Avanafil

Avanafil is the active ingredient of the brand-name product Spedra and, since the patent expired, has also been available as a generic. It is the newest and fastest PDE-5 inhibitor on the market.

The generics contain the identical active ingredient.

The onset of action can occur after as little as 15 minutes.

Avanafil inhibits the enzyme phosphodiesterase-5 (PDE-5) in the erectile tissue. As a result, the messenger molecule cGMP remains active for longer, the blood vessels relax, and more blood can flow into the penis.

Advantages of avanafil:

• Fastest absorption of all PDE-5 inhibitors
• High selectivity for PDE-5
• Possibly fewer side effects

Avanafil generics are suitable for men who:

• Need a fast effect
• Tolerate other PDE-5 inhibitors poorly

• 50 mg
• 100 mg
• 200 mg

As with Spedra: start with 100 mg, adjust depending on the effect.

15-30 minutes before sexual intercourse, with or without food.

Avanafil must not be taken in cases of:

• use of organic nitrates in any form or of nitric oxide donors (e.g. amyl nitrite)
• concomitant use of guanylate cyclase stimulators such as riociguat
• concomitant use of strong CYP3A4 inhibitors (including ketoconazole, ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir and telithromycin)
• a heart attack, stroke or life-threatening heart rhythm disorder within the last 6 months
• persistently low blood pressure (below 90/50 mmHg) or high blood pressure (above 170/100 mmHg)
• unstable angina pectoris, angina pectoris during sexual intercourse or heart failure (congestive heart failure) of NYHA class 2 or higher
• severe hepatic impairment (Child-Pugh class C)
• severe renal impairment (creatinine clearance below 30 ml/min)
• loss of vision in one eye due to non-arteritic anterior ischaemic optic neuropathy (NAION)
• known hereditary degenerative retinal disorders
• hypersensitivity to avanafil or any of the other ingredients

Headache, flushing, stuffy nose, dizziness – as with all PDE-5 inhibitors.

Do not combine with:

• Organic nitrates or nitric oxide donors (e.g., amyl nitrite): Avanafil enhances the blood-pressure-lowering effect of nitrates.
• Riociguat: The combination can lead to a symptomatic drop in blood pressure.
• Strong CYP3A4 inhibitors (including ketoconazole, ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir and telithromycin): They can increase the level of avanafil in the blood.
• Other PDE-5 inhibitors or other treatments for erectile dysfunction: The safety and efficacy of the combination have not been studied.

Not recommended or only with caution:

• Moderate CYP3A4 inhibitors (including erythromycin, amprenavir, aprepitant, diltiazem, fluconazole, fosamprenavir or verapamil): no more than 100 mg of avanafil and at least 48 hours between two doses.
• Alpha blockers (e.g., doxazosin, tamsulosin): A drop in blood pressure is possible. Alpha-blocker therapy should be stabilized beforehand; then start avanafil at the lowest dose of 50 mg.
• Other blood-pressure-lowering medicines: The effects can add up and lead to a drop in blood pressure with dizziness, lightheadedness or fainting.
• Alcohol: can increase the likelihood of low blood pressure, dizziness or fainting.
• CYP inducers, especially CYP3A4 inducers (e.g., bosentan, carbamazepine, efavirenz, phenobarbital, rifampicin): The combination is not recommended, as it can reduce the efficacy of avanafil.
• Grapefruit juice: do not drink grapefruit juice within 24 hours before taking a dose.