> ## Documentation Index
> Fetch the complete documentation index at: https://docs.hi-doctor.ai/llms.txt
> Use this file to discover all available pages before exploring further.
# Avanafil
> What avanafil is, how it works, the fastest-onset figures from its EU trials, and what a doctor checks before prescribing it.
Avanafil is a prescription tablet for erectile dysfunction, authorised across the EU since 2013. It works like other medicines in its class by keeping the blood vessels in the penis relaxed so blood can flow in during sexual arousal, and it must never be taken with nitrate heart medicines.
## What it is
Avanafil is a PDE5-inhibitor tablet taken by mouth, for adult men with erectile dysfunction. It is the most recently approved of the PDE5-inhibitor tablets, authorised for use in the EU since 21 June 2013 under EMA marketing authorisation EMEA/H/C/002581 (branded Spedra). Sexual stimulation is still required for it to work.
Active ingredient: **avanafil**. Available strengths: **50 / 100 / 200 mg**, taken on demand.
## How it works
Avanafil does nothing on its own. When a man is sexually aroused, nerves and the blood-vessel lining in the penis release a gas called nitric oxide — the trigger the EU product information points to as the reason stimulation is required for the tablet to work. Avanafil blocks the PDE5 enzyme that normally ends an erection, so the blood vessels in the penis stay relaxed and fill with blood in response to that arousal.
The EU product information states the usual dose is 100 mg, taken about 15 to 30 minutes before sex.
At most one dose in 24 hours.
50, 100 or 200 mg, on demand.
Nitrates and poppers are contraindicated — blood pressure can fall dangerously.
## What the studies reported
The EMA's Spedra EPAR product information (SmPC sections 4.2, 4.8 and 5.1) reports general-population success rates of approximately 47%, 58% and 59% for the 50, 100 and 200 mg doses, against approximately 28% on placebo. The randomised, double-blind, placebo-controlled trial behind this was published in the *Journal of Sexual Medicine* in 2012 (PMID 22248153), and is registered on ClinicalTrials.gov as the TA-301 avanafil Phase 3 trial (NCT00790751); a second registered trial is listed as NCT00809471.
The often-quoted 15-minute and 6-hour onset figures come from small subsets of attempts — 300 and 80 respectively — inside a 12-week trial, so they are much less precise than the trial's overall 12-week results.
## What has been reported
| Reaction | EU frequency band |
| ---------------- | -------------------------------------------------------------------------------------------------------------------------------- |
| Headache | Common (1 in 100 to 1 in 10) — also one of the most frequently reported reactions in a safety database of 2,566 exposed subjects |
| Flushing | Common (1 in 100 to 1 in 10) |
| Nasal congestion | Common (1 in 100 to 1 in 10); sinus congestion is uncommon |
| Back pain | Uncommon (1 in 1,000 to 1 in 100) — though named among the most frequently reported reactions in the safety summary |
| Dizziness | Uncommon (1 in 1,000 to 1 in 100) |
| Blurred vision | Uncommon (1 in 1,000 to 1 in 100) |
## Who it is not suitable for
Avanafil is contraindicated with nitrate medicines and nitric-oxide donors, and in men with serious cardiovascular conditions such as a recent heart attack, stroke, or unstable angina.
## How Hi-Doctor handles it
A licensed EU doctor reviews your questionnaire and, if avanafil or another treatment is appropriate, issues an electronic prescription valid at any EU pharmacy under Directive 2011/24/EU. Hi-Doctor does not sell or ship medications — the medicine itself is paid separately, at a pharmacy of your choice. See [pricing](/essentials/pricing) for the consultation fee, and the [Spedra (avanafil) guide](/library/guides/spedra-avanafil) for day-to-day dosing detail. If erectile dysfunction is the condition you're exploring treatment for more broadly, see the [erectile dysfunction](/library/conditions/erectile-dysfunction) overview.
## Start a consultation
Answer the sexual health questionnaire and a registered doctor reviews it.
They decide whether treatment is appropriate, which one, and at what dose —
and declining is a normal outcome. See [what it costs](/essentials/pricing)
and [how the review works](/essentials/how-it-works).
This page is reference information, not medical advice and not a prescription.
Whether a medicine is appropriate for you is decided by a registered doctor
after reviewing your consultation.