Avanafil Palpitations: What You Need to Know

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Avanafil Palpitations: Causes, Duration & What to Do

Published: 15 November 2026

Avanafil palpitations—a sensation of your heart racing, pounding, or fluttering—are an uncommon side effect of this erectile dysfunction medicine, but they can be unsettling if they occur. Avanafil (brand name Spedra) is a PDE5 inhibitor that works by relaxing blood vessels, and like all medicines in this class, it can occasionally affect your heart rate or rhythm [6]. Most people tolerate avanafil well, but understanding why palpitations happen, how long they typically last, and when to seek help can give you confidence and peace of mind.

How Common Are Avanafil Palpitations?

Palpitations are classified as an uncommon side effect of avanafil, meaning they occur in fewer than 1 in 100 people who take the medicine [6][12]. In clinical trials, cardiovascular side effects such as palpitations were reported infrequently compared to more common effects like headache or flushing. The majority of men who use avanafil do not experience any noticeable change in heart rate or rhythm.

It's important to distinguish between true palpitations—where you feel your heartbeat is irregular, unusually fast, or forceful—and general awareness of your heartbeat, which can happen when you're anxious or paying close attention to your body. If you notice a racing or fluttering sensation that feels different from your normal heartbeat, especially if it's accompanied by dizziness, chest discomfort, or shortness of breath, it's worth discussing with a healthcare professional.

Your individual risk may be influenced by underlying health conditions, other medicines you take, or the dose of avanafil prescribed. Always complete the online consultation honestly so the prescriber can assess whether avanafil is suitable for you and recommend the safest starting dose [11].

Why Does Avanafil Cause Palpitations?

Avanafil works by inhibiting an enzyme called phosphodiesterase type 5 (PDE5), which leads to relaxation of smooth muscle in blood vessels and improved blood flow to the penis during sexual stimulation [6]. However, PDE5 is also present in small amounts in other tissues, including the heart and blood vessels throughout the body. When avanafil blocks PDE5, it can cause a slight widening of blood vessels elsewhere, which may lead to a modest drop in blood pressure.

This drop in blood pressure can trigger a reflex response from your nervous system, causing your heart to beat faster to maintain adequate circulation—a phenomenon you might perceive as palpitations. Additionally, avanafil can have a mild direct effect on heart muscle cells, though this is not common at therapeutic doses. The effect is usually short-lived and resolves as the medicine is metabolised and cleared from your body.

Certain factors can increase the likelihood of palpitations: taking avanafil with alcohol (which also lowers blood pressure), combining it with medicines that interact with avanafil (such as alpha-blockers or potent CYP3A4 inhibitors), or having an underlying heart condition. Anxiety or nervousness about sexual performance can also make you more aware of your heartbeat, even if the medicine itself is not causing a true arrhythmia [6][12].

Interaction with Other Medicines

If you take medicines for high blood pressure, particularly alpha-blockers such as doxazosin or tamsulosin, the combination with avanafil can amplify the blood-pressure-lowering effect and increase the risk of dizziness or palpitations. You should be stable on your alpha-blocker before starting avanafil, and your prescriber will recommend the lowest effective dose of the PDE5 inhibitor. Potent CYP3A4 inhibitors—including ritonavir, cobicistat, ketoconazole, itraconazole, and clarithromycin—can raise avanafil levels in your blood, increasing the risk of side effects; avanafil is generally avoided or contraindicated with these medicines [6][12]. During your online consultation, declare every medicine you currently take, including over-the-counter products and supplements, so the prescriber can check for interactions.

How Long Do Avanafil Palpitations Last?

Avanafil is a fast-acting PDE5 inhibitor with a relatively short half-life of about 6 to 17 hours, meaning it is cleared from your system more quickly than some other ED medicines [6]. If palpitations occur, they typically begin within 30 minutes to 2 hours of taking the tablet—around the time the medicine reaches peak concentration in your blood—and usually resolve within a few hours as the drug is metabolised.

Most episodes of avanafil-related palpitations are brief and self-limiting, lasting anywhere from a few minutes to a couple of hours. If you experience a racing heartbeat that persists for several hours, becomes progressively worse, or is accompanied by chest pain, severe dizziness, fainting, or difficulty breathing, seek urgent medical attention. These symptoms could indicate a more serious cardiovascular reaction or an unrelated medical emergency.

If you notice palpitations every time you take avanafil, even if they are mild and short-lived, it's worth discussing with your prescriber. They may suggest trying a lower dose, switching to a different PDE5 inhibitor with a different pharmacokinetic profile (such as sildenafil or tadalafil), or investigating whether an underlying heart condition might be contributing to the symptoms [1][2].

Self-Care Tips for Managing Avanafil Palpitations

If you experience mild palpitations after taking avanafil, there are several practical steps you can take to ease the sensation and reduce the likelihood of recurrence. First, sit or lie down in a comfortable position and try to relax; anxiety can make palpitations feel worse. Take slow, deep breaths—inhale through your nose for a count of four, hold for four, and exhale slowly through your mouth. This can help calm your nervous system and slow your heart rate.

Avoid alcohol and caffeine on the day you plan to take avanafil, as both can contribute to dehydration and increase the risk of palpitations. Stay well hydrated by drinking water throughout the day, but avoid large meals immediately before taking the medicine, as heavy digestion can divert blood flow and exacerbate cardiovascular effects. If you are taking avanafil for the first time, consider starting with the lowest available dose (50 mg) to see how your body responds before increasing to a higher strength [6][11].

Do not take a second dose of avanafil or any other PDE5 inhibitor within 24 hours, even if the first dose caused palpitations or did not work as expected. Doubling up can increase the risk of serious side effects. If palpitations are mild and resolve quickly, you may choose to try avanafil again on a different occasion, but if they recur or cause significant discomfort, contact your prescriber to discuss alternative treatments.

When to Avoid Avanafil Altogether

Avanafil is not suitable for everyone. You should not take it if you have been advised that sexual activity is inadvisable due to cardiovascular risk—for example, if you have had a recent heart attack or stroke, unstable angina, severe heart failure, or uncontrolled high or very low blood pressure [6][12]. It is also contraindicated if you take nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or recreational drugs known as 'poppers' (amyl or alkyl nitrites), because the combination can cause a dangerous drop in blood pressure. If you have a history of serious heart rhythm disorders or previous sudden vision loss (NAION), discuss these with your prescriber before starting any PDE5 inhibitor.

When to Seek Urgent Medical Help for Palpitations

While most cases of avanafil palpitations are mild and short-lived, certain warning signs require immediate medical attention. Call 999 or go to A&E if you experience chest pain or tightness during or after sex, especially if it radiates to your arm, jaw, or back, as this could indicate a heart attack. Similarly, seek emergency help if you have severe dizziness, fainting, or loss of consciousness, or if your heart is racing so fast that you feel breathless or unable to speak in full sentences.

If your palpitations are accompanied by sudden vision loss in one or both eyes, or sudden hearing loss or ringing in the ears, stop taking avanafil and seek urgent medical advice, as these are rare but serious side effects that require prompt assessment [6][12]. An erection lasting more than four hours (priapism) is another medical emergency, even though it is not directly related to palpitations; it can cause permanent damage if not treated quickly.

For less urgent concerns—such as recurrent mild palpitations that resolve on their own, or uncertainty about whether your symptoms are related to avanafil—contact your GP or the prescribing service for advice. Do not simply stop all your medicines without guidance, and do not restart avanafil if you have had a serious reaction until you have been reviewed by a healthcare professional [1][2].

Alternatives to Avanafil if Palpitations Persist

If you continue to experience palpitations with avanafil, or if the side effect is troubling enough that you prefer not to take it again, there are several alternative treatments for erectile dysfunction. Other PDE5 inhibitors—sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)—work in a similar way but have different pharmacokinetic profiles, and some men find they tolerate one better than another [3][4][5]. For example, tadalafil has a much longer half-life (up to 36 hours) and may cause fewer acute cardiovascular effects in some individuals, while sildenafil has been used for over two decades and has a well-established safety profile.

Your prescriber can help you choose an alternative based on your medical history, other medicines, and lifestyle preferences. Cured Pharmacy offers a range of licensed ED treatments, all supplied following an online consultation reviewed by a UK prescriber. If oral medicines are not suitable or effective, other options include Vitaros (alprostadil cream applied to the tip of the penis) or Caverject (alprostadil injection), both of which work locally rather than systemically and may carry a lower risk of cardiovascular side effects [7].

It's also important to address any underlying causes of erectile dysfunction. Lifestyle changes—such as losing weight if you are overweight, increasing physical activity, reducing alcohol intake, stopping smoking, and managing stress—can improve erectile function and reduce your reliance on medication [1][2]. If ED is new or worsening, see your GP for a full assessment, as it can be an early warning sign of cardiovascular disease or diabetes and may require investigation and treatment of the root cause.

How Cured Pharmacy Can Help

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering discreet, convenient access to licensed erectile dysfunction treatments. Every order begins with a confidential online consultation, reviewed by a UK-registered prescriber who will check your medical history, current medicines, and suitability for treatment. If avanafil has caused palpitations or other side effects, the prescriber can recommend an alternative PDE5 inhibitor or discuss non-oral options. All medicines are dispensed by our UK-based pharmacy team and delivered in plain, unmarked packaging. If you have questions or concerns after starting treatment, our pharmacists are available to provide advice and support.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 15 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 15 November 2026]
3. Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 15 November 2026]
4. National Institute for Health and Care Excellence. (2014). Erectile dysfunction: avanafil (ESNM45). https://www.nice.org.uk/advice/esnm45 [accessed 15 November 2026]
5. Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [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.