Avanafil Long Term Use: Is It Safe?

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Key takeaways

• Avanafil is safe for long-term use when taken as prescribed and reviewed regularly by a healthcare professional.
• Clinical studies show avanafil maintains effectiveness over time without developing tolerance.
• Take avanafil on demand, 15 to 30 minutes before sex, up to once daily.
• Regular health reviews ensure treatment remains safe and help monitor cardiovascular health.
• Seek urgent help for erections lasting over four hours or sudden vision or hearing loss.

What is avanafil and how does it work?

Avanafil is a phosphodiesterase type 5 (PDE5) inhibitor used to treat erectile dysfunction in adult men [6]. It works by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Avanafil is available in the UK under the brand name Spedra in 50mg, 100mg, and 200mg tablets.

One of avanafil's key advantages is its rapid onset of action—it can start working in as little as 15 to 30 minutes, making it the fastest-acting PDE5 inhibitor currently available [6][11]. The effects typically last for around four to six hours. Like other PDE5 inhibitors, avanafil requires sexual stimulation to work; it does not cause an automatic erection.

Avanafil is taken on demand, meaning you take it when you anticipate sexual activity rather than every day. The usual starting dose is 100mg, taken approximately 15 to 30 minutes before sex, with a maximum of one dose in any 24-hour period [6]. Your prescriber may adjust the dose to 50mg if you experience side effects or to 200mg if the initial dose is not effective enough.

Is avanafil long term use safe?

Clinical evidence supports the safety of avanafil long term use when the medicine is taken as directed and under medical supervision [11]. Studies have evaluated avanafil over periods of up to 12 months and beyond, showing that most men tolerate it well with no significant increase in side effects over time. The safety profile remains consistent with continued use, and there is no evidence that avanafil loses effectiveness or causes cumulative harm when used long term.

As with any prescription medicine, regular monitoring is important. Your prescriber will review your treatment periodically to check that avanafil is still working for you, that you are not experiencing troublesome side effects, and that your overall cardiovascular health remains stable. Erectile dysfunction can be an early warning sign of heart disease or diabetes, so ongoing medical review helps ensure any underlying conditions are identified and managed [1][2].

Common side effects of avanafil include headache, flushing, nasal congestion, and back pain [6]. These are usually mild and temporary. Serious side effects are rare but can include prolonged erections (priapism), sudden vision or hearing loss, and chest pain. If you experience any of these, seek urgent medical help. Long-term use does not appear to increase the risk of serious adverse events in men who are suitable candidates for PDE5 inhibitor therapy.

Who should not use avanafil long term?

Avanafil is not suitable for everyone. You must not take avanafil if you use nitrate medicines (such as GTN spray, isosorbide mononitrate, or isosorbide dinitrate), nicorandil, riociguat, or recreational drugs known as 'poppers' (amyl or alkyl nitrites), as the combination can cause a dangerous drop in blood pressure [6]. Avanafil is also contraindicated if you have had a recent heart attack or stroke, unstable angina, severe heart failure, very low blood pressure, or previous non-arteritic anterior ischaemic optic neuropathy (NAION), a rare form of sudden vision loss.

Men taking potent CYP3A4 inhibitors such as ritonavir, cobicistat, ketoconazole, itraconazole, or clarithromycin should avoid avanafil, as these medicines significantly increase avanafil levels in the blood [6]. If you take alpha-blockers for prostate symptoms or high blood pressure, your prescriber will assess whether avanafil is safe for you, as the combination can cause dizziness or low blood pressure. Always declare all your current medicines, including over-the-counter products and supplements, during your consultation.

At a glance

Does avanafil remain effective with long term use?

Avanafil maintains its effectiveness over time in most men who respond well to it initially [11]. Clinical trials have demonstrated sustained improvement in erectile function with continued use, and there is no evidence of tolerance developing—meaning you do not need to keep increasing the dose to achieve the same effect. Men who find avanafil effective in the first few weeks of treatment typically continue to benefit from it over months and years.

However, erectile dysfunction can change over time due to ageing, progression of underlying health conditions (such as diabetes or cardiovascular disease), lifestyle factors, or psychological stress. If you notice that avanafil becomes less effective, it is important to discuss this with your prescriber rather than simply increasing the dose on your own. They can review your overall health, check for new or worsening conditions, and consider whether a different dose, a different PDE5 inhibitor, or additional treatments might be more appropriate.

Lifestyle changes can also enhance the effectiveness of avanafil and other ED treatments. Maintaining a healthy weight, exercising regularly, limiting alcohol, stopping smoking, and managing stress all support better erectile function [1][2]. Addressing these factors alongside medication can improve your long-term outcomes and may reduce your reliance on higher doses.

How to use avanafil safely for long term treatment

For safe and effective avanafil long term use, always follow your prescriber's instructions. Take avanafil on demand, approximately 15 to 30 minutes before you anticipate sexual activity, and do not take more than one dose in 24 hours [6]. Swallow the tablet whole with water; you can take it with or without food, although a very heavy or high-fat meal may delay its onset of action.

Do not combine avanafil with other PDE5 inhibitors (such as sildenafil, tadalafil, or vardenafil) or with any of the medicines listed as contraindicated. Avoid grapefruit juice, as it can increase avanafil levels in your blood. Limit alcohol consumption, as heavy drinking can worsen erectile dysfunction and increase the risk of side effects such as dizziness and low blood pressure.

Keep your prescriber informed of any changes to your health or other medicines. If you develop new symptoms, experience side effects, or if avanafil stops working as well, arrange a review. Regular check-ups are particularly important if you have diabetes, high blood pressure, high cholesterol, or other cardiovascular risk factors. Your GP or prescriber may recommend blood tests or other investigations to monitor your overall health and ensure that long-term ED treatment remains safe and appropriate for you.

When to seek medical advice

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]. These are rare but serious side effects that require immediate attention. Priapism can cause permanent damage to the penis if not treated promptly, and sudden vision or hearing loss may indicate a serious underlying problem.

You should also contact your GP or prescriber if you develop new or worsening side effects, if avanafil becomes less effective, or if your erectile dysfunction worsens despite treatment. New-onset ED or a sudden change in your symptoms can be a sign of an underlying health condition that needs investigation [1][2]. Do not stop taking avanafil or change your dose without discussing it with a healthcare professional first.

Avanafil long term use compared to other ED treatments

Avanafil is one of four PDE5 inhibitors licensed in the UK for erectile dysfunction, alongside sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) [3][4][5][6]. All four medicines work in a similar way and have comparable safety profiles for long-term use. The main differences lie in how quickly they start working and how long their effects last.

Avanafil has the fastest onset of action (15 to 30 minutes) and a duration of around four to six hours, making it a good choice for men who want flexibility and spontaneity [6][11]. Sildenafil takes about an hour to work and lasts four to six hours [3]. Tadalafil can be taken on demand (working in 30 minutes and lasting up to 36 hours) or as a low daily dose for continuous effect [4]. Vardenafil works in 25 to 60 minutes and lasts four to six hours [5].

The choice of PDE5 inhibitor for long-term use depends on your individual needs, lifestyle, how you respond to each medicine, and any other health conditions or medicines you take. Some men find one PDE5 inhibitor more effective or better tolerated than another, so it is worth discussing your options with your prescriber. All four are considered safe for long-term use when prescribed appropriately and monitored regularly.

Getting avanafil long term use treatment at Cured Pharmacy

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering convenient access to avanafil (Spedra) and other ED treatments following a clinical consultation with a UK-registered prescriber. Our online service allows you to complete a confidential health questionnaire, which is reviewed by a qualified prescriber to ensure the treatment is safe and suitable for you.

Spedra (avanafil) is available at Cured Pharmacy for £20.95, or £16.76 for your first order with code Ednew. If avanafil is not the best option for you, our prescribers can recommend alternative PDE5 inhibitors. Sildenafil (generic Viagra) starts at £0.45 (£0.36 with code Ednew), tadalafil (generic Cialis) at £7.95 (£6.36 with code Ednew), and vardenafil (generic Levitra) at £16.95 (£13.56 with code Ednew). All prices include the prescriber review and discreet delivery to your door.

For long-term treatment, you can set up repeat prescriptions through your Cured Pharmacy account, ensuring you always have your medication when you need it. Our pharmacists and prescribers are available to answer questions, review your treatment regularly, and adjust your prescription if your needs change. If you have any concerns about side effects, effectiveness, or interactions with other medicines, our team is here to support you throughout your treatment journey.

Why choose Cured Pharmacy for long-term ED treatment?

Cured Pharmacy combines clinical expertise with convenience and discretion. All consultations are reviewed by UK-registered prescribers, and our service is regulated by the General Pharmaceutical Council. We offer a wide range of ED treatments at transparent prices, with no hidden fees or subscription traps. Your medication is dispensed by our registered pharmacy and delivered in plain, unmarked packaging.

We encourage open communication with your GP, especially if you are using ED treatment long term. Erectile dysfunction can be an early sign of cardiovascular disease or diabetes, and regular monitoring by your GP ensures that any underlying conditions are identified and managed [1][2]. Our prescribers work alongside your existing healthcare team to provide safe, effective treatment tailored to your individual needs.

When to get urgent help

• Erection lasting more than 4 hours (priapism) – go to A&E immediately
• Sudden loss of vision or hearing – seek urgent medical attention
• Chest pain during sexual activity – stop and call 999
• Severe dizziness or fainting after taking avanafil – seek same-day medical advice

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

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