Avanafil (Stendra, Spedra, Avana): How Fast It Works and How It Compares

Avanafil is the newest of the four erection tablets in the same drug class as Viagra, and the least understood. It is sold as Stendra in the US, as Spedra in the UK, Europe and Australia, and under Indian brand names such as Avana, Avanair and Avaforce. Its selling point is speed: the US label allows it to be taken as little as 15 minutes before sex.

This guide sets out what the trials behind that label actually measured, how avanafil compares with sildenafil and tadalafil, and who should not take it. We sell several avanafil brands, and we think the numbers matter more than the marketing.

The short answer

Avanafil is a PDE5 inhibitor approved by the FDA in 2012 for erectile dysfunction. The usual starting dose is 100 mg, taken as early as about 15 minutes before sexual activity, adjustable up to 200 mg or down to 50 mg, never more than once a day. It is absorbed faster than sildenafil and has a half-life of about five hours. In the main US trial, 100 mg and 200 mg roughly doubled the rate of successful intercourse compared with placebo. The 15 minute claim is real but modest: at that point about one attempt in four succeeded, against one in seven on placebo. Headache and flushing are the most common side effects, and nitrates are an absolute no.

What avanafil is, and the names you will see

Every avanafil product contains the same molecule. What changes between them is the maker, the market and the price.

Name	Maker	Where it is sold	Strengths
Stendra	Petros Pharmaceuticals	United States (brand)	50, 100, 200 mg
Generic avanafil	Hetero Labs for Camber	United States, marketed since June 2024	50, 100, 200 mg
Spedra	Menarini	UK, EU, Australia (prescription only)	50, 100, 200 mg
Avana 50, 100 and 200	Sunrise Remedies	India, export	50, 100, 200 mg
Avanair 100 and 200	Cipla	India, export	100, 200 mg
Avagra 100	HAB Pharmaceuticals	India, export	100 mg
Avaforce 100	Centurion Laboratories	India, export	100 mg

Products with dapoxetine added, such as Top Avana and Super Avana, are a different thing and are covered further down.

How avanafil works

An erection starts when sexual stimulation releases nitric oxide in the penis, which raises a messenger called cGMP and lets blood flow in. The enzyme PDE5 breaks cGMP down. Avanafil blocks PDE5, so the signal lasts longer. It does nothing without stimulation, the same as every drug in the class.

What sets avanafil apart on paper is selectivity. According to the FDA label, it is more than 100 times more potent against PDE5 than against PDE6, the retinal enzyme linked to the blue tinge some men notice on sildenafil, and more than 10,000 times more potent than against PDE1 and PDE11. In practice, across every avanafil trial in the label, one subject reported a change in colour vision. For men who dislike the visual side effects of sildenafil, that is a meaningful difference.

How fast does avanafil work?

Avanafil reaches peak blood levels at a median of 30 to 45 minutes on an empty stomach, quicker than the roughly one hour typical of sildenafil. The FDA reviewed a dedicated onset study (Study 4) in 440 men, 41 percent of them with severe ED, who were told to attempt sex about 15 minutes after dosing and to time it with a stopwatch.

Successful intercourse at about 15 minutes (Study 4)	Placebo	Avanafil 100 mg	Avanafil 200 mg
Mean share of attempts	14.9%	25.9%	29.1%
Median share of attempts	0%	11.1%	13.3%

Read that carefully. Avanafil beat placebo at 15 minutes, and the result was statistically significant. But at that point most attempts still did not succeed. The label wording, "as early as approximately 15 minutes", is accurate. It does not mean most men will be ready in 15 minutes. For the best result, allow around 30 minutes, which is the timing the main efficacy trials used.

How well it works: the trial numbers

Three placebo-controlled US trials of about three months each form the core evidence. The measure that matters most to users is SEP3: the share of attempts where the erection lasted long enough for successful intercourse.

Population	Placebo	50 mg	100 mg	200 mg
General ED, 646 men (Study 1)	27.0%	41.3%	57.1%	57.0%
ED with diabetes, 390 men (Study 2)	20.5%	not tested	34.4%	40.0%
After nerve-sparing prostatectomy, 286 men (Study 3)	8.9%	not tested	23.4%	26.4%

Three things stand out. First, 100 mg and 200 mg performed almost identically in the general population. Second, men with diabetes and men after prostate surgery responded less well, which is true of every PDE5 inhibitor. Third, even in the hardest group, avanafil more than doubled the placebo success rate. A 2023 meta-analysis of 11 publications (PMID 37484697) confirmed the overall picture: avanafil improved erectile function scores by about 4.4 points over placebo and more than tripled the chance of successful penetration.

Avanafil 50mg vs 100mg vs 200mg

The label logic is simple: start at 100 mg, go up to 200 mg if the effect is not enough and the side effects are tolerable, or drop to 50 mg if side effects are a problem. The 50 mg dose should be taken about 30 minutes before sex rather than 15.

• 50 mg is the required starting dose for men on a stable alpha blocker for blood pressure or prostate symptoms, and the maximum for men taking a moderate CYP3A4 inhibitor such as erythromycin, diltiazem, verapamil or fluconazole.
• 100 mg is the standard dose and, in Study 1, delivered the same intercourse success rate as 200 mg.
• 200 mg scored slightly higher on erectile function questionnaires in the meta-analysis above (about 1.2 points), with no difference in successful intercourse or overall side effect rates. In the 12 month extension study, about three quarters of the 712 men chose to move up to 200 mg, which suggests many found the step worth it.

Side effects by dose

Table 1 of the FDA label pools the three 12 week placebo-controlled trials:

Adverse reaction	Placebo	50 mg	100 mg	200 mg
Headache	1.7%	5.1%	6.9%	10.5%
Flushing	0.0%	3.2%	4.3%	4.0%
Nasal congestion	1.1%	1.8%	2.9%	2.0%
Nasopharyngitis	2.9%	0.9%	2.6%	3.4%
Back pain	1.1%	3.2%	2.0%	1.1%

Only headache rises clearly with dose. Discontinuation for side effects was 1.4 to 2.0 percent on avanafil against 1.7 percent on placebo, so very few men stopped because of them. For context, the tadalafil label reports headache in 15 percent of men at 20 mg, so avanafil sits at the lower end of the class, though trials of different drugs are not directly comparable.

Avanafil 200 mg also lowered blood pressure by about 8 mmHg systolic and 3 mmHg diastolic versus placebo one hour after dosing in healthy men. That is minor for most people and relevant for men already on several blood pressure drugs.

Avanafil vs sildenafil

This is the comparison most people want. There is one randomised head-to-head trial (PMID 35080051): 220 men received avanafil 100 mg or sildenafil 50 mg for 12 weeks, with the option to step up to 200 mg or 100 mg respectively.

• At 12 weeks, avanafil improved erectile function scores by 2.1 points more than sildenafil.
• On a modified measure of early response, 84.8 percent responded on avanafil against 28.2 percent on sildenafil.
• Dose escalation was needed by 40.0 percent on avanafil and 45.6 percent on sildenafil.
• Headache was the most common side effect in both groups.

Two cautions. It is a single trial, and it compared the starting doses of each drug rather than their maximum doses. Earlier pooled analyses were more measured: a meta-analysis of the placebo-controlled avanafil trials (PMID 26646748) found efficacy comparable to the older PDE5 inhibitors with fewer drug related side effects, and a 2013 review (PMID 24259695) noted a network analysis in which avanafil scored lower on a global question about whether treatment improved erections. The fair summary: avanafil works about as well as sildenafil, acts faster, and tends to be better tolerated. It is not dramatically stronger. Our sildenafil guide covers the other side of the comparison.

Avanafil vs tadalafil

These two solve different problems. Tadalafil has a half-life of about 17.5 hours, works for up to 36 hours, and can be taken as a low daily dose. Avanafil has a half-life of about five hours and suits men who want a quick, short-lived effect on the day. If you want to plan a weekend, tadalafil fits better. If you want spontaneity without the drug lingering into the next day, avanafil fits better. See our tadalafil vs sildenafil comparison for how tadalafil behaves.

The four ED tablets side by side

Feature	Avanafil	Sildenafil	Vardenafil	Tadalafil
Typical time to peak (fasted)	30 to 45 min	About 60 min	About 60 min	About 2 hours
Half-life	About 5 hours	About 4 hours	4 to 5 hours	About 17.5 hours
Earliest labelled timing before sex	About 15 min	About 1 hour	About 1 hour	Before activity, effect up to 36 hours
Daily dosing option	No	No	No	Yes, 2.5 or 5 mg
Generic available in the US	Yes, since 2024	Yes	Yes	Yes

For a deeper look at the older three, read our sildenafil, tadalafil and vardenafil comparison.

Food and alcohol

The label says avanafil can be taken with or without food, and total absorption barely changes. But a high fat meal delayed the peak by over an hour and cut the peak level by 39 percent. If speed is the reason you chose avanafil, take it on a light stomach.

On alcohol, the label warns that more than about 3 units can bring on dizziness, a faster heart rate and a drop in standing blood pressure. In a study where men drank about 3 ounces of 80-proof vodka (for a 70 kg man) with 200 mg of avanafil, blood pressure fell by a further 3.5/4.5 mmHg and pulse rose by 9 beats a minute compared with alcohol alone. A drink or two is not a problem for most men. A heavy night is a bad pairing. Grapefruit juice can also raise avanafil levels and is best avoided on the day.

Who should not take avanafil

• Anyone using nitrates in any form, including nitroglycerin sprays, isosorbide tablets and recreational poppers. If a nitrate becomes necessary in an emergency, at least 12 hours must pass after the last avanafil dose, shorter than the 48 hours specified for tadalafil.
• Men taking riociguat or vericiguat.
• Men taking strong CYP3A4 inhibitors, including ketoconazole, itraconazole, clarithromycin, ritonavir and several other HIV protease inhibitors.
• Men with severe kidney disease or on dialysis, or with severe liver disease. These groups were not studied.
• Men with a heart attack, stroke or serious arrhythmia in the last six months, resting blood pressure below 90/50 or above 170/100, unstable angina, or heart failure of NYHA class 2 or above. These groups were excluded from the trials.
• Men with hereditary retinal disease such as retinitis pigmentosa.

Interactions that change the dose

Avanafil is broken down by the liver enzyme CYP3A4, so drugs that block it push levels up sharply. Ketoconazole raised avanafil exposure about 13-fold and stretched its half-life to about 9 hours. Erythromycin raised exposure roughly three to four times. Even amlodipine, a very common blood pressure tablet, raised avanafil exposure by about 70 percent. If you take any regular medicine, check it with a pharmacist before your first dose. Never combine avanafil with another ED tablet.

Avanafil with dapoxetine: Top Avana, Super Avana and Extra Super Avana

Several Indian products add dapoxetine, a short-acting drug for premature ejaculation, to avanafil in one tablet:

• Top Avana: avanafil 50 mg with dapoxetine 30 mg.
• Super Avana and Avaforce D: avanafil 100 mg with dapoxetine 60 mg.
• Extra Super Avana: avanafil 200 mg with dapoxetine 60 mg.

Dapoxetine is licensed for premature ejaculation in the UK and a number of other countries, but not in the US, and no major regulator has approved a combined avanafil and dapoxetine tablet. Dapoxetine can cause fainting, especially with alcohol or dehydration, and adding it to a blood pressure lowering drug stacks that risk. If you only have an erection problem, plain avanafil is the better choice. If premature ejaculation is the main issue, read our dapoxetine dosage guide and the sildenafil and dapoxetine combination guide first.

Is there a generic avanafil?

Yes, in the US. The FDA approved Hetero Labs' generic, and Camber began marketing it in June 2024. Prices are still high by ED standards: US discount card prices in 2026 run from roughly $10 to $36 per tablet, against a few dollars for generic sildenafil or tadalafil. In the UK only the Spedra brand is available, and in Australia Spedra is a Schedule 4 prescription medicine. Indian brands such as Avana and Avanair are made for the Indian and export markets and are not approved by the FDA, the MHRA or the TGA.

If you are in the US, check the current customs position before ordering any prescription medicine from abroad. A US Customs rule with an October 22, 2026 compliance date changes how international mail containing FDA-regulated products, including prescription medicines, is processed.

Who avanafil suits best

• Men who find sildenafil works but dislike the wait, or the visual side effects.
• Men who want a short-acting tablet that is largely gone by the next morning.
• Men who got headaches or flushing on sildenafil and want to try a better tolerated option in the same class.

It is a weaker fit for men who want a daily tablet or a weekend-long window, where tadalafil is the natural choice, and for anyone on a strong CYP3A4 inhibitor, where it should not be used at all.

How to take avanafil for the best result

1. Take one tablet with water, 15 to 30 minutes before sex for 100 or 200 mg, and about 30 minutes before for 50 mg.
2. Avoid a heavy fatty meal just before, or allow extra time.
3. Keep alcohol light.
4. Remember that stimulation is still needed.
5. Judge it over several attempts, not one. Trial results were measured across weeks.
6. Never take more than one dose in 24 hours.

Warning signs that need emergency care

• An erection lasting more than four hours.
• Sudden loss of vision in one or both eyes.
• Sudden decrease or loss of hearing, sometimes with ringing or dizziness.
• Chest pain, fainting or severe dizziness during or after sex.
• Swelling of the face, lips or eyelids.

More options are covered on our erectile dysfunction page and, for combined problems, our premature ejaculation page.

References

• FDA prescribing information for avanafil tablets (DailyMed, Hetero Labs for Camber Pharmaceuticals, revised 11/2025): sections 2 (Dosage and Administration), 4 (Contraindications), 5 (Warnings and Precautions), 6.1 Table 1 (adverse reactions), 7 (Drug Interactions), 12.1 to 12.3 (Clinical Pharmacology) and 14 (Clinical Studies, Tables 7 to 10)
• The Efficacy and Safety of Avanafil During a Treatment of Male Erectile Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PMID 37484697
• Efficacy and safety of avanafil as compared with sildenafil in the treatment of erectile dysfunction: a randomized, double blind, multicenter clinical trial. PMID 35080051
• Meta-analysis of placebo-controlled trials of avanafil as a second generation PDE5 inhibitor. PMID 26646748
• Avanafil for erectile dysfunction. PMID 24259695
• TGA Australian Register of Therapeutic Goods: Spedra (avanafil), sponsor A. Menarini Australia

Medical disclaimer: this article is for information only and is not medical advice. Avanafil is a prescription medicine. Do not combine it with nitrates or other ED medicines, and speak to a doctor before use if you have heart disease, low or uncontrolled blood pressure, or take other regular medicines. If an erection lasts more than four hours or you suddenly lose vision or hearing, seek emergency care.