Spedra reviews: what clinical trials and patient experiences show
- What Spedra is and how it's taken
- What the phase III trials found
- The themes that come up most in patient experiences
- The main pros and cons
- How it compares with Viagra and Cialis
- Who should speak to a prescriber about it
What is Spedra?
Spedra is the brand name for avanafil, a prescription-only medicine for erectile dysfunction (ED) in adult men. Like sildenafil (Viagra) and tadalafil (Cialis), it's a PDE5 inhibitor, one of the main ED medicines listed by the NHS.
By blocking the PDE5 enzyme, avanafil slows the breakdown of cGMP, a messenger released during arousal that relaxes the smooth muscle in the penis's blood vessels so blood can flow in. Sexual stimulation is still needed.
The usual starting dose is 100 mg, taken about 15 to 30 minutes before sex and no more than once a day. A prescriber may adjust this to 50 mg or 200 mg. Read more on our Spedra treatment page.
What do the clinical trials show?
NICE's evidence summary reviewed three 12-week randomised, double-blind phase III trials comparing avanafil with placebo in 1,334 men: a general ED population, men with diabetes and men who'd had nerve-sparing prostate removal surgery. The main measure was the percentage of sexual attempts that led to successful intercourse.
The table shows, for each trial group, roughly how many attempts at sex out of every 100 led to successful intercourse.
| Trial group | Placebo | Spedra 50 mg | Spedra 100 mg | Spedra 200 mg |
|---|---|---|---|---|
| General ED population | 28 in 100 | 47 in 100 | 58 in 100 | 59 in 100 |
| Men with diabetes | 21 in 100 | Not studied | 34 in 100 | 40 in 100 |
| After prostate surgery | 9 in 100 | Not studied | 23 in 100 | 26 in 100 |
Source: Spedra SmPC, section 5.1
Response rates fell as ED became more severe, according to the European public assessment report cited by NICE.
A separate study, described in the SmPC, looked at men who tried to have sex about 15 minutes after taking Spedra. At that point, roughly 25 in 100 attempts were successful on 100 mg and 28 in 100 on 200 mg, compared with 14 in 100 on placebo.
Side effects were reported by roughly 30-40 in 100 men taking Spedra and about 25 in 100 taking placebo, and most were mild to moderate. The most common are headache, flushing and a blocked nose, each affecting up to 1 in 10 people.
Good to know
Trial figures are group averages, not a prediction for you. Men who hadn't responded to or tolerated other PDE5 inhibitors were excluded, so the trials can't show how Spedra works for them.
What do patient reviews of Spedra say?
The themes below come from two places. The first is the top-ranked reviews among 62 user reviews on Drugs.com, an independent medicines site, where Spedra is sold under the name Stendra. The second is a 2024 study that followed 112 men in Taiwan taking Spedra and asked them how satisfied they were. We've summarised what comes up most often, without quoting anyone or showing ratings. Online reviews aren't checked and tend to come from people with strong views, and neither source is from the UK, so treat these themes as experiences rather than proof that Spedra works.
Onset
Many reviewers say it starts working within about 15 to 30 minutes, though a few say it took longer or didn't work at all. A high-fat meal can slow it down by around 1.25 hours.
Spontaneity
Many like being able to take it at short notice. Several also point out that it only works with sexual arousal and doesn't increase desire, which is what the product information says too.
Side effects
Many reviewers had few or none. The ones mentioned most are headache, flushing, a blocked nose and back pain, all listed in the SmPC. In the Taiwanese study, about 41% of men had side effects, and all were mild.
Effectiveness
Views are split. Some say it works reliably, while others found another ED tablet worked better for them or needed a higher dose. In the 2024 study, about 88% of men who stayed in the study to the end were satisfied, though the authors point out it was small and run at a single clinic.
Cost
Price comes up often. Drugs.com reviews reflect US prices, but NICE also found Spedra cost considerably more than generic sildenafil in the UK.
Pros and cons of Spedra
| Pros | Cons |
|---|---|
| Taken about 15 to 30 minutes before sex | Needs sexual stimulation to work |
| Improved success rates over placebo in all 3 trial populations | Lower response in diabetes, after prostate surgery and with more severe ED |
| Can be taken with or without food | A high-fat meal may delay its effect |
| Side effects mostly mild to moderate in trials | Not suitable with nitrates, riociguat and some other medicines |
| 3 strengths allow the dose to be adjusted | Costs more than generic sildenafil |
How does Spedra compare with Viagra and Cialis?
There are no head-to-head trials comparing avanafil with sildenafil (Viagra) or tadalafil (Cialis). NICE cautions that indirect comparisons are limited by differences in trial design and definitions of success, and notes avanafil's safety profile appears similar to other PDE5 inhibitors. One practical difference is timing: NICE notes sildenafil is taken about 1 hour before sex.
Who should speak to a prescriber about Spedra?
If erection problems keep happening, the NHS recommends seeing a GP, as they can be a sign of a treatable health condition. A prescriber's assessment is particularly important if you:
- Take nitrates, riociguat, alpha-blockers or medicines such as ketoconazole, ritonavir or erythromycin
- Have had a heart attack, stroke or life-threatening heart rhythm problem in the last 6 months
- Have unstable angina, heart failure or blood pressure that's low or uncontrolled
- Have severe liver or kidney problems
- Have lost vision in one eye from NAION, or have an inherited retinal condition
Warning !
Stop taking Spedra and get urgent medical help if an erection lasts 4 hours or more, or if you notice sudden loss of vision or hearing. Alcohol can increase the risk of dizziness and low blood pressure, and grapefruit juice should be avoided for 24 hours before a dose. Report suspected side effects through the MHRA Yellow Card scheme.
How can you access Spedra through a consultation?
Through DoktorABC, you complete a confidential online medical questionnaire, which a UK-registered prescriber reviews alongside your medical history and current medicines. If Spedra is clinically appropriate, a prescription is issued and a pharmacy dispatches it. The final decision is always the prescriber's.
Final thoughts
Spedra reviews give a mixed picture. Trials show avanafil improved success rates over placebo across all three populations studied, though results were lower in harder-to-treat groups and as ED severity increased. Patient experiences most often mention the short timing window and mild side effects, alongside divided views on reliability and cost. Whether it suits you depends on your health and other medicines, which a UK-registered prescriber can assess.
FAQ
How quickly does Spedra work?
The SmPC recommends taking it about 15 to 30 minutes before sex. A high-fat meal can delay its effect.
Is Spedra more effective than Viagra or Cialis?
There are no head-to-head trials, so a direct comparison isn't possible.
What are the most common side effects of Spedra?
Headache, flushing and nasal congestion. In trials, most side effects were mild to moderate.
Does Spedra work for men with diabetes?
In the diabetes trial, success rates were about 34% on 100 mg and 40% on 200 mg, against about 21% on placebo.
How often can I take Spedra?
No more than once a day, or at least 48 hours apart if you take certain medicines, such as erythromycin.
The DoktorABC medical advisory board
Dr. Roland Ruiken
Medical advisor, Norway
Dr. Viktor Simunovic
Medical advisor, Croatia