Avanafil

Key points

• Effects usually begin 15 to 30 minutes after a tablet is taken, and they can last 4 to 6 hours.
• In trials, reactions reported by 2% or more of patients were headache, flushing, nasal congestion, nasopharyngitis and back pain.
• Avanafil needs sexual stimulation to act, and it does not create desire or cure erectile dysfunction.

What avanafil is used for

Avanafil treats Erectile Dysfunction in adult men and belongs to the PDE5 inhibitor group. Arousal is still required, because the tablet supports the body’s response to stimulation and does not remove the underlying cause of the difficulty. Use is limited to adults. Some men also use it in connection with Premature Ejaculation, where the combination product that adds dapoxetine is the option available here.

How avanafil works

During sexual stimulation, nitric oxide is released in penile tissue, and levels of a signalling molecule called cyclic guanosine monophosphate (cGMP) rise. PDE5 is the enzyme that clears cGMP away. Avanafil inhibits PDE5 selectively and reversibly, so cGMP stays elevated for longer and the smooth muscle of the erectile tissue stays relaxed. Blood flow to that tissue improves, and an erection can be achieved and maintained while stimulation continues. The effect fades as the medicine is cleared from the body.

Tablets and brands

Stendra and Avana are tablets containing avanafil alone, in 50 mg, 100 mg and 200 mg strengths. Super Avana combines avanafil 100 mg with dapoxetine 60 mg in a single tablet and is used for erectile dysfunction together with premature ejaculation. Tablets are the only form in which this ingredient is supplied, the strengths differ between the single-ingredient and combination products, and the combination tablet comes in one strength only. Orders are prepared by pharmacy partners in India and shipped to Malaysia in discreet packaging.

Safety

Do not take avanafil with any nitrate medicine, in any form. That combination is contraindicated because avanafil can potentiate the blood-pressure-lowering effect of nitrates. It is also unsuitable after a recent myocardial infarction, in severe hypotension, or for anyone with hypersensitivity to avanafil. Mention liver problems to your prescriber, since hepatic impairment needs caution, and expect blood pressure to be monitored during treatment.

Seek immediate medical attention for an erection lasting more than four hours, for sudden vision loss, or for a severe cardiovascular event. An erection that persists beyond four hours can damage penile tissue and cause permanent loss of potency when treatment is delayed.

Avanafil interacts with alpha-blockers and with cytochrome P450 inhibitors, so give your prescriber a full medication list before starting. Headache, flushing and nasal congestion are generally mild and settle as the medicine leaves the body. Dyspepsia and dizziness are also reported. Anyone who is breastfeeding should confirm suitability with a clinician or pharmacist first.

What the sources say

• Avanafil is cleared mainly by liver metabolism, chiefly through CYP3A4 and to a smaller degree through the CYP2C isoform. (DailyMed)
• The terminal elimination half-life is around 5 hours. (DailyMed)
• In the fasted state, blood levels reach a median peak 30 to 45 minutes after an oral dose. (DailyMed)

Further reading

• Avanafil
• Australian Public Assessment Report for Avanafil
• Avanafil: MedlinePlus Drug Information
• PDE5 Inhibitors - StatPearls - NCBI Bookshelf - NIH