What makes avanafil different

Avanafil was designed after the first generation of PDE5 inhibitors, with two goals: get into the bloodstream faster, and hit PDE5 more selectively so fewer unrelated enzymes are affected. It largely succeeded at both.

Onset compared across the class
MedicationTypical onsetUseful window
Avanafil15–30 minutesAbout 6 hours
Sildenafil30–60 minutes4–6 hours
Vardenafil30–60 minutes4–8 hours
Tadalafil30 minutes – 2 hoursUp to 36 hours

The greater selectivity means less PDE6 blockade (fewer visual disturbances) and less PDE11 blockade (less back and muscle ache). For men who tried sildenafil and hated the headache, or tadalafil and hated the backache, that profile is the main reason to consider it.

Doses and timing

  • Available as 50 mg, 100 mg and 200 mg tablets.
  • Usual starting dose is 100 mg, taken roughly 15–30 minutes before sex.
  • Maximum once in 24 hours.
  • Food has only a modest effect, so a normal meal is not a problem.
  • Lower doses are used with alpha-blockers or moderate CYP3A4 inhibitors.

Side effects

Headache, flushing and nasal congestion remain the most common effects. Rates of visual disturbance and muscle pain are lower than with the older drugs, which is the main tolerability argument in its favour.

Who should not take it

  • Strong CYP3A4 inhibitors (ritonavir, ketoconazole, itraconazole, clarithromycin) — avanafil should generally be avoided.
  • Alpha-blocker users — start at 50 mg only when stable on the alpha-blocker.
  • Severe hepatic or renal impairment.
  • Unstable cardiac disease, until cleared by a clinician.

The cost problem

This is where avanafil struggles. Generic availability in US retail pharmacies has been patchy and prices remain well above generic sildenafil or tadalafil. Insurance coverage for ED drugs is poor across the board, so most people pay cash — and at cash prices, avanafil is usually several times the cost of the alternatives.

FAQ

Frequently asked questions

Is avanafil really faster than Viagra?
Yes, meaningfully so. Trials showed benefit at 15 minutes; sildenafil generally needs 30 to 60 minutes, longer after a heavy meal.
Is it more effective than the older drugs?
No. Its advantages are speed and tolerability, not a higher success rate.
Why is it so much more expensive?
It is the newest drug in the class and generic competition has been limited. Sildenafil and tadalafil have had years of generic price erosion that avanafil has not.
Can I take it with food?
Yes. Food has less effect on avanafil than on sildenafil or vardenafil, though a very heavy meal will still slow things down somewhat.
Sources

What this is based on

We link to primary sources — clinical guidelines, regulator publications and peer-reviewed research — wherever possible. Links open on third-party sites we do not control.

  1. [01]U.S. Food and Drug Administration. Drugs@FDA — approved drug products and prescribing information.
  2. [02]American Urological Association. Erectile Dysfunction: AUA Guideline (2018).
  3. [03]MedlinePlus (National Library of Medicine). Drugs, Herbs and Supplements.