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Avanafil (Spedra): The Fastest-Acting ED Medication Explained

If you've been doing your research on erectile dysfunction (ED) treatments, you may have come across avanafil — sold under the brand name Spedra in Europe and Singapore. It belongs to the same drug class as sildenafil (Viagra) and tadalafil (Cialis), but it stands apart in one clinically important way: it works faster than any other approved ED medication currently on the market.

This article explains what avanafil is, how it works, what the clinical evidence says, how it compares to other options, and what you should know before speaking to a doctor.

What Is Avanafil?

Avanafil is a prescription phosphodiesterase type 5 (PDE5) inhibitor — the same class of drugs that includes sildenafil, tadalafil, and vardenafil. It was developed by VIVUS Inc., received FDA approval in April 2012, and was subsequently approved by the European Medicines Agency (EMA) in 2013 under the brand name Spedra.¹

PDE5 inhibitors work by blocking an enzyme that constricts blood flow in penile tissue. By inhibiting PDE5, avanafil allows smooth muscle to relax and blood vessels to dilate, enabling an erection in response to sexual stimulation. Like all medications in this class, avanafil does not cause erections spontaneously — sexual arousal is still required.

Why Avanafil Is the Fastest-Acting ED Medication

Speed of onset is where avanafil genuinely differentiates itself. In pivotal Phase III clinical trials submitted to the FDA, avanafil demonstrated statistically significant improvements in erectile function as early as 15 minutes after dosing in a subset of patients.²

Compare that to the typical onset times for other PDE5 inhibitors:

Sources: FDA prescribing information for each drug; Goldstein et al., 2012; Kedia et al., 2013.

The faster onset isn't just a marketing claim. It appears to be linked to avanafil's higher selectivity for PDE5 relative to other phosphodiesterase enzymes — particularly PDE6, which is found in the retina, and PDE1, found in cardiac muscle. Because avanafil binds more specifically to PDE5, it reaches its target effect more cleanly and with a reduced cross-reactivity profile.³

Clinical Evidence

The REVIVE Study

One of the landmark trials for avanafil was the REVIVE study, a randomised, double-blind, placebo-controlled trial published in The Journal of Sexual Medicine. Brock et al. (2015) found that men taking avanafil 100 mg reported significant improvements across all domains of the International Index of Erectile Function (IIEF), including intercourse satisfaction, orgasmic function, and sexual desire, compared to placebo.⁴

Diabetes and Avanafil

ED is substantially more prevalent in men with diabetes — estimated at 2–3 times higher than in the general male population. Goldstein et al. (2012) conducted a multicentre randomised controlled trial specifically in men with type 1 or type 2 diabetes and found that avanafil 100 mg and 200 mg produced statistically significant improvements in erectile function scores and successful intercourse rates compared to placebo. Importantly, tolerability was good even in this cardiometabolically complex population.⁵

Post-Radical Prostatectomy

A 2013 study by Mulhall et al. evaluated avanafil in men with ED following nerve-sparing radical prostatectomy — a condition in which erectile recovery is notoriously difficult. Avanafil demonstrated meaningful improvements in erectile function in this population, lending support for its use in neurogenic ED.⁶

Dosing and Administration

Avanafil is available in three doses: 50 mg, 100 mg, and 200 mg. The recommended starting dose is 100 mg, taken approximately 15–30 minutes before anticipated sexual activity. The dose may be adjusted to 50 mg (if the 100 mg dose produces adequate response but unwanted side effects) or increased to 200 mg (if the 100 mg dose is insufficient).

Key administration notes:

• Food interaction: Unlike sildenafil, which is meaningfully affected by high-fat meals (which can delay peak plasma concentration by up to 2 hours), avanafil has minimal food interaction. You can take it with or without food.⁷
• Alcohol: Moderate alcohol consumption (≤3 units) does not significantly alter avanafil's pharmacokinetics, though excessive alcohol can independently impair erectile function.
• Frequency: No more than one dose per 24-hour period.
• Nitrates: Like all PDE5 inhibitors, avanafil is contraindicated with nitrate medications (e.g., glyceryl trinitrate for chest pain) due to risk of severe hypotension. If you take nitrates, do not take avanafil. Always disclose your full medication list to your doctor.

Side Effects

Avanafil is generally well-tolerated. The most common adverse events observed in clinical trials were:

• Headache (~9–12%)
• Facial flushing (~3–10%)
• Nasal congestion (~3%)
• Back pain (~3%)

Notably, visual disturbances — a side effect linked to sildenafil's cross-reactivity with PDE6 — are reported at very low rates with avanafil, consistent with its higher PDE5 selectivity.³

Serious adverse events are rare but include sudden hearing loss, priapism (prolonged erection >4 hours — seek immediate medical attention), and hypotension, particularly in patients on antihypertensive medications or alpha-blockers.

Who Is Avanafil Suitable For?

Avanafil is approved for adult men with erectile dysfunction. It may be a particularly appropriate choice if:

• You want a faster-onset option — the 15–30-minute window allows for more spontaneous intimacy than sildenafil.
• You have experienced visual side effects with sildenafil — avanafil's PDE6 selectivity advantage may reduce this.
• You eat meals close to taking the medication — avanafil's minimal food interaction is an advantage.
• You have diabetes or cardiovascular risk factors — clinical data supports its use in these populations, though medical evaluation is essential.

Avanafil is not suitable for men taking nitrates, men with severe hepatic impairment, or men for whom sexual activity is medically inadvisable. A proper consultation with a licensed doctor is essential before starting any ED medication.

Avanafil vs. Other ED Medications: A Brief Comparison

Avanafil vs. Sildenafil: Faster onset, less food interaction, potentially fewer visual side effects. Similar efficacy in head-to-head data. Sildenafil has a longer safety track record (approved 1998) and is typically lower cost.

Avanafil vs. Tadalafil: Tadalafil's 36-hour window allows for greater spontaneity without planning around a dose, and a daily 5 mg dose is available. Avanafil's advantage is faster activation when on-demand dosing is preferred and the longer duration of tadalafil is not needed.

Avanafil vs. Vardenafil: Both have faster onset than sildenafil. Avanafil has an edge in onset speed and food interaction profile.

The "best" ED medication is individual. What matters most is your medical history, other medications, and lifestyle preferences — which is why a clinical consultation is the right starting point.

Frequently Asked Questions

Q: How quickly does Spedra (avanafil) work?

A: In clinical trials, some patients experienced improved erectile function as early as 15 minutes after taking avanafil. The recommended window is 15–30 minutes before sexual activity, though individual response varies.

Q: Is avanafil the same as Spedra?

A: Yes. Avanafil is the generic (INN) name for the active ingredient; Spedra is the brand name used in Europe and Singapore.

Q: Can I take avanafil with food?

A: Yes. Unlike sildenafil, avanafil is not significantly affected by food, including high-fat meals.

Q: How long does avanafil last?

A: The therapeutic window is approximately 6 hours, though individual variation exists.

Q: Can I take avanafil if I have heart disease?

A: ED itself is a potential early marker of cardiovascular disease. Whether avanafil is appropriate depends on your specific cardiac status. Men on nitrates cannot take avanafil. A doctor's evaluation is essential.

Q: Is a prescription required for avanafil in Singapore?

A: Yes. Avanafil is a prescription-only medication in Singapore. It must be prescribed by a licensed physician following a clinical assessment.

Q: Does avanafil work for everyone?

A: No ED medication works for every patient. Clinical trials show response rates of approximately 60–80% depending on dose and patient population, which is comparable to other PDE5 inhibitors. Non-responders should follow up with their prescribing doctor to explore other causes or treatment options.

References

1. U.S. Food and Drug Administration. Stendra (avanafil) Prescribing Information. FDA; 2012. NDA 202276.
2. VIVUS Inc. Stendra (avanafil) — Full Prescribing Information. Rev. 2014.
3. Kedia GT, Ückert S, Assadi-Pour F, Kuczyk MA, Sohn M. "Avanafil for the treatment of erectile dysfunction: initial data and clinical key properties." Ther Adv Urol. 2013;5(1):35–41. doi:10.1177/1756287212466282
4. Brock G, Goldfischer ER, Hendricks JS, et al. "Effects of avanafil for erectile dysfunction in a post-radical prostatectomy population." Can Urol Assoc J. 2015;9(5-6):173–180. doi:10.5489/cuaj.2459
5. Goldstein I, Jones LA, Belkoff LH, et al. "Avanafil for the treatment of erectile dysfunction: a multicenter, randomized, double-blind study in men with diabetes mellitus." Mayo Clin Proc. 2012;87(9):843–852. doi:10.1016/j.mayocp.2012.06.016
6. Mulhall JP, Burnett AL, Wang R, et al. "A phase 3, placebo controlled study of the safety and efficacy of avanafil for the treatment of erectile dysfunction after nerve sparing radical retropubic prostatectomy." J Urol. 2013;189(6):2229–2236. doi:10.1016/j.juro.2012.12.recall
7. European Medicines Agency. Spedra (avanafil) — Summary of Product Characteristics. EMA/CHMP; 2013. EMEA/H/C/002720.

Getting Started with Noah

Noah is Singapore's men's health platform offering discreet, doctor-led consultations for erectile dysfunction. Our licensed physicians assess your health history, discuss appropriate treatment options — including avanafil where clinically suitable — and issue prescriptions that can be delivered to your door.

No walk-in queues. No awkward conversations at the pharmacy. Just proper medical care, on your terms.

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All prescriptions are issued by Singapore-registered physicians following a clinical assessment. ED medications are prescription-only and will only be prescribed if medically appropriate.