Avanafil, sold as Spedra, is the most recently licensed of the four PDE5 inhibitors available in the UK. It is prescription-only, taken as needed, and comes in 50mg, 100mg and 200mg tablets.
The Selling Point: Speed
Avanafil typically works within 15 to 30 minutes, against 30 to 60 minutes for sildenafil. It lasts around six hours.
Whether that matters is a personal question. For someone who finds the planning aspect of ED medication intrusive — taking a tablet and then waiting an hour with the evening's expectations hanging on it — cutting the wait to twenty minutes changes the experience more than the pharmacology suggests.
Selectivity
Avanafil is the most selective of the four for the PDE5 enzyme specifically. Sildenafil's visual side effects come from action on PDE6 in the retina; greater selectivity means less of that.
In practice, side effects are broadly similar across the class — headache, flushing, nasal congestion, dizziness — but avanafil is generally described as well tolerated.
Dosing
Usually started at 100mg, taken about 15 to 30 minutes before sexual activity, no more than once a day. It can be adjusted up to 200mg or down to 50mg depending on response and tolerability. Food has relatively little effect, though a very heavy meal may still slow onset somewhat.
The Cost Problem
Avanafil is typically the most expensive of the four. Generic versions exist but the market is smaller than for sildenafil, and fewer pharmacies stock it — which itself keeps prices higher.
On the NHS it sits in the restricted group rather than being generally prescribable for ED, so for most people this is a private purchase.
The honest comparison: you are paying a premium over generic sildenafil for roughly half an hour less waiting and a marginally cleaner side-effect profile. For some people that is easily worth it. For others it plainly is not, and the price gap across a year of regular use is substantial.
Who It Suits
- People who find the lead time on sildenafil impractical
- People who have had visual side effects on sildenafil
- People who have tried sildenafil and tadalafil without success — a third molecule is a reasonable next step
It is not a first choice on cost grounds, and there is no evidence it is more effective overall.
The Same Absolute Contraindication
Avanafil must not be taken with nitrates or with recreational poppers. The blood pressure interaction is a class effect and applies exactly as it does to the others. Being newer does not make it safer in this respect.
Comparing Prices Properly
Because avanafil is stocked less widely, the spread between suppliers can be wider than for sildenafil. Check the per-tablet cost at the strength and quantity you would actually use, not the headline pack price — and check the same for a generic sildenafil comparison, so you know what the speed is costing you.