What to Do When Avanafil Stopped Working

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Why avanafil stopped working: common causes

Avanafil belongs to a class of medicines called PDE5 inhibitors, which work by increasing blood flow to the penis during sexual stimulation [6]. When avanafil appears to have stopped working, the issue is rarely that your body has become 'immune' to the drug. Instead, several factors can reduce its effectiveness over time.

Worsening cardiovascular health is one of the most common reasons. Erectile dysfunction is often an early warning sign of conditions like diabetes, high blood pressure, or narrowing of the arteries [1]. If these underlying conditions progress, even effective ED treatment may struggle to compensate. Similarly, weight gain, reduced physical activity, increased alcohol consumption, or smoking can all impair blood flow and make any PDE5 inhibitor less effective [2].

Psychological factors also play a significant role. Stress, anxiety, depression, or relationship difficulties can interfere with sexual arousal, and because avanafil requires sexual stimulation to work, psychological barriers can prevent the medicine from having its full effect [1]. Additionally, taking avanafil after a heavy meal—especially one high in fat—can delay absorption and reduce effectiveness, as can certain medications that interact with avanafil [6].

Medication interactions that reduce avanafil effectiveness

Certain medicines can interfere with how avanafil works in your body. CYP3A4 inducers—drugs that speed up the breakdown of avanafil—include rifampicin (an antibiotic), carbamazepine and phenytoin (anti-epileptics), and the herbal remedy St John's wort. These can lower avanafil levels in your blood, making it less effective [6].

Conversely, potent CYP3A4 inhibitors such as ritonavir, cobicistat (found in some HIV medicines), ketoconazole, itraconazole, and clarithromycin raise avanafil levels, which can increase the risk of side effects. Avanafil is contraindicated or requires dose adjustment with these medicines, and your prescriber will check your current medications during consultation [6][12].

If you've recently started a new medicine and noticed avanafil stopped working as well, this interaction may be the cause. Never stop a prescribed medicine without medical advice, but do inform your prescriber or pharmacist of all medications, supplements, and herbal remedies you're taking so they can assess for interactions and adjust your treatment safely.

Lifestyle factors that affect avanafil

Heavy alcohol intake not only worsens erectile dysfunction directly but also adds to the blood-pressure-lowering effect of avanafil, potentially causing dizziness and reducing the quality of erections [6]. Grapefruit juice can raise avanafil levels in the blood, which may sound helpful but actually increases the risk of side effects without improving effectiveness [12].

Timing matters too. Avanafil is designed to work quickly—typically within 15 to 30 minutes—but taking it after a large or fatty meal can significantly delay absorption [6]. For best results, take avanafil on an empty stomach or after a light meal, and allow adequate time before sexual activity.

Is it tolerance, or something else?

True pharmacological tolerance—where your body adapts to a drug and requires higher doses for the same effect—is not a well-documented phenomenon with PDE5 inhibitors like avanafil [2]. What often feels like tolerance is usually one of the factors already discussed: worsening health, psychological stress, or suboptimal timing and conditions when taking the tablet.

That said, some men do report that avanafil seems less effective after months or years of use. In many cases, this reflects progression of the underlying cause of ED rather than the medicine itself losing potency. Conditions such as diabetes and cardiovascular disease are progressive, and as they advance, achieving and maintaining an erection becomes more challenging even with treatment [1][2].

If you feel avanafil has stopped working, it's important to see your GP or have a medication review with a prescriber. They can assess whether your ED has an underlying cause that needs treatment, check for new medications or health changes, and discuss whether a different PDE5 inhibitor or a higher dose might be more suitable. Do not simply increase your dose without medical advice, as this can increase the risk of side effects without necessarily improving results.

What you need to know

• Avanafil stopping working is usually due to health changes, interactions, or timing—not true tolerance.
• Switching to sildenafil, tadalafil, or vardenafil may restore effectiveness; individual responses vary.
• See your GP if avanafil has stopped working—ED can signal heart disease or diabetes needing treatment.
• Take avanafil on an empty stomach, limit alcohol, and allow 15–30 minutes for best results.
• Never increase your dose without prescriber advice; higher doses raise side-effect risk.

Switching from avanafil to other ED treatments

If avanafil stopped working effectively for you, switching to a different PDE5 inhibitor is often a sensible next step. Although all PDE5 inhibitors work in a similar way, individual responses can vary, and some men find one drug more effective than another [2][8].

Sildenafil (Viagra) is the most widely used PDE5 inhibitor. It's taken about one hour before sex, and its effects last around four to six hours [3]. Tadalafil (Cialis) offers a longer window—up to 36 hours—making it popular for men who prefer spontaneity; it can be taken on-demand or as a low daily dose [4]. Vardenafil (Levitra) works similarly to sildenafil but may be effective in some men who don't respond well to sildenafil [5].

Your prescriber can help you choose an alternative based on your health, other medications, and lifestyle. All PDE5 inhibitors require sexual stimulation to work and share similar contraindications—particularly the absolute prohibition on use with nitrates, nicorandil, riociguat, or recreational 'poppers' due to the risk of dangerous blood pressure drops [3][4][5][6]. Switching is straightforward and done safely during an online consultation with a UK prescriber.

Non-tablet options if PDE5 inhibitors don't work

If you've tried multiple PDE5 inhibitors without success, other prescription treatments are available. Vitaros is an alprostadil cream applied to the tip of the penis, and Caverject is an alprostadil injection into the side of the penis; both work locally rather than systemically and can be effective when tablets are not [7].

Vacuum erection devices, available without prescription, are another option and can be used alone or alongside medication. For complex cases, your GP may refer you to a specialist urology or sexual health service for further assessment and treatments such as penile implants. The key message is that if avanafil stopped working, effective alternatives exist, and you should not simply give up on treatment [2][8].

Practical steps when avanafil stopped working for you

First, review how you're taking avanafil. Are you allowing 15 to 30 minutes before sex? Are you taking it on an empty stomach or after only a light meal? Are you limiting alcohol and avoiding grapefruit juice? Small adjustments in timing and conditions can sometimes restore effectiveness [6].

Second, consider recent changes in your health, medications, or lifestyle. Have you started a new prescription, gained weight, increased alcohol intake, or experienced new stress or relationship difficulties? Identifying and addressing these factors—whether through lifestyle changes, counselling, or a medication review—can make a significant difference [1][2].

Third, book a consultation with your GP or an online prescriber. Be open about the lack of effectiveness; they can check for underlying health issues (such as poorly controlled diabetes or cardiovascular disease), review your current medicines for interactions, and discuss alternative PDE5 inhibitors or other treatments. Do not increase your avanafil dose on your own, as higher doses increase side-effect risk without guaranteed benefit and must be prescribed after clinical assessment [6][12].

When to get urgent help

• Erection lasting more than 4 hours (priapism)—go to A&E immediately to prevent permanent damage.
• Sudden loss of vision or hearing after taking avanafil—stop the medicine and seek urgent medical help.
• Chest pain during or after sex—stop activity, call 999, and do NOT take GTN spray if you've used avanafil.
• Severe dizziness, fainting, or signs of 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.

How Cured Pharmacy can help if avanafil stopped working

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering discreet access to the full range of licensed ED treatments in the UK. If avanafil stopped working for you, our online consultation allows you to discuss your experience with a UK-registered prescriber, who will review your medical history, current medications, and symptoms to recommend the most suitable alternative.

We stock sildenafil (from £0.45 per tablet, or £0.36 with first-order code Ednew), tadalafil (from £7.95, or £6.36 with code Ednew), vardenafil (£16.95, or £13.56 with code Ednew), and avanafil itself (Spedra, £20.95, or £16.76 with code Ednew), as well as branded Viagra and Cialis. Switching between treatments is straightforward, and our prescribers will ensure any new medicine is safe and appropriate for you, taking into account interactions and contraindications.

All ED medicines at Cured Pharmacy require a prescription, which is issued after your online consultation is reviewed and approved by a UK prescriber. Your treatment is then dispensed by our pharmacy team and delivered discreetly to your door. If you have questions or need advice, our pharmacists are available to help you get the most from your treatment and support you in finding an effective solution.

Why see a doctor if avanafil stopped working

Erectile dysfunction can be an early warning sign of serious health conditions, particularly cardiovascular disease and diabetes [1][10]. If a previously effective treatment like avanafil has stopped working, it may indicate that an underlying condition is progressing and needs medical attention.

Your GP can arrange blood tests (for cholesterol, blood sugar, and hormone levels), check your blood pressure, and assess your heart health. Treating these conditions not only improves your general health and reduces your risk of heart attack and stroke, but often improves erectile function as well [2]. Don't ignore the signal your body is sending—book an appointment and get checked.

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