Description
Avana (avanafil)
Avanafil’s main clinical argument is speed. In trials, 67 to 72% of men achieved successful intercourse within 15 minutes of taking 100 mg — faster than sildenafil, faster than tadalafil, faster than vardenafil. It was approved by the FDA in 2012, the most recently approved oral PDE5 inhibitor, and its selectivity for PDE5 over other phosphodiesterase enzymes is higher than older drugs in the class. Whether that translates to fewer side effects in practice varies between individuals, but the data for headache, flushing, and visual disturbances does favor avanafil in comparative studies.
Available in 50 mg, 100 mg, and 200 mg tablets. The recommended starting dose is 100 mg.
The 15-minute window
Taking avanafil as little as 15 minutes before sexual activity is supported by clinical evidence — the label states “as early as approximately 15 minutes before sexual activity.” This is the most practically significant difference from sildenafil’s 30 to 60 minute requirement. Duration is approximately 4 to 6 hours. Like all on-demand PDE5 inhibitors, it requires sexual stimulation; it has no effect without it.
Mechanism
Avanafil inhibits PDE5 in penile smooth muscle, preventing breakdown of cyclic GMP and sustaining the vasodilatory response to sexual arousal. The higher selectivity for PDE5 compared to older PDE5 inhibitors — particularly PDE6 (found in the retina) — is the proposed reason for the lower incidence of visual disturbances.
Nitrates
Like all PDE5 inhibitors, avanafil is absolutely contraindicated with nitrates: nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, amyl nitrate. The combination causes potentially fatal hypotension. There is no safe version of this combination.
Contraindications
All forms of nitrate therapy. Heart failure, recent stroke, or recent myocardial infarction. Unstable angina. History of NAION (non-arteritic anterior ischemic optic neuropathy). Retinitis pigmentosa. Severe renal or hepatic impairment. Hypersensitivity to avanafil.
In patients with mild to moderate kidney disease, no dose adjustment is required — this is a practical advantage compared to some other PDE5 inhibitors where careful titration is needed. Same for elderly patients: the pharmacokinetic profile doesn’t require routine dose adjustment in older men.
Side effects
Headache, flushing, nasal congestion, back pain, nausea, and dizziness — the standard PDE5 inhibitor side effect profile. The comparative advantage of avanafil’s selectivity is modest rather than dramatic; some patients notice a difference versus prior sildenafil use, others don’t. Electrocardiographic changes have been reported, which is why the cardiovascular precautions relevant to this drug class apply here.
Priapism — erection lasting more than 4 hours — requires emergency treatment. Delay causes permanent tissue damage.
Food
High-fat meals modestly delay avanafil’s onset, similar to sildenafil. For the fastest effect — which is the drug’s main argument — taking it on an empty stomach or after a light meal is preferable.
