What is Spedra and how does it work?

DoktorABC editorial team

Accurate, up-to-date health information written by our editorial team and reviewed by UK-registered prescribers.

What is Spedra?

Spedra is the brand name for avanafil, a phosphodiesterase type 5 (PDE5) inhibitor, the same class of medicine as sildenafil (Viagra). It's made by Menarini. According to NICE's evidence summary on avanafil, it received a European marketing authorisation in June 2013 and was launched in the UK in March 2014.

In the UK, Spedra is prescription-only and comes in 3 strengths: 50mg, 100mg and 200mg. The Spedra Summary of Product Characteristics (SmPC) sets the recommended dose at 100mg, which may be increased to 200mg or reduced to 50mg depending on effect and tolerability, with a maximum of 1 dose a day.

How does Spedra work?

An erection happens when blood flows into the penis. When you're sexually aroused, your body releases a chemical signal that relaxes the blood vessels and tissue in the penis so blood can flow in. An enzyme called PDE5 normally switches that signal off.

Spedra blocks PDE5, so the signal lasts longer and it's easier to get and keep an erection when you're aroused. Because it works on that natural signal, the SmPC states that avanafil has no effect in the absence of sexual stimulation.

How long does Spedra take to work?

The SmPC recommends taking the 100mg dose approximately 15 to 30 minutes before sexual activity. The patient information leaflet (PIL) gives timings by strength: about 30 minutes for 50mg, and approximately 15 to 30 minutes for 100mg and 200mg.

In one study, men attempted intercourse about 15 minutes after dosing. Successful intercourse was reported in 24.71% of attempts at 100mg and 28.18% at 200mg, compared with 13.78% on placebo. In another study, some men taking 200mg had erections firm enough for penetration as early as 20 minutes after dosing. Response varies between individuals.

Food can make a difference. Avanafil reaches peak blood levels at a median of 30 to 45 minutes, but a high-fat meal delays this by an average of 1.25 hours. The PIL notes Spedra can be taken with or without food, but may take longer to work after food.

How long does Spedra 200mg last?

The SmPC doesn't give a set number of hours for how long the effect lasts, at 200mg or any other strength. Hour counts quoted online aren't stated in the UK product information.

What the SmPC does say:

• 200mg is the maximum dose, used depending on how well 100mg works and is tolerated. It doesn't say the higher strength lasts longer
• Spedra should be taken no more than once a day
• Avanafil's terminal half-life is approximately 6 to 17 hours. This describes how your body clears the medicine, not how long it helps with erections

If Spedra isn't working well enough, it's worth asking your prescriber to review the dose rather than changing it yourself.

Is Spedra better than Viagra?

The evidence doesn't show that either is better overall. Both are PDE5 inhibitors and work in the same way.

The main documented difference is timing. NICE notes that sildenafil's SmPC advises taking it 1 hour before sexual activity, while the current Spedra SmPC gives approximately 15 to 30 minutes for 100mg. NICE also found avanafil's safety profile appeared similar to other PDE5 inhibitors.

However, NICE reports there are no direct head-to-head comparisons of PDE5 inhibitors, so how avanafil compares with sildenafil, tadalafil and vardenafil is not known. The right choice tends to depend on your medical history, other medicines and preferences such as timing. 

Spedra and alcohol: what should you know?

Avanafil widens blood vessels, causing mild and temporary drops in blood pressure. Alcohol taken with avanafil can increase the potential for symptomatic low blood pressure, and that this may mean dizziness or fainting.

In a study described in the SmPC, the maximum drop in diastolic blood pressure was significantly greater with avanafil and alcohol together than with either alone. The PIL adds that drinking alcohol at the same time may increase your heart rate and lower your blood pressure. If you drink regularly, it's worth mentioning this in your consultation.

Who should not take Spedra?

According to the SmPC, you shouldn't take Spedra if you:

• Use any nitrate medicine or nitric oxide donor, including amyl nitrite ("poppers")
• Take riociguat, or a potent CYP3A4 inhibitor such as ketoconazole, ritonavir or clarithromycin
• Have had a heart attack, stroke or life-threatening irregular heartbeat in the last 6 months
• Have resting blood pressure below 90/50 mmHg or above 170/100 mmHg
• Have unstable angina, angina during sex, or heart failure classed as New York Heart Association class 2 or above
• Have severe liver or kidney problems
• Have lost vision in one eye due to non-arteritic anterior ischaemic optic neuropathy (NAION), or have a hereditary degenerative retinal disorder
• Are allergic to avanafil or any of its ingredients

How to get Spedra in the UK

Spedra can only be supplied in the UK with a valid prescription, through your GP or a regulated online service. At DoktorABC, you complete an online consultation covering your symptoms, medical history and current medicines. A UK-registered prescriber reviews your answers and, if Spedra is suitable, can issue a prescription. Find out more on our Spedra treatment page and in our erectile dysfunction hub.

Conclusion

Spedra (avanafil) is a prescription-only ED treatment that supports your body's natural response to arousal, so it only works with sexual stimulation. Depending on the strength, it's taken about 15 to 30 minutes before sex, although food can slow it down, and there's no set number of hours for how long it lasts. It works in the same way as Viagra. The main difference is timing, and there's no direct evidence that one is better than the other. Alcohol can increase the risk of dizziness or fainting, and some health conditions and medicines rule Spedra out, which is why a prescriber checks it's suitable for you first.

FAQ

The DoktorABC medical advisory board

Dr. Roland Ruiken

Medical advisor, Norway

Dr. Viktor Simunovic

Medical advisor, Croatia

To the medical advisory board