Avanafil (Spedra): The Fastest-Onset ED Medication — UK Guide

Avanafil is the newest of the four MHRA-approved phosphodiesterase type 5 (PDE5) inhibitors for erectile dysfunction, licensed under the brand name Spedra in the UK (Stendra in the USA). Its defining characteristic is speed: avanafil can work in as little as 15–30 minutes — significantly faster than sildenafil, tadalafil, or vardenafil. It also has the highest receptor selectivity of the four drugs, which underpins its comparatively favourable tolerability profile. This guide covers dosage, onset and duration, side effects, and how to get Spedra in the UK. For a comparison of all four options, see: Viagra vs Cialis vs Levitra vs Stendra.

What Is Avanafil (Spedra)?

Avanafil is a PDE5 inhibitor developed by Menarini, approved by the EMA in 2013 and available in the UK under the brand name Spedra. No generic avanafil is currently available in the UK — it is a branded product only, which makes it more expensive than generic sildenafil or tadalafil.

Avanafil blocks the PDE5 enzyme in the smooth muscle of penile blood vessels — the same fundamental mechanism as the other three approved ED medications. What distinguishes it is its very high PDE5 selectivity: it is approximately 100 times more selective for PDE5 over PDE6 (the enzyme involved in retinal function) and other PDE subtypes than sildenafil. This selectivity is the pharmacological basis for its lower incidence of visual disturbances compared to sildenafil, and generally lower rates of some other side effects.

Onset and Duration

The fast onset is avanafil's defining clinical advantage. For men for whom the 30–60 minute wait with sildenafil feels like an obstacle — creating anticipatory anxiety or disrupting spontaneity — avanafil's 15–30 minute window is meaningfully shorter.

Dosage

Never exceed one dose in a 24-hour period. Avanafil is not affected by food in the same way as sildenafil — a moderate meal does not significantly alter absorption — though a very high-fat meal may modestly delay onset. Take approximately 15–30 minutes before anticipated sexual activity.

Side Effects of Avanafil

Avanafil's high PDE5 selectivity confers a comparatively favourable tolerability profile. In clinical trials, rates of visual disturbances (the blue-tinge effect of PDE6 inhibition) and nasal congestion were lower with avanafil than with sildenafil.

Common

• Headache — most common; mild in most men
• Facial flushing — warmth and redness, typically brief
• Nasal congestion — reported less frequently than with sildenafil
• Back pain — less prominent than with tadalafil due to shorter half-life
• Dizziness — blood-pressure-lowering effect; do not stand too quickly; limit alcohol

Less Common

• Visual disturbances (blue tinge, light sensitivity) — rare compared to sildenafil; related to mild PDE6 activity
• Indigestion
• Palpitations

Contraindications and Drug Interactions

Avanafil shares the same absolute contraindications as all four PDE5 inhibitors. The most critical:

• Nitrate medicines in any form — absolute contraindication. The combination causes a severe and potentially fatal drop in blood pressure. This includes GTN spray, isosorbide mononitrate, and recreational poppers (amyl nitrite). No exceptions.
• Riociguat (Adempas)
• Cardiovascular events within the past 6 months (MI, stroke)
• Severe hepatic impairment
• Severe hypotension or uncontrolled hypertension

CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir, clarithromycin) substantially increase avanafil plasma levels. Dose should be reduced to 50mg maximum, and potent inhibitors such as ritonavir may preclude use entirely. Your prescriber will screen for interactions during the consultation.

Alcohol: as with all PDE5 inhibitors, limit to 1–2 units maximum with avanafil.

Who Is Avanafil (Spedra) Best For?

Avanafil is particularly well-suited for:

• Men who want the shortest possible lead time before sexual activity — particularly those who find the 45–60 minute sildenafil window creates performance anxiety or disrupts spontaneity
• Men who experience significant visual disturbances with sildenafil and want a more PDE5-selective alternative
• Men for whom other PDE5 inhibitors have been tried and avanafil offers a different pharmacological option

The principal trade-off is cost: as a branded-only product, Spedra is more expensive than generic sildenafil or generic tadalafil. For most men starting ED treatment, sildenafil is the appropriate first choice on both efficacy and cost grounds.

For a comprehensive overview of erectile dysfunction — causes, symptoms, and all treatment options — visit our complete guide to erectile dysfunction.