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 in the UK under the brand name Spedra (Stendra in the USA). Its defining feature is speed: avanafil can work in as little as 15–30 minutes, which is noticeably faster than sildenafil, tadalafil or vardenafil. It also has the highest receptor selectivity of the four, which is what gives it 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. There's no generic avanafil in the UK at the moment — it's a branded product only, which makes it more expensive than generic sildenafil or generic tadalafil.

Avanafil blocks the PDE5 enzyme in the smooth muscle of penile blood vessels — the same basic mechanism as the other three approved ED medications. What sets it apart is its very high PDE5 selectivity: it's roughly 100 times more selective for PDE5 over PDE6 (the enzyme involved in retinal function) and other PDE subtypes than sildenafil. That selectivity is why visual disturbances are less common with avanafil than with sildenafil, and why some of its other side effects occur at lower rates too.

Onset and Duration

That fast onset is avanafil's real clinical advantage. For men who find the 30–60 minute wait with sildenafil an obstacle — because it creates anticipatory anxiety or breaks the spontaneity of the moment — avanafil's 15–30 minute window is meaningfully shorter.

Dosage

Never exceed one dose in a 24-hour period. Avanafil isn't affected by food the way sildenafil is — a moderate meal doesn't significantly alter absorption — though a very high-fat meal may modestly delay onset. Take it roughly 15–30 minutes before you anticipate sexual activity.

Side Effects of Avanafil

Avanafil's high PDE5 selectivity gives it 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 — the most common; mild in most men
• Facial flushing — warmth and redness, usually brief
• Nasal congestion — reported less often than with sildenafil
• Back pain — less prominent than with tadalafil thanks to the shorter half-life
• Dizziness — blood-pressure-lowering effect; don't stand up 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. The dose should be reduced to a maximum of 50mg, and potent inhibitors such as ritonavir may rule it out entirely. Your prescriber will screen for interactions during the consultation.

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

Who Is Avanafil (Spedra) Best For?

Avanafil is particularly well-suited to:

• Men who want the shortest possible lead time before sex — especially those who find the 45–60 minute sildenafil window creates performance anxiety or disrupts spontaneity
• Men who get 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 main 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.