How Does Avanafil Compare for Erectile Dysfunction?
How Does Avanafil Compare for Erectile Dysfunction?
Avanafil's rapid onset, short duration of action, higher selectivity, and favorable side-effect profile make it an interesting new addition to the PDE5-inhibitor class. It should be considered with the other available PDE5 inhibitors as first-line therapy for ED and as an alternative for patients who are not fully satisfied with previous options.
While PDE5 inhibitors have become popular because they are safe and effective, no one drug has proven itself safer or more effective than the others. It is our recommendation to work with each patient to individualize his therapy according to his preferences, current medications, and comorbidities. Ultimately, the patient's perception of efficacy will drive treatment choice. It is reasonable to start with one PDE5 inhibitor and, if needed, to try others until the patient identifies one that best suits him. Important points to discuss when counseling a patient include:
If the patient does not respond to the first trial of a PDE5 inhibitor, consider increasing the dosage and counsel the patient on proper timing and frequency of dosing, the need for adequate sexual stimulation, and avoidance of high-fat meals and heavy alcohol use.
If the patient continues to experience no results after maximum dosage and proper education and counseling, it is unlikely that he will respond to another PDE5 inhibitor.
Additionally, it is known that ED is a harbinger of other diseases and comorbidities including cardiovascular disease and diabetes. The work-up of the patient offers an opportunity for screening, prevention, and treatment of underlying disease to improve erectile function and responsiveness to PDE5 inhibitors and to improve overall morbidity, mortality, and quality of life. ED is also common in men who are post-prostatectomy or have nerve damage. The aforementioned patients tend to be more difficult to treat and may not respond to currently available PDE5 inhibitors. New therapies are currently being developed to address such patients.
How to Counsel Patients
Avanafil's rapid onset, short duration of action, higher selectivity, and favorable side-effect profile make it an interesting new addition to the PDE5-inhibitor class. It should be considered with the other available PDE5 inhibitors as first-line therapy for ED and as an alternative for patients who are not fully satisfied with previous options.
While PDE5 inhibitors have become popular because they are safe and effective, no one drug has proven itself safer or more effective than the others. It is our recommendation to work with each patient to individualize his therapy according to his preferences, current medications, and comorbidities. Ultimately, the patient's perception of efficacy will drive treatment choice. It is reasonable to start with one PDE5 inhibitor and, if needed, to try others until the patient identifies one that best suits him. Important points to discuss when counseling a patient include:
How quickly the patient can expect the drug to take effect. Use of PDE5 inhibitors usually requires planning on the patient's part. Avanafil has a particularly rapid onset of action: many patients are able to successfully engage in sexual intercourse after 15 minutes, making it attractive for quicker on-demand use.
How long he can expect the drug's effect to last. Tadalafil has a particularly long duration of action, up to 36 hours, and can be dosed once daily. This allows for a longer window of opportunity for the patient to successfully engage in intercourse. Avanafil can have an effect for greater than 6 hours and can be dosed twice in a day.
The effect of food intake before dosing. High-fat food intake before dosing can decrease the efficacy of sildenafil and vardenafil. It is recommended that these drugs be taken on an empty stomach. This is not the case with avanafil or tadalafil.
Common side effects. These include headache, flushing, dyspepsia, nasal congestion, etc. Side effects of concern include severe hypotension and priapism.
Medication that should not be taken with PDE5 inhibitors: nitrates. Avanafil has the potential for use with nitrates, although more studies are needed before recommendations can be made. Phase 2 studies showed smaller changes in systolic blood pressure and heart rate when dosed with nitrates as compared with sildenafil, most likely due to avanafil's short half-life.
Medications to take with care and caution: alpha-blockers and potent CYP3A4 inhibitors.
If the patient does not respond to the first trial of a PDE5 inhibitor, consider increasing the dosage and counsel the patient on proper timing and frequency of dosing, the need for adequate sexual stimulation, and avoidance of high-fat meals and heavy alcohol use.
If the patient continues to experience no results after maximum dosage and proper education and counseling, it is unlikely that he will respond to another PDE5 inhibitor.
Additionally, it is known that ED is a harbinger of other diseases and comorbidities including cardiovascular disease and diabetes. The work-up of the patient offers an opportunity for screening, prevention, and treatment of underlying disease to improve erectile function and responsiveness to PDE5 inhibitors and to improve overall morbidity, mortality, and quality of life. ED is also common in men who are post-prostatectomy or have nerve damage. The aforementioned patients tend to be more difficult to treat and may not respond to currently available PDE5 inhibitors. New therapies are currently being developed to address such patients.
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