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
Avanafil
Sildenafil vs. Avanafil Dosage
Sildenafil
Avanafil
| 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 |
| 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
| 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
| 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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