Avanafil Nosebleed: Causes & What to Do
Learn how common this side effect is, why it happens, and when to seek help from a UK pharmacist.
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Avanafil and Nosebleeds: What You Need to Know
Published: 15 November 2026
An avanafil nosebleed is an uncommon but recognised side effect of this erectile dysfunction medicine. Avanafil (sold as Spedra in the UK) belongs to a group of medicines called PDE5 inhibitors, which can affect blood vessels throughout the body, not just in the penis. While most men tolerate avanafil well, understanding why nosebleeds can occur and what to do about them helps you use your treatment safely and confidently.
Stop Nosebleeds Quickly
Sit down, lean forward, and pinch the soft part of your nose firmly for 10–15 minutes. Apply a cold compress to the bridge of your nose and breathe through your mouth until bleeding stops.
How Common Are Nosebleeds with Avanafil?
Nosebleeds (epistaxis) are listed as an uncommon side effect of avanafil, meaning they occur in fewer than 1 in 100 men who take the medicine [6]. This makes them much less frequent than the most common side effects such as headache, flushing, or nasal congestion, which affect more than 1 in 10 users.
In clinical trials of avanafil, nasal and sinus symptoms were reported more often than actual nosebleeds [11]. Many men experience a stuffy or runny nose after taking the medicine, and this nasal congestion can sometimes make the delicate blood vessels in the nose more prone to bleeding, especially if you blow your nose forcefully or the air is very dry.
It's important to remember that nosebleeds can happen for many reasons unrelated to avanafil, including dry air, allergies, high blood pressure, or minor trauma. If you've had a single, brief nosebleed that stopped quickly, it may not be directly caused by your ED medicine. However, if nosebleeds become frequent or heavy after starting avanafil, it's worth discussing with your prescriber.
Most men who experience an avanafil nosebleed find it is mild, stops within a few minutes with simple first aid, and does not recur with every dose. Serious or prolonged bleeding is very rare.
Why Does Avanafil Cause Nosebleeds?
Avanafil works by blocking an enzyme called phosphodiesterase type 5 (PDE5), which allows blood vessels in the penis to relax and fill with blood during sexual stimulation [6]. However, PDE5 is also present in blood vessels elsewhere in the body, including those in the nose and sinuses.
When avanafil blocks PDE5 in these areas, it can cause the small blood vessels in the nasal lining to widen slightly. This increased blood flow can lead to nasal congestion (a stuffy nose), which is one of the most common side effects of all PDE5 inhibitors. The swollen, congested nasal lining becomes more fragile, and the tiny blood vessels near the surface may break more easily, leading to a nosebleed.
Additionally, avanafil can cause a small, temporary drop in blood pressure as blood vessels throughout the body relax [6]. While this effect is usually mild and well tolerated, it can occasionally contribute to bleeding from delicate areas such as the nose, particularly if you already have a tendency towards nosebleeds or take other medicines that affect blood clotting or blood pressure.
Environmental factors such as dry air, central heating, or cold weather can make the nasal lining even more prone to bleeding, especially when combined with the nasal congestion caused by avanafil.
Other Medicines That May Increase Risk
If you take medicines that affect blood clotting—such as aspirin, clopidogrel, warfarin, or newer anticoagulants like rivaroxaban or apixaban—you may be at slightly higher risk of nosebleeds when using avanafil. These medicines do not interact dangerously with avanafil, but the combination of nasal congestion and reduced clotting can make bleeding more likely or harder to stop.
Always tell your prescriber about every medicine you take, including over-the-counter painkillers and supplements, during your online consultation. Your prescriber will check whether avanafil is suitable for you and may suggest starting on a lower dose or monitoring for side effects more closely.
When to get urgent help
- Nosebleed lasting more than 20 minutes despite continuous pressure
- Very heavy bleeding (filling a cup or bowl) or bleeding that keeps restarting
- Feeling faint, dizzy, or short of breath during or after a nosebleed
- Chest pain, sudden severe headache, or sudden loss of vision or hearing after taking avanafil
- Difficulty breathing or swallowing due to blood running down your throat
Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.
How Long Does an Avanafil Nosebleed Last?
Most nosebleeds caused by avanafil are brief and stop within 5 to 10 minutes when you use simple first-aid measures. The bleeding typically occurs within a few hours of taking the tablet, when the medicine's effects on blood vessels are strongest.
Avanafil is a fast-acting PDE5 inhibitor, usually taken 15 to 30 minutes before sexual activity, and its effects last for around 4 to 6 hours [6][11]. Any nasal congestion or increased tendency to nosebleeds should fade as the medicine leaves your system. If you take avanafil occasionally (on-demand), the side effect will not be continuous.
If a nosebleed lasts longer than 20 minutes despite applying pressure, or if bleeding is heavy or keeps restarting, seek medical advice the same day. Prolonged or recurrent nosebleeds may need assessment by a GP or an ear, nose, and throat (ENT) specialist, especially if they happen every time you take avanafil.
Some men find that nasal congestion and minor nosebleeds improve after the first few doses as their body adjusts to the medicine. However, if the problem persists or worsens, your prescriber can discuss alternative ED treatments that may suit you better.
Self-Care Tips for Managing Avanafil Nosebleeds
If you experience a nosebleed after taking avanafil, sit down and lean forward slightly—do not lie down or tilt your head back, as this can cause blood to run down your throat. Pinch the soft part of your nose (just below the bony bridge) firmly for 10 to 15 minutes, breathing through your mouth. Apply a cold compress or ice pack wrapped in a towel to the bridge of your nose to help constrict blood vessels.
Once the bleeding has stopped, avoid blowing your nose, bending down, or doing strenuous exercise for several hours, as this can dislodge the clot and restart the bleeding. If the air in your home is dry, especially during winter, use a humidifier in your bedroom to keep the nasal lining moist. You can also apply a thin layer of petroleum jelly (such as Vaseline) or a water-based nasal gel just inside your nostrils before bed to prevent drying and cracking.
Stay well hydrated by drinking plenty of water, and avoid heavy alcohol on the day you take avanafil, as alcohol can worsen nasal congestion and dehydration. If you need to blow your nose, do so gently, one nostril at a time, rather than forcefully.
Keep a record of when nosebleeds occur, how long they last, and any other symptoms you notice. This information will help your prescriber assess whether avanafil is the likely cause and whether a change in dose or medicine is needed.
When to Contact Your Prescriber
Contact your prescriber or pharmacist if you have more than one nosebleed after taking avanafil, if bleeding is heavy or difficult to stop, or if you develop other new symptoms such as severe headache, dizziness, or chest pain. Your prescriber may suggest trying a lower dose of avanafil (for example, 50 mg or 100 mg instead of 200 mg) or switching to a different PDE5 inhibitor that may cause less nasal congestion, such as tadalafil or vardenafil.
Do not stop taking avanafil suddenly without discussing it with your prescriber, especially if it has been effective for your erectile dysfunction. There are several alternative treatments available, and your prescriber will work with you to find the best option.
At a glance
When to Seek Urgent Medical Help for Avanafil Nosebleed
While most nosebleeds are minor and stop quickly, some situations require urgent medical attention. Call 999 or go to A&E if a nosebleed lasts longer than 20 minutes despite applying continuous pressure, if bleeding is very heavy (for example, filling a cup or bowl), or if you feel faint, dizzy, or short of breath, which may indicate significant blood loss.
Seek urgent help if you have difficulty breathing or swallowing due to blood running down the back of your throat, or if you have a nosebleed after a head injury. If you take anticoagulant medicines (blood thinners) and have a nosebleed that won't stop, contact your GP urgently or call 111 for advice, as you may need specialist assessment.
If you experience chest pain, sudden severe headache, or sudden loss of vision or hearing alongside a nosebleed after taking avanafil, call 999 immediately. These are rare but serious side effects of PDE5 inhibitors that require emergency treatment [6].
For less urgent concerns—such as recurrent mild nosebleeds or questions about whether to continue avanafil—contact your GP or the prescribing service during normal hours. Your prescriber can review your treatment and suggest alternatives if needed.
Alternatives to Avanafil if Nosebleeds Persist
If you continue to experience nosebleeds with avanafil despite self-care measures and dose adjustments, several alternative ED treatments are available. Other PDE5 inhibitors—such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra)—work in a similar way but may cause different side effects in different men [3][4][5]. Some men find that tadalafil causes less nasal congestion than avanafil, while others tolerate sildenafil better.
Tadalafil has the advantage of lasting up to 36 hours, so you can take it well in advance of sexual activity and may find the side effects less noticeable. It is also available as a low-dose daily tablet (2.5 mg or 5 mg), which provides continuous support for erections without the peak side effects that can occur with higher on-demand doses [4].
If PDE5 inhibitors are not suitable or well tolerated, other options include Eroxon, a topical gel that works locally on the penis without affecting blood vessels elsewhere in the body, or prescription treatments such as Vitaros (alprostadil cream) or Caverject (alprostadil injection), which use a different mechanism of action [7].
All prescription ED medicines at Cured Pharmacy are supplied only after an online consultation reviewed by a UK-registered prescriber, who will check your medical history, current medicines, and any side effects you've experienced. Your prescriber will recommend the most suitable treatment for you and can adjust your prescription at any time if side effects become troublesome.
Discussing Your Options with a Prescriber
During your consultation, be open about any side effects you've noticed, including nosebleeds, headaches, flushing, or nasal congestion. Your prescriber can often resolve these issues by adjusting the dose, suggesting a different PDE5 inhibitor, or recommending practical measures such as taking the tablet with food or using a nasal saline spray.
Remember that erectile dysfunction can be an early warning sign of underlying health conditions such as diabetes, high blood pressure, or heart disease [1][2]. If you have not seen your GP about your ED, it's a good idea to book a check-up, especially if you also have other symptoms such as chest pain, shortness of breath, or unexplained weight loss.
In summary
- Avanafil nosebleeds are uncommon, affecting fewer than 1 in 100 men, and usually stop quickly with first aid.
- Nasal congestion from avanafil makes delicate blood vessels more prone to bleeding, especially in dry air.
- Pinch your nose for 10–15 minutes, lean forward, and use a cold compress to stop bleeding.
- Seek urgent help if bleeding lasts more than 20 minutes, is very heavy, or you feel faint.
- Alternative ED treatments are available if nosebleeds persist; discuss options with your prescriber.
Scientific References
- NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 15 November 2026]
- National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 15 November 2026]
- Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 15 November 2026]
- Joint Formulary Committee. (n.d.). Tadalafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/tadalafil/ [accessed 15 November 2026]
- Joint Formulary Committee. (n.d.). Vardenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/vardenafil/ [accessed 15 November 2026]
- Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 15 November 2026]
- Joint Formulary Committee. (n.d.). Alprostadil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/alprostadil/ [accessed 15 November 2026]
- National Institute for Health and Care Excellence. (2014). Erectile dysfunction: avanafil (ESNM45). https://www.nice.org.uk/advice/esnm45 [accessed 15 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.
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Medically reviewed by
Tarun Kumar, Superintendent Pharmacist (GPhC 2233073)