Avanafil and COVID: Is It Safe?

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Can You Take Avanafil If You Have COVID-19?

If you have COVID-19 but are not taking any specific antiviral or prescription COVID treatments, avanafil itself is not contraindicated by the infection alone. COVID-19 is a respiratory viral illness, and avanafil (Spedra) is a PDE5 inhibitor used to treat erectile dysfunction by improving blood flow to the penis when you are sexually aroused [6]. The virus does not directly interact with the way avanafil works in your body.

However, if you feel unwell with COVID symptoms—such as fever, fatigue, breathlessness, or body aches—sexual activity may not be advisable simply because your body needs rest to recover. Avanafil requires sexual stimulation to work, and if you are too unwell or fatigued, it is unlikely to be effective or appropriate to use [1][6]. Always listen to your body and prioritise recovery.

The main concern arises if you are prescribed antiviral medications to treat COVID-19, particularly Paxlovid, which contains ritonavir—a potent CYP3A4 inhibitor that significantly raises avanafil levels in the blood and increases the risk of side effects. This interaction is covered in detail below.

Avanafil and COVID Treatments: Key Drug Interactions

The most important interaction between avanafil and COVID treatments involves Paxlovid (nirmatrelvir/ritonavir), which is sometimes prescribed for people at higher risk of severe COVID-19. Ritonavir is a potent inhibitor of the liver enzyme CYP3A4, which is responsible for breaking down avanafil in your body [6]. When ritonavir blocks this enzyme, avanafil levels can rise significantly, increasing the risk of side effects such as headache, flushing, dizziness, low blood pressure, and visual disturbances.

According to the British National Formulary, avanafil is contraindicated (must not be used) with potent CYP3A4 inhibitors, including ritonavir and cobicistat [6]. This means you should not take avanafil while you are on a course of Paxlovid. A typical Paxlovid course lasts five days, and it is safest to wait until the treatment is finished and the drug has cleared your system (usually a few days after the last dose) before resuming avanafil. Always check with your prescriber or pharmacist before restarting.

Other COVID treatments, such as molnupiravir (Lagevrio) or remdesivir, do not have the same enzyme-blocking effect and are not known to interact significantly with avanafil. If you are unsure which COVID treatment you have been given, check the packaging or ask your pharmacist. During any online consultation at Cured Pharmacy, our UK prescribers review all your current medicines, including any recent or ongoing COVID treatments, to ensure avanafil is safe for you.

What About Other Medicines You Might Take During COVID?

During COVID-19, you might also take over-the-counter medicines such as paracetamol or ibuprofen to manage fever and aches. These do not interact with avanafil and can be used safely alongside it [6]. However, if you are prescribed antibiotics (such as clarithromycin or erythromycin) for a secondary bacterial infection, be aware that clarithromycin is also a potent CYP3A4 inhibitor and can raise avanafil levels, requiring dose adjustment or avoidance [6]. Always declare every medicine—prescription, over-the-counter, or herbal—during your consultation so the prescriber can check for interactions.

How Does Avanafil Work and Why Does It Matter for COVID?

Avanafil (sold as Spedra in the UK) is a phosphodiesterase type 5 (PDE5) inhibitor licensed to treat erectile dysfunction in adult men [6][11]. It works by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually stimulated. Avanafil is known for its relatively fast onset—it can start working in as little as 15 to 30 minutes—and is available in 50mg, 100mg, and 200mg tablets [6]. The usual starting dose is 100mg, taken about 30 minutes before sexual activity, and it should not be used more than once a day.

Understanding how avanafil is processed by your body helps explain why certain COVID treatments cause problems. Avanafil is broken down primarily by the liver enzyme CYP3A4 [6]. If a medicine like Paxlovid blocks this enzyme, avanafil stays in your bloodstream longer and at higher concentrations, which can lead to more pronounced side effects or even unsafe drops in blood pressure, especially if you are also taking other blood-pressure-lowering medicines.

COVID-19 itself does not change how your liver processes avanafil, but severe illness, dehydration, or reduced food and fluid intake during infection can sometimes affect how medicines work in general. If you are significantly unwell, it is sensible to postpone non-essential medicines like avanafil until you feel better and can engage in sexual activity safely [1].

What you need to know

• Avanafil is generally safe if you have COVID-19, but avoid it if you are taking Paxlovid due to a serious drug interaction.
• Paxlovid contains ritonavir, which raises avanafil levels significantly and makes the combination contraindicated.
• COVID vaccines do not interact with avanafil and you can continue treatment around vaccination.
• New erectile dysfunction after COVID should be assessed by your GP to rule out cardiovascular or metabolic causes.
• Always declare recent COVID illness and treatments during your online consultation for safe prescribing.

Long COVID, Erectile Dysfunction, and Avanafil

Some men report new or worsening erectile dysfunction after recovering from COVID-19, a phenomenon sometimes linked to 'long COVID' or post-COVID syndrome. Research is ongoing, but possible mechanisms include damage to blood vessels (endothelial dysfunction), reduced oxygen levels during illness, psychological stress, fatigue, and hormonal changes [1]. Erectile dysfunction can also be an early warning sign of cardiovascular disease, which COVID-19 may exacerbate in some individuals [10].

If you have developed erectile dysfunction after COVID, it is important to see your GP for a full assessment. Your doctor can check for underlying causes such as diabetes, high blood pressure, high cholesterol, or heart disease—all of which are treatable and may have been unmasked or worsened by COVID [1][2]. Treating these conditions not only improves erectile function but also protects your long-term health.

Avanafil and other PDE5 inhibitors can be effective treatments for erectile dysfunction related to long COVID, provided there are no contraindications [6][11]. At Cured Pharmacy, our online consultation includes questions about your COVID history, current symptoms, and any ongoing treatments, so our prescribers can recommend the safest and most appropriate option for you. Spedra (avanafil) is available from £20.95 per pack (£16.76 for first orders with code Ednew), and treatment is only supplied after a clinical review by a UK-registered prescriber.

When to Seek Medical Advice

If you experience new erectile dysfunction after COVID, especially if it is sudden or accompanied by chest pain, breathlessness, or other cardiovascular symptoms, seek medical advice promptly [1]. Erectile dysfunction can be an early marker of heart disease, and COVID-19 is known to increase cardiovascular risk in some people. Your GP can arrange tests such as blood pressure, cholesterol, blood sugar, and heart function checks to rule out serious underlying conditions [2]. Do not rely solely on ED medication without investigating the cause.

Avanafil and COVID Vaccines: Are There Any Concerns?

There is no evidence that avanafil interacts with COVID-19 vaccines or affects vaccine efficacy. COVID vaccines work by training your immune system to recognise and fight the virus, and avanafil does not interfere with immune responses [1]. You can continue to take avanafil as prescribed before or after receiving a COVID vaccine.

Some people experience mild side effects after vaccination, such as a sore arm, tiredness, headache, or mild fever. These are normal immune responses and usually resolve within a day or two. If you feel unwell after a vaccine, you may choose to wait until you feel better before using avanafil, simply because you may not feel like engaging in sexual activity. Paracetamol or ibuprofen can be used to manage vaccine side effects and do not interact with avanafil [6].

If you have any concerns about combining avanafil with a COVID vaccine, speak to the healthcare professional administering your vaccine or contact your pharmacist. At Cured Pharmacy, our team is available to answer questions about medicine safety and interactions at any time.

When to get urgent help

• Erection lasting more than 4 hours (priapism)—go to A&E immediately
• Sudden loss of vision or hearing—stop avanafil and seek urgent medical help
• Chest pain during or after sexual activity—call 999
• Severe breathlessness, chest pain, or rapid heartbeat during or after COVID—call 999 or go to A&E
• Severe dizziness, fainting, or very low blood pressure—seek same-day medical advice

Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.

Practical Steps: Using Avanafil Safely During and After COVID

If you are currently taking avanafil and develop COVID-19, the first step is to check whether you have been prescribed any antiviral treatment. If you are given Paxlovid, do not take avanafil during the five-day course and for a few days afterwards; consult your prescriber or pharmacist for specific advice on when it is safe to restart [6]. If you are not on antiviral treatment, you can continue avanafil if you feel well enough for sexual activity, but prioritise rest and recovery.

If you are recovering from COVID or experiencing long COVID symptoms, and you notice new or worsening erectile dysfunction, book an appointment with your GP to investigate possible causes [1][2]. Once any underlying health issues are addressed, avanafil may be a suitable treatment option. You can request avanafil through Cured Pharmacy's online consultation, where a UK prescriber will review your medical history, current medicines (including any recent COVID treatments), and overall health to ensure it is safe and appropriate for you.

Always be honest and thorough when completing your online consultation. Declare all medicines you are taking—including over-the-counter drugs, supplements, and herbal remedies—and mention any recent illnesses, including COVID-19. This information is essential for safe prescribing. If you have any questions or your circumstances change (for example, if you are prescribed a new medicine), contact Cured Pharmacy before taking your next dose of avanafil. Our pharmacists are here to help you use your treatment safely and effectively.

What If You Need Urgent Help?

Serious side effects from avanafil are rare, but you should seek urgent medical help if you experience an erection lasting more than four hours (priapism), sudden loss of vision or hearing, or chest pain during sexual activity [6]. If you develop severe breathlessness, chest pain, or other concerning symptoms during or after COVID, call 999 or go to A&E immediately—these could be signs of a serious complication unrelated to avanafil. Never delay seeking help because you are worried about disclosing medicine use; healthcare professionals need to know what you have taken to treat you safely.