Avanafil NICE Guidelines: What You Need to Know

Avanafil NICE Guidelines: Evidence-Based Guidance for Erectile Dysfunction

Published: 6 November 2026

The avanafil NICE guidelines recognise avanafil (brand name Spedra) as a clinically effective phosphodiesterase type 5 (PDE5) inhibitor for the treatment of erectile dysfunction in adult men [11]. NICE published evidence summary ESNM45 in 2014, confirming that avanafil has a similar efficacy and safety profile to other PDE5 inhibitors such as sildenafil, tadalafil and vardenafil, with the advantage of a faster onset of action—typically within 15 to 30 minutes [6][11]. This page explains what the NICE guidance says, how avanafil compares to other ED treatments, and how you can access it safely through a UK-registered online pharmacy after a clinical consultation.

What Do the Avanafil NICE Guidelines Say?

NICE published an evidence summary (ESNM45) in 2014 specifically reviewing avanafil for erectile dysfunction [11]. The guidance confirms that avanafil is an effective treatment option for men with ED, with clinical trial data showing significant improvements in erectile function compared to placebo. NICE noted that avanafil works in a similar way to other PDE5 inhibitors by relaxing blood vessels in the penis, allowing increased blood flow during sexual stimulation [6][11].

The NICE summary highlights that avanafil may offer a faster onset of action than some other PDE5 inhibitors, which can be beneficial for men seeking more spontaneity [11]. Avanafil is available in three strengths—50mg, 100mg and 200mg—and the recommended starting dose is usually 100mg, taken approximately 15 to 30 minutes before sexual activity [6]. NICE does not mandate avanafil as a first-line choice over other PDE5 inhibitors; instead, it recognises all licensed PDE5 inhibitors as suitable options, with the choice depending on individual patient preference, response and tolerability [2][11].

The broader NICE Clinical Knowledge Summary on erectile dysfunction recommends offering oral PDE5 inhibitors as first-line pharmacological treatment for most men with ED, after addressing any underlying causes and lifestyle factors [2]. Avanafil fits within this framework as one of four licensed oral PDE5 inhibitors available in the UK, alongside sildenafil, tadalafil and vardenafil [2][6].

How Does Avanafil Work and How Quickly?

Avanafil is a selective PDE5 inhibitor that works by blocking the enzyme phosphodiesterase type 5, which normally breaks down cyclic guanosine monophosphate (cGMP) in the smooth muscle of the penis [6]. When cGMP levels rise, the smooth muscle relaxes, blood vessels widen, and blood flow to the penis increases, making it easier to achieve and maintain an erection during sexual stimulation. Crucially, avanafil—like all PDE5 inhibitors—requires sexual arousal to work; it does not cause an automatic erection [6].

One of the key advantages highlighted in the avanafil NICE guidelines is its rapid onset of action [11]. Clinical studies show that avanafil can start working in as little as 15 minutes in some men, though the usual recommendation is to take it about 15 to 30 minutes before sexual activity [6]. This is faster than sildenafil (which typically takes about an hour) and offers more flexibility for spontaneous intimacy. The effect of avanafil can last for up to six hours, giving a reasonable window of opportunity without the very long duration of tadalafil (which can last up to 36 hours) [4][6].

Avanafil is taken on demand, not daily, and the maximum recommended frequency is once per day [6]. It is absorbed more quickly when taken on an empty stomach, though it can be taken with or without food. Men should avoid heavy or high-fat meals immediately before taking avanafil, as this can delay absorption and reduce effectiveness [6].

Avanafil Dosing and Adjustment

The usual starting dose of avanafil is 100mg, taken as needed approximately 15 to 30 minutes before sexual activity [6]. Depending on individual response and tolerability, the dose may be increased to a maximum of 200mg or reduced to 50mg. Men taking certain medicines—particularly potent CYP3A4 inhibitors such as ritonavir, cobicistat, ketoconazole or itraconazole—should not use avanafil, as these drugs significantly raise avanafil levels and increase the risk of side effects [6]. Similarly, men on alpha-blockers for prostate or blood pressure problems need careful assessment and may require a lower starting dose to avoid dizziness or a sudden drop in blood pressure [6]. A prescriber will review all current medications during the consultation to ensure avanafil is safe and appropriate.

Avanafil NICE Guidelines: Safety and Contraindications

The NICE evidence summary on avanafil confirms that its safety profile is consistent with other PDE5 inhibitors [11]. Common side effects include headache, flushing, nasal congestion and back pain, which are usually mild and temporary [6]. Serious side effects are rare but include priapism (a painful erection lasting more than four hours), sudden vision or hearing loss, and chest pain during sexual activity. Any of these symptoms requires urgent medical attention [6].

Avanafil must never be taken alongside nitrates (such as GTN spray, isosorbide mononitrate or dinitrate), nicorandil, riociguat, or recreational drugs known as 'poppers' (alkyl nitrites), because the combination can cause a dangerous and potentially life-threatening drop in blood pressure [6]. It is also contraindicated in men with severe cardiovascular disease where sexual activity is inadvisable, those with very low blood pressure, a history of non-arteritic anterior ischaemic optic neuropathy (NAION), or certain inherited retinal disorders [6].

Men with diabetes, high blood pressure, high cholesterol or a history of heart disease can often use avanafil safely, but a full medical assessment is essential [2][6]. NICE guidance emphasises that erectile dysfunction can be an early warning sign of cardiovascular disease or diabetes, so new or worsening ED should always prompt a review by a GP to check for underlying health conditions [1][2]. Addressing these root causes—through lifestyle changes, better management of chronic conditions, or stopping smoking—can improve both general health and erectile function [1][2].

How Does Avanafil Compare to Other PDE5 Inhibitors?

The avanafil NICE guidelines place it alongside sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) as effective first-line treatments for erectile dysfunction [2][11]. All four medicines work in a similar way by inhibiting PDE5, but they differ in onset, duration and dosing flexibility. Sildenafil, the first PDE5 inhibitor licensed in the UK, typically takes about an hour to work and lasts for around four to six hours [3]. Tadalafil has the longest duration—up to 36 hours—and is also available as a low-dose daily tablet (2.5mg or 5mg) for men who prefer not to plan ahead [4].

Vardenafil has a similar onset to sildenafil (25 to 60 minutes) and lasts about four to five hours [5]. Avanafil's main distinguishing feature is its rapid onset—often within 15 to 30 minutes—making it a good choice for men who value spontaneity but do not want the very long duration of tadalafil [6][11]. NICE does not recommend one PDE5 inhibitor over another; the choice depends on individual lifestyle, preferences, how quickly the medicine is needed, how long the effect should last, and any relevant medical history or drug interactions [2].

Cost can also be a factor. Generic versions of sildenafil and tadalafil are widely available and tend to be less expensive than branded or newer options. At Cured Pharmacy, sildenafil starts from £0.45 per tablet (£0.36 with first-order code Ednew), while Spedra (avanafil) is priced at £20.95 (£16.76 with code Ednew). All require a prescription following an online consultation reviewed by a UK-registered prescriber.

Choosing the Right PDE5 Inhibitor for You

When deciding between avanafil and other PDE5 inhibitors, consider how much notice you typically have before sex, how long you want the effect to last, and any other medicines you take. If you prefer a fast-acting option with a moderate duration, avanafil may be ideal. If you want the flexibility of a very long window (up to 36 hours), tadalafil is often preferred. For cost-effectiveness, generic sildenafil or tadalafil may be the best choice. A prescriber can help you weigh these factors during your consultation and recommend the most suitable treatment based on your health, lifestyle and any potential drug interactions [2][6].

Who Can Use Avanafil Under NICE Guidance?

NICE Clinical Knowledge Summaries recommend that PDE5 inhibitors, including avanafil, are suitable for most adult men with erectile dysfunction, provided there are no contraindications [2]. Avanafil is licensed for men aged 18 and over. It is not suitable for women or children [6]. Men with well-controlled diabetes, high blood pressure or mild to moderate cardiovascular disease can often use avanafil safely, but a thorough medical assessment is required to ensure sexual activity itself is not inadvisable [2][6].

Avanafil should not be used by men taking nitrates or nicorandil for angina, those on potent CYP3A4 inhibitors (such as certain HIV antiretrovirals or antifungal medicines), or men with severe liver or kidney impairment [6]. Men on alpha-blockers (for prostate enlargement or high blood pressure) need careful dose adjustment and should be stable on their alpha-blocker before starting avanafil [6]. A prescriber will check your full medication list and medical history during the consultation.

If you have new or worsening erectile dysfunction, NICE guidance strongly recommends seeing your GP for a full assessment [1][2]. ED can be an early sign of cardiovascular disease, diabetes or hormonal imbalance, and identifying the underlying cause is important for your overall health. Lifestyle changes—such as losing weight, exercising regularly, stopping smoking, reducing alcohol intake and managing stress—can significantly improve erectile function and may reduce or eliminate the need for medication [1][2].

How to Access Avanafil Safely in the UK

Avanafil (Spedra) is a prescription-only medicine in the UK, meaning it can only be supplied after a consultation with a qualified prescriber [6]. At Cured Pharmacy, a GPhC-registered online pharmacy (GPhC 9012511), you can request avanafil by completing a confidential online health questionnaire. Your answers are reviewed by a UK-registered prescriber—either a doctor or an independent prescribing pharmacist—who will check your medical history, current medications and any contraindications before approving the prescription.

If avanafil is deemed suitable, your medicine is dispensed by our pharmacy team and delivered discreetly to your home, usually within one to two working days. Spedra (avanafil) is available at Cured Pharmacy for £20.95, or £16.76 for first-time customers using code Ednew at checkout. If avanafil is not appropriate for you—for example, due to a drug interaction or medical condition—the prescriber may suggest an alternative PDE5 inhibitor such as sildenafil or tadalafil, or recommend that you see your GP for further investigation [2][6].

Never buy avanafil or any other prescription ED medicine from unregulated websites or without a proper consultation. Counterfeit medicines are common online and may contain incorrect doses, harmful ingredients or no active ingredient at all. Using a GPhC-registered pharmacy ensures you receive genuine, licensed medicines and professional clinical oversight. If you experience any side effects or have concerns about your treatment, contact the prescribing service or your GP for advice. Do not take more than the recommended dose, and do not combine avanafil with other PDE5 inhibitors or any of the contraindicated medicines listed above [6].

What to Expect During Your Online Consultation

The online consultation for avanafil involves answering questions about your general health, cardiovascular history, current medications, allergies and any previous experience with ED treatments. You may be asked about lifestyle factors such as smoking, alcohol use and exercise, as these can all affect erectile function. The prescriber will also check for any contraindications—such as nitrate use, severe heart disease or recent stroke—that would make avanafil unsafe. If approved, your prescription is sent electronically to the pharmacy for dispensing. The entire process is confidential, and your information is handled in line with UK data protection regulations. If you have any questions or need to update your medical details, you can contact the clinical team at any time.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 6 November 2026]
2. National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 6 November 2026]
3. Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 6 November 2026]
4. Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 6 November 2026]
5. National Institute for Health and Care Excellence. (2014). Erectile dysfunction: avanafil (ESNM45). https://www.nice.org.uk/advice/esnm45 [accessed 6 November 2026]

Information on this page is for educational purposes only and is not medical advice. Prescription treatments require clinical assessment by a UK-registered prescriber. Always consult a qualified healthcare professional before starting or changing any medication.