Sildenafil vs Vardenafil vs Avanafil: Speed vs Staying Power

January 30, 2026
Blog
Journal

Authors

Reviewed by Dr. Rasoul Montazeri

Triple Board Certified Physician and The Founder

Niayesh Najafi

Medical student and researcher in Health Sciences

Table of contents

Overview of Erectile Dysfunction Medications: Sildenafil, Vardenafil, and Avanafil
Comparing ED Onset: Which Medication Works Fastest?
Duration Chart: How Long Do the Effects Last?
Effectiveness in Treating Erectile Dysfunction
Side Effect Profiles: Tolerability and Safety
Drug Interactions, Cautions, and Special Considerations
Speak With a Healthon Provider
Frequently Asked Questions

Key takeaways

All three are effective: Sildenafil, vardenafil, and avanafil work the same way and have strong success rates for treating ED.
Timing differs, duration is similar: Sildenafil and vardenafil take about 1 hour to work; avanafil may act faster. All last about 4–6 hours.
Side effects vary by person: Common effects include headache and flushing; avanafil may cause fewer side effects for some men.
Safety matters: These drugs must not be used with nitrates, and a healthcare provider should help choose the safest option.

Blue erectile dysfunction tablets in prescription bottle representing PDE5 inhibitor medications such as sildenafil, vardenafil, and avanafil

Sildenafil typically begins working within 30 minutes and lasts up to four hours. Vardenafil has a similar onset and may remain effective for as long as six hours. Avanafil absorbs faster, often taking effect in about 15 minutes, which supports more spontaneous use. Each option offers a different balance of timing and duration, allowing treatment to align with specific needs and health factors.

Overview of Erectile Dysfunction Medications: Sildenafil, Vardenafil, and Avanafil

Illustration comparing sildenafil, vardenafil, and avanafil based on onset speed, duration, and tolerability for ED treatment

Sildenafil, vardenafil, and avanafil are all oral medications prescribed for the treatment of erectile dysfunction. They belong to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors. Their primary function is to enhance erectile response when you are sexually aroused by increasing blood flow to the penis.

What are PDE5 Inhibitors and How Do They Work for ED?

PDE5 inhibitors are the first-line therapy for most men with erectile dysfunction. But what exactly do they do? Their mechanism of action is tied to a natural chemical process in your body that occurs during sexual stimulation. When you're aroused, your body releases nitric oxide in the corpus cavernosum (the spongy tissue in the penis).

This release of nitric oxide triggers the production of another messenger called cyclic guanosine monophosphate (cGMP), which causes the smooth muscles to relax and blood vessels to widen.

Key Similarities and Differences Among the Three Medications

Sildenafil, vardenafil, and avanafil work in much the same way. Each inhibits the PDE5 enzyme, which supports erection by improving blood flow during sexual stimulation. All three have strong evidence supporting their effectiveness across a broad range of men with ED.

Comparing ED Onset: Which Medication Works Fastest?

Sildenafil and vardenafil have a more traditional timeframe, typically requiring you to take them about an hour before you plan to be intimate. While still highly effective, they necessitate a bit more planning. Knowing these timelines helps you schedule your dose for optimal results.

Duration Chart: How Long Do the Effects Last?

Typical Duration of Sildenafil vs Vardenafil vs Avanafil

These medications have a similar duration of effect. After a single dose, the response window typically lasts four to six hours, during which erections are easier to achieve with arousal. This timeframe is sufficient for most situations.

Effectiveness in Treating Erectile Dysfunction

Man holding oral ED medication tablet illustrating proper use of PDE5 inhibitors for erectile dysfunction

Success Rates and Clinical Outcomes

Clinical trials for sildenafil, vardenafil, and avanafil have demonstrated impressive results. In these studies, success is often measured by the ability of participants to get and keep an erection firm enough for successful sexual intercourse. Across the board, all three medications have shown significantly better outcomes than a placebo.

The key takeaway from the clinical data is that you have a high probability of success with any of these three options. If one doesn't provide the desired result, it's possible that another one will, as individual responses can vary. A healthcare provider can help you find the right drug and dosage to maximize your chances of success.

User Experiences: Real-World Comparisons

Satisfaction is often a balance between effectiveness and tolerability. A medication might be highly effective, but if it causes bothersome adverse effects like headaches or nasal congestion, a user might want to switch. Some men who experience side effects with sildenafil or vardenafil report having fewer issues when they switch to avanafil, possibly due to its higher selectivity.

Side Effect Profiles: Tolerability and Safety

Man holding head in pain illustrating common side effects such as headache associated with PDE5 inhibitor erectile dysfunction medications

Common Side Effects and Frequency

Avanafil is often highlighted as having fewer side effects. Because it's more selective for the PDE5 enzyme, it's less likely to affect other enzymes in the body, which can cause issues like vision changes.

Common side effects for all three can include:

Headache
Flushing (redness of the face)
Nasal congestion or stuffy nose
Back pain
Upset stomach
Vision changes (less common with avanafil)

Who is Most Likely to Experience Side Effects?

The risk of side effects may be higher for:

People taking higher doses of the medication.
Older adults, who may be more sensitive to a drug's effects.
People with certain health conditions, such as severe liver or renal impairment.
Those taking other medications that interact with PDE5 inhibitors.

Drug Interactions, Cautions, and Special Considerations

The most critical drug interaction with all PDE5 inhibitors involves nitrates. These drugs are often prescribed for chest pain (angina). Taking a PDE5 inhibitor with a nitrate can cause a severe and potentially life-threatening drop in blood pressure. You must not use these medications together.

Other substances can also interact. For example, certain drugs known as CYP3A4 inhibitors (like some antifungal or antibiotic medications) can dramatically increase the levels of the ED drug in your bloodstream, raising the risk of side effects. Your doctor may need to adjust your dosage or advise against using them together.

Be cautious with the following:

Nitrates: Includes nitroglycerin, isosorbide dinitrate, and the recreational drug "poppers" (amyl nitrite).
Alpha-blockers: Often used for high blood pressure or an enlarged prostate.
Potent CYP3A4 inhibitors: Such as ketoconazole or ritonavir.
Alcohol: Consuming substantial amounts of alcohol can increase the risk of dizziness and low blood pressure.

Important Health Considerations and Warnings

Beyond drug interactions, your personal health history is a major consideration. Men with certain underlying health conditions should use PDE5 inhibitors with caution or not at all. It's vital to be transparent with your provider about your entire health profile.

A key warning relates to cardiovascular disease. If your doctor has advised you that sexual activity is unsafe due to your heart health, you should not use these medications. Also, seek immediate medical attention if you experience chest pain, dizziness, or nausea during sex.

Other important warnings include:

Priapism: A painful erection lasting more than 4 hours is a medical emergency that can cause permanent damage.
Sudden Vision Loss: A rare condition called NAION has been reported. Stop taking the medication and see a doctor if this occurs.
Sudden Hearing Loss: Though rare, sudden loss of hearing has been associated with these drugs. Discontinue use and seek medical help if this happens.

Speak With a Healthon Provider

Choosing between sildenafil, vardenafil, and avanafil is a decision that should be made with professional medical guidance. While this guide provides a helpful comparison, it cannot replace a consultation with a qualified healthcare provider. A provider can assess your individual health needs, review your medical history, and help you weigh the pros and cons of each option. They can determine the right medication and dosage for you, ensuring your treatment is both safe and effective.

At Healthon, our team of licensed healthcare professionals is here to support you. We can answer your questions, address your concerns, and provide the personalized advice you need to manage erectile dysfunction with confidence. Don't let uncertainty hold you back. Reach out to a Healthon provider to start a conversation about the treatment of erectile dysfunction and find a solution that works for you.

Frequently Asked Questions

Is avanafil a good alternative if sildenafil or vardenafil don’t work?

Yes, avanafil can be a great alternative. If you experience bothersome side effects with sildenafil or vardenafil, you might find avanafil more tolerable due to its higher selectivity. If one drug isn't effective, another might work better due to individual differences in response, so it's worth discussing with your provider.

Do these ED medications differ in cost or availability in the United States?

Yes, there are differences. Sildenafil is widely available as a generic, making it the most affordable option. Vardenafil also has a generic version. Avanafil is currently only available under the brand name Stendra in the United States, which typically makes it more expensive than the generic alternatives.

What should I consider when choosing between sildenafil, vardenafil, and avanafil?

Consider your lifestyle, health profile, and priorities. Think about how important a fast onset of action is versus potential side effects. Discuss your cardiovascular health and any other medications you take with your provider. Your personal response and tolerability will be the ultimate guide to the best treatment for you.