosebleeds
Skin rash
Increased liver enzymes
Rare but more significant side effects
Priapism (erection lasting more than 4 hours) — medical emergency
Severe hypotension (particularly with nitrates or alpha-blockers — see absolute contraindications)
Allergic skin reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis (very rare)
Stop and seek urgent medical advice if
You have an erection lasting longer than 4 hours (priapism — urgent medical emergency)
You develop sudden vision changes or loss of vision
You develop sudden hearing loss or significant tinnitus
You develop chest pain, particularly during or after sexual activity
You develop signs of severe allergic reaction
You develop significant skin reaction with blistering or peeling
You develop significant dizziness or fainting
Yellow Card reporting
You can report suspected adverse drug reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk. Reporting helps build the safety picture for everyone.
Drug interactions with Avarante
Avarante has several significant drug interactions. Furthermore, our pharmacist will check the picture during your consultation.
Absolute contraindications
Nitrates: glyceryl trinitrate (GTN), isosorbide mononitrate, isosorbide dinitrate, nicorandil. Combined with tadalafil can cause life-threatening hypotension. Never combine
Amyl nitrite and other recreational nitrate inhalants ("poppers")
Guanylate cyclase stimulators (riociguat, used for pulmonary hypertension)
Significant interactions requiring care
Alpha-blockers (alfuzosin, doxazosin, tamsulosin, terazosin, prazosin, indoramin): risk of postural hypotension; ensure stable on alpha-blocker before starting tadalafil
Other PDE5 inhibitors (sildenafil, vardenafil, avanafil): don't combine; overdose risk
Strong CYP3A4 inhibitors (ritonavir, ketoconazole, itraconazole, clarithromycin, erythromycin): increased tadalafil levels; consult prescriber before use
Grapefruit juice in large amounts: may increase tadalafil levels
Antihypertensives in general: additive blood pressure lowering; usually clinically acceptable but worth being aware of
Less significant interactions
Most antibiotics (apart from CYP3A4 inhibitors above): no significant interaction
Most antidepressants: no significant interaction
Most pain medicines (paracetamol, NSAIDs): no significant interaction
Not significant interactions
Most blood pressure medicines at standard doses (with the alpha-blocker exception above)
Statins: no significant interaction
PPIs and H2 antagonists (apart from cimetidine which is a CYP3A4 inhibitor)
Most asthma inhalers: no significant interaction
Most allergy medicines: no significant interaction
For men on multiple medicines, particularly cardiovascular medicines or any nitrate, our pharmacist will check the picture carefully before supplying Avarante.
Frequently asked questions about Avarante
What is Avarante used for?
Avarante 10mg Tablets is licensed for the treatment of erectile dysfunction in adult men aged 18 and over. Furthermore, it works by enhancing the natural erection response to sexual stimulation.
How is Avarante different from Viagra Connect?
Both are pharmacy-only (P) ED treatments from Viatris. The main differences:
Avarante: tadalafil; up to 36 hours duration; no significant food effect
Viagra Connect: sildenafil; 4 to 6 hours duration; better on empty stomach
Furthermore, the choice often comes down to lifestyle preferences. Avarante suits men wanting spontaneity over a longer window. Viagra Connect suits men preferring shorter-acting medicine for planned occasions.
How quickly does Avarante work?
Avarante typically begins working within 30 minutes. Furthermore, peak effect occurs around 2 hours after dosing. As a result, the SmPC recommends taking at least 30 minutes before anticipated sexual activity.
How long does Avarante last?
Up to 36 hours. Furthermore, this is the longest duration of any oral ED medicine currently licensed in the UK. As a result, tadalafil is sometimes called the "weekend pill" — a Friday evening dose can support sexual activity through to Sunday.
However, the 36-hour window doesn't mean continuous erection. It means the medicine remains effective in response to sexual stimulation throughout this time.
Do I need to be sexually aroused for Avarante to work?
Yes. Tadalafil enhances the natural erection response to sexual stimulation rather than causing automatic erections. As a result:
Sexual stimulation (psychological, physical, or both) is required
Avarante won't cause erections without arousal
Take time for unhurried sexual stimulation
If you're not aroused, the medicine won't be effective
Can I take Avarante daily?
No. Avarante is for as-needed use, with a maximum of one tablet per 24 hours.
For men needing daily continuous treatment, prescription daily tadalafil 2.5mg or 5mg is available. Furthermore, this would require GP or our prescriber's assessment rather than pharmacy supply.
Can I take Avarante with alcohol?
Limit alcohol intake. Furthermore, combining tadalafil with significant alcohol can:
Increase risk of postural hypotension and dizziness
Reduce sexual response (alcohol itself can contribute to ED)
Mask judgment about whether the medicine is working
As a result, moderate alcohol intake (1-2 units) is generally acceptable but heavy drinking is not.
Can I take Avarante with food?
Yes. Tadalafil has minimal food interactions and can be taken with or without food. Furthermore, this is an advantage over sildenafil, where high-fat meals can significantly delay onset.
What if Avarante doesn't work the first time?
Don't give up on the first attempt. Furthermore, several considerations:
Confirm you allowed at least 30 minutes after taking the tablet
Confirm there was adequate sexual stimulation
Confirm alcohol was minimal
Consider whether stress, anxiety, or distraction reduced the effect
Up to 8 attempts may be needed to assess true response
Try again on subsequent occasions
If multiple attempts haven't been successful, contact our pharmacist or your GP
Why can't I take Avarante with nitrate medicines?
This is the most important safety point. Combining tadalafil with any nitrate (GTN, isosorbide mononitrate, isosorbide dinitrate, nicorandil, amyl nitrite) can cause severe, prolonged, life-threatening hypotension.
As a result, if you take any nitrate medicine for angina or any other condition, Avarante is absolutely contraindicated. Furthermore, this includes recreational nitrate inhalants ("poppers").
If you're not sure whether your medicine contains nitrate, our pharmacist can check. Furthermore, your prescription medicine packaging or patient information leaflet will indicate this.
What if I have a heart condition?
Sexual activity carries a small inherent cardiovascular demand. As a result, men with significant heart disease should discuss with their GP or cardiologist before using Avarante.
Specifically, Avarante is contraindicated in men with:
Recent heart attack (within 90 days)
Unstable angina or angina with sexual activity
Heart failure (significant)
Significant cardiac arrhythmias
Severe or uncontrolled hypertension
Significant hypotension
Recent stroke (within 6 months)
Any condition where exercise tolerance is significantly limited
Can older men take Avarante?
Yes, with care. Furthermore, ED becomes more common with age, and many older men benefit from PDE5 inhibitor treatment.
Multiple medicines including possible nitrate prescriptions
Reduced hepatic or renal function affecting tadalafil clearance
Increased risk of postural hypotension
As a result, careful pharmacist screening is appropriate before starting Avarante in older men.
Can I take Avarante if I have diabetes?
Yes, in most cases. Furthermore, ED is common in men with diabetes (affecting up to 60%), and PDE5 inhibitors are effective treatment.
However, the diagnosis of diabetes also means cardiovascular risk should be carefully assessed. Furthermore, some men with diabetes have ED that responds less well to PDE5 inhibitors. As a result, our pharmacist will discuss your specific situation.
Can I take Avarante with my blood pressure medicine?
Depends on which blood pressure medicine. Most are compatible with care:
ACE inhibitors, ARBs, calcium channel blockers, beta-blockers, most diuretics: usually compatible with monitoring for additive blood pressure effects
Alpha-blockers (alfuzosin, doxazosin, tamsulosin): require care; need stable alpha-blocker treatment before starting tadalafil
As a result, our pharmacist will check your specific blood pressure medicine before supplying Avarante.
What happens if I have an erection that won't go away?
Seek immediate medical attention if you have an erection lasting longer than 4 hours. Furthermore, this is called priapism and is a medical emergency.
Don't wait to see if it resolves. Furthermore, untreated priapism can cause permanent damage to the penile tissue. As a result, attend A&E or call 999 if urgent emergency support is needed.
Can Avarante affect my vision?
Mild vision changes are uncommon but can occur. Furthermore, very rarely, PDE5 inhibitors have been associated with a serious condition called non-arteritic anterior ischaemic optic neuropathy (NAION), which can cause sudden vision loss.
As a result, if you experience sudden vision changes, stop taking Avarante and seek urgent medical attention. Furthermore, NAION is more common in men with diabetes, hypertension, hyperlipidaemia, smoking, age over 50, or a "crowded optic disc".
Can Avarante affect my hearing?
Rarely. PDE5 inhibitors have been very rarely associated with sudden hearing loss or significant tinnitus. As a result, if you develop sudden hearing changes, stop taking Avarante and seek medical attention.
What if I take an alpha-blocker for my prostate?
Alpha-blockers like tamsulosin, doxazosin, and alfuzosin are commonly prescribed for prostate symptoms. Furthermore, combining alpha-blockers with tadalafil can cause postural hypotension.
As a result, you should be stable on your alpha-blocker before starting tadalafil. Furthermore, our pharmacist will discuss your specific situation, and in some cases, GP review of the alpha-blocker dose may be appropriate before starting Avarante.
Can Avarante affect my fertility?
There is no evidence that tadalafil affects fertility, sperm count, or sperm quality. Furthermore, the medicine works by enhancing blood flow rather than affecting hormones or sperm production.
As a result, men trying to conceive can generally use Avarante without concerns about fertility. However, if you have specific concerns about fertility, discuss with your GP.
How should I store Avarante?
Store at room temperature, in the original packaging, away from heat and moisture. Keep out of sight and reach of children.
How do I order Avarante from Courier Pharmacy?
Add the product to your basket on courierpharmacy.co.uk and complete the pharmacist consultation. Our pharmacist will review your answers and confirm suitability. Furthermore, free pharmacist support is available before and after your order.
More than a prescription: our community
Healthcare shouldn't only happen when you're paying for it.
Every fortnight we run free drop-in talks and clinics at Insomnia, Derby, from 10am to 12pm. We show up, even when it's free.
Bring a question, bring a friend, bring a stack of bewildering letters from another clinic. We'll sit with you.
We cover men's health, ED, premature ejaculation, low testosterone, prostate health, MCAS, CFS, fibromyalgia, allergies, asthma, hair loss, weight management, digestive health, and whatever else people bring through the door. No appointment. No cost. No pressure. Just real support and treatment that fits.
Disclaimer: This article is for information only and isn't a substitute for personal medical advice. Always speak to a qualified prescriber before starting or changing treatment.
How this content was created
Written by the Courier Pharmacy editorial team and reviewed by a GPhC-registered pharmacist.
The content is grounded in the latest NHS, BNF, EMC, and BSSM (British Society for Sexual Medicine) guidance. Furthermore, it draws on the real questions patients bring to our drop-in clinics in Derby.
