Avanafil is an erectile dysfunction (ED) medication very similar to Cialis, Viagra, and Levitra.
The main selling point for this particular ED medication is its rapid onset of effects — setting in roughly 20 minutes faster than Viagra.
In this article, you’ll learn how to use Avanafil safely, what side effects you can expect, and how this popular ED medication compares to others in its class.
What is Avanafil?
Avanafil is the drug name for Stendra® and Spedra®. It’s one of several effective medications used for treating erectile dysfunction .
This medication works by blocking an enzyme called phosphodiesterase type 5 (PDE5) — which is an enzyme that breaks down cyclic-GMP (cGMP).
cGMP is responsible for inducing widening (dilating) the arteries that fill the erectile tissue with blood to form an erection. By slowing the breakdown of cGMP, erections form more easily, become more rigid, and last longer.
What really sets this drug apart from others in its class is the rapid onset of effects. Avanafil reaches peak levels within 30 minutes, and most users are able to engage in sexual intercourse within 15 minutes of using the drug. It’s the fastest-acting PDE5 inhibitor on the market today.
What’s the Dose of Avanafil?
Avanafil (Stendra) is available in three doses — 100 mg or 200 mg tablets. Most doctors will start new patients on the 100 mg dose first. If a higher dose is needed, the doctor will upgrade to a 200 mg tablet instead. If side effects occur at the 100 mg dose, your doctor may choose to reduce the dose to the 50 mg tablet instead.
The maximum dose is 1 tablet per day with or without food.
Most people find the 100 mg dose of Stendra is more than sufficient.
How Long Does Avanafil Last?
Avanafil lasts around 6 hours, but has been reported to last up to 12 hours.
If you experience an erection lasting longer than 6 hours, or experience a painful erection, it’s important to see a doctor immediately. Severe priapism (painful erection) can result in permanent damage to the penis and needs to be treated immediately.
Compared to other ED medications, avanafil has an average duration of effects:
- Cialis (tadalafil) — 36 hours (longest lasting)
- Stendra (avanafil) — 6 hours
- Levitra (vardenafil) — 5 hours
- Viagra (sildenafil) — 3 hours (shortest duration of effects)
The History of Avanafil
This drug was first invented by Mitsubishi Tanabe Pharma and licensed to Vivus Inc. After the drug was approved for sale in 2012, Vivus Inc. partnered with Menari Group to market the drug in Australia, New Zealand, and various European countries.
In the United States, Vivus Inc. granted exclusive rights to Metuchen Pharmaceuticals to market and distribute the medication.
Who Should Consider Taking Avanafil?
The only FDA-approved use of avanafil is in the treatment of erectile dysfunction. There are no other approved uses of this medication.
Erectile dysfunction is diagnosed when someone is unable to achieve or maintain a strong enough erection to engage in sexual intercourse after several attempts over a few days or weeks.
Avanafil is a good option to consider if fast-acting effects are a priority. If it’s more important to find a low-cost alternative, Kamagra, or other generic forms of sildenafil are a better option. If the most important factor is the duration of effects, Cialis is a stronger choice.
Is Avanafil Safe?
Avanafil has been proven safe through phase I, II, and III clinical trials. Since the drug was first registered in 2012, there have been no attempts to have the drug removed from the approved drug list, and the vast majority of people using the medication won’t experience any side effects.
The side effects that do occur are mild in nature, and can usually be avoided by taking the medication with food and water or requesting a lower dose for their next prescription.
The incidence of side effects reported for Avanafil is below 10%, with less than 1% of patients experiencing severe side effects or complications like deep vein thrombosis, hematuria, or kidney damage.
Side Effects of Avanafil
- Headache (5.6%)
- Flushing (3.5%)
- Back pain (2.0%)
- Constipation (<2%)
- Dyspepsia (<2%)
- Hypertension (<2%)
- Nasal congestion (2.1%)
- Nasopharyngitis (2.6%)
- Nausea (<2%)
- Rash (<2%)
- Sinus congestion (<2%)
- Upper respiratory infection (<2%)
- Cough (<1%)
- Deep vein thrombosis (<1%)
- Depression (<1%)
- Fatigue (<1%)
- Gastroesophageal reflux disease (<1%)
- Hematuria (<1%)
- Insomnia (<1%)
- Nephrolithiasis (<1%)
- Oropharyngeal pain (<1%)
- Peripheral edema (<1%)
Avanafil Drug Interactions
Nitrite medications should never be combined with Stendra. The effects of both medications together can result in dizziness and fainting.
2. Antihypertensives & Alcohol
Medications used for treating high blood pressure are referred to as antihypertensives. Avanafil and other PDE5 inhibitors have blood-pressure reducing side effects. If used alongside other medications that reduce blood pressure, it can cause the pressure to go too low — resulting in dizziness and fainting.
Common classes of antihypertensives include:
- ACE Inhibitors
- Calcium Channel Blockers
- Peripheral Adrenergic
Alcohol has a similar effect. It causes blood vessels to relax and blood pressure to drop. It’s also a diuretic, which compounds the effects even further. You should never mix alcohol with ED medications for the same reasons you should avoid blood pressure medications.
Stomach acid is an important component of digestion, and without it the body will have a hard time absorbing avanafil. Therefore, it’s best you avoid using antacids for at least 2 hours before and after you take avanafil. Combining these two medications could render the effect of avanafil useless.
6. CYP3A4 Inhibitors
All drugs are metabolized by the liver by a large and diverse group of proteins known as the CYP450 enzymes. Depending on the structure of the molecule being metabolized, a different group of CYP450 enzymes is required to break it apart.
In the case of avanafil, the enzymes the body uses to break it down is the CYP3A4 group. This particular group is the most common enzyme group used to metabolize prescription drugs.
The liver only has a set amount of these enzymes available. So if there’s a lot of compounds in the blood that have to go through this pathway, they can start to become backed up in the bloodstream.
If other compounds are used alongside avanafil that also require this pathway, it can cause both drugs to have much slower metabolism — potentially leading to side effects.
7. Other PDE5 Inhibitors
Avanafil should never be combined with other erectile dysfunction medications. The effects of both drugs will have a compounding effect and can easily lead to negative side effects or overdose.
Taking two ED medications at the same time isn’t going to offer any additional benefits for producing an erection either — so it’s best to just stick to one. If avanafil or other ED medications aren’t working, visit your doctor to discuss alternative options.
Who Should Avoid Taking Avanafil?
Aside from anybody taking the medications outlined above, there are certain medical conditions that could make avanafil dangerous in some individuals.
Avanafil should be avoided if you have the following medical conditions:
- Allergies to PDE5 inhibitors or avanafil
- Patients with pulmonary hypertension
- Patients who were told to avoid sexual activity due to a health condition
- Patients with Peyronie’s disease
- Patients with eye disorders unless cleared by your doctor
- Patients with uncontrollable blood pressure dysfunction
- Patients with chronic liver or kidney disease
- Patients with stomach ulcers
- Anybody under the age of 18
Avanafil is a prescription medication — which means you’ll need to speak with your doctor before you’re granted a prescription to buy the drug. It’s important to be honest and upfront with any symptoms you may have, or drugs and medications you may be using. Your doctor will use this information to weigh the risks of using avanafil to the benefit.
How Does Avanafil Work?
Avanafil works by making it easier for the corpora cavernosa to fill with blood — thus resulting in an erection.
This medication doesn’t stimulate or induce an erection — it merely makes it easier for an erection to occur when you’re aroused.
An erection starts in the brain. The limbic system uses sensory information like sound, touch, taste, and sight to initiate the reaction. Dopamine and oxytocin are released in the brain, producing what we feel as arousal or sexual interest. A signal is also sent to the base of the penis where nitric oxide is released into the area.
As nitric oxide interacts with the blood vessels, another compound, called cyclic-GMP (cGMP) is produced. It’s cGMP that tells the blood vessels at the base of the penis to dilate or widen. As these arteries widen, they allow more blood to flow through and into the spongy tissue that makes up the bulk of the penis.
cGMP is then broken down by the PDE5 enzyme. In order to maintain an erection, cGMP needs to be produced on a continual basis. As soon as it’s no longer being released into the area, the blood vessels contract, and blood stop flowing into the penis — causing the penis to return to normal.
People experiencing erectile dysfunction have a problem keeping the blood vessels dilated. If they contract too quickly, blood starts to leave the penis before a full erection is able to form.
Avanafil works by blocking the ability for PDE5 enzymes to destroy cGMP — allowing it to reach higher concentrations. Avanafil reduces the threshold needed for an erection to occur and allows an erection to become harder and last longer than normal.
Avanafil is just one of many drugs in its class. While this medication has a few advantages over its competitors, there are a few reasons why someone may want to find an alternative.
Whether you’re looking for a natural alternative to avanafil or want another pharmaceutical option, there are plenty of options available to you depending on where you live.
The PDE5 inhibitor class of drugs is very large. Many of the drugs in this class have been on the market for well over 20 years — which means any patents granting the manufacturer exclusive rights have since expired. There are now dozens of generic (non-name brand) versions of these drugs available on the market.
- Sildenafil (Viagra, Kamagra)
- Vardenafil (Levitra, Staxyn, and Vivanza)
- Mirodenafil (Mvix)
- Udenafil (Zydena)
- Tadalafil (Cialis, Tadalista)
All of the drugs listed above are available by prescription only, and have their own set of side effects and safety concerns to watch out for. Many people experiencing mild to moderate ED prefer trying all-natural options before seeking pharmaceutical treatment.
If you want to try an all-natural approach to managing ED first, here are a few supplements to get you started.
- Horny goat weed (Epimedium spp.)
- Ginseng (Panax ginseng)
- Muira puama (Ptychopetalum olacoides)
- Catuaba (Trichilia catigua or Erythroxylum catuaba)
- Yohimbe (Pausinystalia johimbe)
- Tribulus (Tribulus terrestris)
You can also order all-natural formulas that combine some or all of the ingredients listed above, here are a few of the top branded herbal and nutritional formulas for ED:
- VigRX Plus
Where to Buy Avanafil in 2020
Avanafil is available by prescription only — which means you’ll need to visit your doctor first before placing an order for avanafil (Stendra).
Your doctor will first check your current medication list, consider any underlying medical conditions, and may request some diagnostic testing to rule out any potential risk factors before giving you a prescription for the drug.
You can find avanafil in North America under the brand name Stendra, or as Spedra in Europe, Australia, and New Zealand.
Once you’ve received your prescription, head to the Stendra website, and download a copy of the $0 copay card. This will give you $30 per tablet off the remaining cost of Stendra after commercial benefit.
References Cited In This Article
- Kyle, J. A., Brown, D. A., & Hill, J. K. (2013). Avanafil for erectile dysfunction. Annals of Pharmacotherapy, 47(10), 1312-1320.
- Limin, M., Johnsen, N., & Hellstrom, W. J. (2010). Avanafil, a new rapid-onset phosphodiesterase 5 inhibitor for the treatment of erectile dysfunction. Expert opinion on investigational drugs, 19(11), 1427-1437.
- Sanford, M. (2013). Avanafil: a review of its use in patients with erectile dysfunction. Drugs & aging, 30(10), 853-8
- Hurt, K. J., Sezen, S. F., Champion, H. C., Crone, J. K., Palese, M. A., Huang, P. L., … & Burnett, A. L. (2006). Alternatively spliced neuronal nitric oxide synthase mediates penile erection. Proceedings of the National Academy of Sciences, 103(9), 3440-3443.