Sildenafil vs. Avanafil

See how Sildenafil and Avanafil compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Sildenafil and avanafil are both PDE5 inhibitors taken as needed before sexual activity to treat erectile dysfunction.

  • Avanafil tends to work faster, with some men noticing effects in as little as 15 minutes, while sildenafil is more affected by food.

  • Sildenafil is available as a low-cost generic, while avanafil has no generic option and remains the priciest PDE5 inhibitor.

Sildenafil vs. Avanafil Drug Summary

Sildenafil

Sildenafil is a phosphodiesterase-5 (PDE5) inhibitor used to treat erectile dysfunction by increasing blood flow to the penis during sexual stimulation. It comes as an oral tablet taken as needed, roughly an hour before sexual activity. Sildenafil was the first oral PDE5 inhibitor approved for ED and has been used since 1998.

Avanafil

Avanafil is a phosphodiesterase-5 (PDE5) inhibitor that also treats erectile dysfunction by increasing blood flow to the penis. It is taken as an oral tablet as needed, and many men notice it working within 15 to 30 minutes. Approved in 2012, avanafil is the newest PDE5 inhibitor available.

Sildenafil vs. Avanafil Side Effects

Sildenafil

Most common
Headache (up to 16%)
Flushing (up to 10%)
Dyspepsia (up to 7%)
Nasal congestion (up to 4%)

Avanafil

Most common
Headache (10-16%)
Flushing (5-12%)
Dyspepsia (4-12%)
Nasal congestion (1-10%)

Sildenafil vs. Avanafil Dosage

Sildenafil

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 25 mg as needed At the start
Maximum dose 100 mg as needed If needed
Dose changes 2 increases As tolerated

Avanafil

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 50 mg as needed At the start
Maximum dose 200 mg as needed If needed
Dose changes 2 increases As tolerated

Sildenafil vs. Avanafil Indications

Sildenafil

Sildenafil is FDA-approved to treat erectile dysfunction in men, and a different formulation (Revatio) is approved for pulmonary arterial hypertension. Doctors also prescribe it off-label for conditions like Raynaud's phenomenon and to help prevent high-altitude pulmonary edema. It is not approved for use in women or for chronic pediatric pulmonary hypertension.

  • Treats erectile dysfunction in adult men

  • Revatio brand treats pulmonary arterial hypertension

  • Off-label use for Raynaud's phenomenon

  • Off-label use for female sexual arousal disorder

Avanafil

Avanafil is FDA-approved only for treating erectile dysfunction in adult men. It has no other approved uses and no well-established off-label applications. It is not approved for use in women or in pediatric patients.

  • Treats erectile dysfunction in adult men

  • No other FDA-approved uses

  • Not approved for use in women

  • Not approved for pediatric patients

Sildenafil vs. Avanafil Pros and Cons

Sildenafil

Sildenafil has the longest real-world track record of any PDE5 inhibitor and is widely available as an affordable generic. Its effects can take longer to kick in, especially after a fatty meal, and it carries the same cardiovascular warnings as other PDE5 inhibitors.

Pros

  • Available as a low-cost generic, often far less than avanafil's $160 to $2,000 list price

  • Longest real-world safety track record, in use since 1998

  • Also approved as Revatio for pulmonary arterial hypertension

Cons

  • Onset can take up to 60 minutes

  • High-fat meals can delay or reduce absorption

  • Effects typically last only 4 to 6 hours

Avanafil

Avanafil stands out for its fast onset, with some men responding in as little as 15 minutes. It is less affected by food than sildenafil, but it is only approved for erectile dysfunction and has no generic option.

Pros

  • Fastest onset among PDE5 inhibitors, sometimes 15 minutes

  • Less affected by food than sildenafil

  • Newer formulation, approved in 2012

Cons

  • No generic version available in the U.S.

  • List price runs $160 to $2,000 per month, above generic sildenafil

  • Only approved for erectile dysfunction, no other indications

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