Avanafil

Avanafil is the newest of the approved PDE5 inhibitors, the class that keeps an erection’s signal running by blocking the enzyme that shuts it off. Two things set it apart from sildenafil and tadalafil. It absorbs fast, so it’s ready in about a quarter of an hour instead of an hour. And it’s picky: the older drugs also touch nearby enzymes, PDE6 in the retina, where sildenafil’s blue tint comes from, and PDE11 in muscle, the usual suspect for tadalafil’s back ache. Avanafil mostly leaves those alone.

Think of it as a faster, gentler sildenafil with a window of several hours. It doesn’t give you tadalafil’s all-weekend coverage, and nobody has built a daily protocol around it. If sildenafil works but you hate planning around it, or sildenafil and vardenafil both leave you flushed and stuffed up, try this.

Solid phase 3 trials plus a head-to-head against sildenafil, which is rarer in this class than it should be. Speed is the claim, and speed has the receipts:

Take 100 mg about 15 to 30 minutes before sex. That’s the standard dose and where most men stay. It doesn’t demand an empty stomach the way sildenafil does, though a heavy meal still slows it, so if speed is the point, don’t stack it on a steak dinner. The 15 minutes is when it starts, not when it ends; it keeps working for several hours, so you don’t need to sprint. If 100 falls short after a few tries, 200 is the next stop and rescues plenty of men who miss at 100. If 50 does the job, that’s winning.

Drop to 50 if you’re on an alpha-blocker or a moderate CYP3A4 blocker like erythromycin, fluconazole or diltiazem. Strong blockers such as ketoconazole, ritonavir or clarithromycin rule avanafil out. A couple of drinks is fine; heavy drinking stacks with the blood pressure dip and blunts erections anyway. And the hard rule, same as every PDE5: never with nitrates, meaning nitroglycerin, isosorbide or poppers, or with riociguat, a lung blood-pressure drug.

Same class, quieter profile: