Avana (Avanafil)

Medically reviewed by Dr. Sarah Mitchell, RPh, Clinical Pharmacist — Updated January 2026

What Is Avana — and How Does It Relate to Stendra in Canada?

Avanafil is the active ingredient in both brand Stendra (Vivus Inc./Menarini Group, FDA-approved in the USA) and generic Avana (Sunrise Remedies). Both contain identical Avanafil at the same dosage. The difference is the manufacturer, brand name, and price.

Avana vs Viagra vs Cialis vs Levitra — The Complete Comparison for Canadian Men

Choose Avana (Avanafil) if: you want the absolute fastest onset of all ED medications, you have experienced visual blue tinge or light sensitivity with Sildenafil, you take antiarrhythmic medications and need the ED pill with the most favourable cardiac profile, or you want the newest-generation medication with the best PDE5 selectivity available.

How Does Avana Work — The Science Behind 15-Minute Onset

Avanafil is a PDE5 inhibitor — the same drug class as Sildenafil, Tadalafil, and Vardenafil. During sexual arousal, nitric oxide (NO) is released in penile tissue, stimulating production of cGMP (cyclic guanosine monophosphate). cGMP relaxes smooth muscle in the corpus cavernosum, allowing increased blood flow and producing an erection. PDE5 breaks down cGMP, shortening the erection window. Avanafil competitively inhibits PDE5, preserving cGMP and enabling sustained erections during sexual stimulation.

Why Avanafil reaches therapeutic levels in 15 minutes: Avanafil reaches maximum serum concentration in approximately 30 to 45 minutes — significantly faster than Sildenafil (60 minutes) or Tadalafil (120 minutes). More importantly, therapeutic concentrations sufficient to produce an erection are reached in many men within 15 minutes. In a dedicated randomised, double-blind, placebo-controlled study (Hellstrom et al., Journal of Urology, 2015), Avanafil 100 mg and 200 mg demonstrated statistically significant improvements in erectile function compared to placebo at the 15-minute time point — the only PDE5 inhibitor study to demonstrate this.

Why Avanafil causes no visual blue tinge: Sildenafil has moderate cross-reactivity with PDE6 — the enzyme in retinal photoreceptors responsible for colour vision. This causes the blue tinge or visual disturbances seen with Viagra. Avanafil has approximately 100-fold greater selectivity for PDE5 over PDE6 than Sildenafil. As a result, visual colour disturbances are not a reported side effect of Avanafil — making it the preferred choice for Canadian men who experienced these effects with Sildenafil.

Why Avanafil has the safest cardiac profile: Vardenafil prolongs the cardiac QT interval more than other PDE5 inhibitors — requiring caution in men taking Class IA and III antiarrhythmic medications. Avanafil has the most favourable QT interval profile of all four PDE5 inhibitors. Additionally, Avanafil is more selective for PDE5 over PDE11 (expressed in cardiac muscle) than Tadalafil — which may explain why back pain and muscle aches are less common with Avanafil.

Critical: Avana works only with sexual stimulation. Without arousal, no erection occurs regardless of dose — it is not an aphrodisiac and does not increase sexual desire. It does not protect against sexually transmitted infections.

Clinical Evidence — Avanafil's Track Record

Avanafil was approved by the US FDA in April 2012. It has the most extensive evidence base of any newly developed ED medication, with multiple Phase III randomised controlled trials:

• 15-minute onset study (Hellstrom et al., Journal of Urology, 2015): Randomised, double-blind, placebo-controlled study specifically investigating efficacy at 15 minutes after dosing. Avanafil 100 mg and 200 mg demonstrated statistically significant improvements versus placebo — the only PDE5 inhibitor study to establish efficacy at this time point
• General ED efficacy (Goldstein et al., 2012): Phase III trial showing that 77% of men on Avanafil 200 mg reported improved erections versus 25% on placebo
• Diabetes population (Goldstein et al., Mayo Clinic Proceedings, 2012): Multicentre, randomised, double-blind study in men with type 1 and type 2 diabetes. Avanafil demonstrated significant improvements versus placebo in this challenging population — validating it as an effective option for Canadian men with diabetic ED
• Post-prostatectomy ED (Mulhall et al.): Clinical studies demonstrating Avanafil efficacy in men following nerve-sparing radical prostatectomy — a common procedure in Canada for prostate cancer treatment

Dosage Guide — Avana (Avanafil) for Canadian Men

Important: Avana is an on-demand medication taken before sexual activity. It is not a daily continuous treatment. Take only when planning sexual activity — not on a scheduled daily basis.

Standard starting dose — 100 mg: Take approximately 15 to 30 minutes before anticipated sexual activity. This is Avanafil's defining advantage — you need only 15 minutes versus 30 to 60 minutes for Sildenafil or Tadalafil.

Dose options:

• 50 mg — recommended starting dose for men over 65, those with mild to moderate hepatic impairment, and men taking moderate CYP3A4 inhibitors (erythromycin, diltiazem, verapamil, fluconazole). Also appropriate for men who find 100 mg too strong
• 100 mg — standard starting dose for most Canadian men. Take 15 to 30 minutes before sexual activity
• 200 mg — maximum dose. Use only if 100 mg is consistently insufficient after multiple attempts and is well-tolerated

With or without food: Avanafil absorption is minimally affected by most meals — unlike Sildenafil which is significantly impaired by high-fat meals. Taking Avana after a standard meal produces reliable onset within 15 to 30 minutes. A very high-fat meal may modestly slow absorption.

Alcohol: One to two standard Canadian drinks are generally tolerable for healthy men. Larger amounts lower blood pressure and may impair erection quality independently.

Grapefruit juice: Avoid on the day of use — inhibits CYP3A4 and can increase Avanafil blood levels unpredictably.

Frequency: No more than once per 24 hours.

Price Comparison — Avana vs Stendra vs Other ED Medications in Canada

Avana is priced higher than Sildenafil and Tadalafil generics due to Avanafil's newer patent status and lower global generic production volume. For Canadian men who specifically need the fastest-acting ED medication or who experienced visual side effects with Sildenafil — Avana represents significant savings versus brand Stendra at identical therapeutic effect.

Legal Status in Canada — Health Canada and Personal Importation

Health Canada status: Avanafil is not registered by Health Canada under the Stendra or any other brand name. It is not available at Canadian pharmacies as a Health Canada-approved product. There is no Canadian DIN for Avanafil. Canadian men require a prescription for any ED medication at regulated Canadian pharmacies.

Personal importation grey area: Purchasing Avanafil from international online pharmacies for personal use in small quantities exists in a legal grey area in Canada. The Canada Border Services Agency (CBSA) may inspect incoming parcels. For personal-use quantities from reputable sources, enforcement against individual consumers is rare — but not guaranteed.

Our recommendation: Consult a Canadian GP, urologist, or men's health specialist before starting Avanafil — particularly if you have cardiovascular conditions, take any heart medications, antiarrhythmic drugs, blood pressure medications, alpha-blockers, or strong CYP3A4 inhibitors. Canadian telehealth platforms including Maple, Dialogue, and Tia Health offer convenient same-day consultations for men's sexual health.

Drug Interactions — Critical Safety Information for Canadian Men

Avanafil has several clinically important drug interactions. Always inform your doctor or pharmacist about all medications before taking Avana.

Absolute contraindications — never combine:

• Nitrate medications (nitroglycerin/GTN spray, isosorbide dinitrate, isosorbide mononitrate) — used for angina. The combination causes severe, potentially life-threatening hypotension. Absolute contraindication — no safe dose of Avanafil for men taking nitrates in any form
• Poppers (amyl nitrite, butyl nitrite) — same life-threatening blood pressure drop as cardiac nitrates. Absolute contraindication
• Riociguat (Adempas) — for pulmonary hypertension. Absolute contraindication
• Strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir, clarithromycin, nefazodone) — this is Avanafil's unique and most important drug interaction. Strong CYP3A4 inhibitors dramatically increase Avanafil blood levels to potentially dangerous concentrations. Avanafil is contraindicated with strong CYP3A4 inhibitors — more strictly than Sildenafil or Tadalafil. This means Canadian men taking antifungals (ketoconazole, itraconazole), HIV antiretrovirals (ritonavir), or certain antibiotics (clarithromycin) must not take Avanafil simultaneously
• Other PDE5 inhibitors — never combine two ED medications simultaneously or within 24 hours

Use with caution — inform your doctor:

• Alpha-blockers (tamsulosin/Flomax, doxazosin/Cardura) — commonly prescribed to Canadian men for BPH or hypertension. Additive blood pressure lowering. Start Avanafil at 50 mg under medical supervision if taking an alpha-blocker
• Moderate CYP3A4 inhibitors (erythromycin, fluconazole, diltiazem, verapamil, amprenavir) — increase Avanafil levels moderately. Limit to 50 mg maximum per dose with these medications
• Antihypertensive medications — additive blood pressure lowering. Monitor blood pressure when starting Avanafil
• Alcohol — one to two standard Canadian drinks tolerable for most men. Larger amounts increase blood pressure drop and can independently impair erection quality
• Grapefruit juice — CYP3A4 inhibitor, unpredictable Avanafil level increase. Avoid on the day of use

Side Effects of Avana (Avanafil)

Common side effects (affect 1 in 10 users):

• Headaches
• Facial flushing
• Nasal congestion
• Back pain — less common than with Tadalafil, more common than with Sildenafil
• Dizziness

Avana does NOT cause: visual colour disturbances or blue tinge — specific to Sildenafil's lower PDE6 selectivity. Avanafil's superior PDE5/PDE6 selectivity ratio means visual side effects are not a feature of this medication.

Rare but serious — seek immediate medical attention at your nearest emergency department:

• Priapism — painful erection lasting more than 4 hours. Requires immediate hospital treatment. Call 911 or go to nearest ER immediately
• Sudden vision loss — stop immediately and seek urgent medical attention
• Sudden hearing loss or tinnitus
• Severe allergic reactions (swelling of face, tongue, throat — difficulty breathing)
• Chest pain during or after sexual activity — stop immediately and call 911

Who Should Not Take Avana

Avanafil is contraindicated in men who:

• Take nitrate medications or nitric oxide donors in any form
• Take riociguat (Adempas)
• Take strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir, clarithromycin, nefazodone)
• Have severe cardiovascular disease or recent heart attack or stroke (within 3 months)
• Have unstable angina
• Have severe hepatic impairment
• Have hereditary degenerative retinal disorders (retinitis pigmentosa)
• Have uncontrolled hypotension or hypertension
• Have a history of NAION (non-arteritic anterior ischaemic optic neuropathy)
• Are women or under 18 years of age

Delivery to All Canadian Provinces

drugs-canada.com ships discreetly to all Canadian provinces and territories. Standard delivery: 4–9 business days.

Ontario (Toronto, Ottawa, Mississauga, Hamilton, Brampton) — British Columbia (Vancouver, Victoria, Surrey, Kelowna) — Quebec (Montreal, Quebec City, Laval, Gatineau) — Alberta (Calgary, Edmonton, Red Deer) — Manitoba (Winnipeg) — Saskatchewan (Saskatoon, Regina) — Nova Scotia (Halifax) — New Brunswick (Moncton, Fredericton) — and all remaining provinces and territories.

Frequently Asked Questions — Avana (Avanafil) in Canada

Is Avana the same as Stendra in Canada? Therapeutically identical — both contain Avanafil at the same dosage. Stendra is the brand name (Vivus/Menarini) approved by the US FDA. Avana is the generic equivalent manufactured by Sunrise Remedies. The onset (15 minutes), duration (4–6 hours), mechanism of action, efficacy, and side effects are identical. Stendra is not individually registered with Health Canada — it is not available at Canadian pharmacies as an approved product.

How fast does Avana work in Canada? Avana (Avanafil) is the fastest-acting ED medication available — onset in as little as 15 minutes for many men, compared to 15–30 minutes for Vardenafil, and 30–60 minutes for Sildenafil and Tadalafil. A dedicated clinical study (Hellstrom et al., Journal of Urology, 2015) specifically demonstrated statistically significant efficacy at the 15-minute time point — making Avanafil unique among all PDE5 inhibitors.

Is Avanafil better than Viagra in Canada? For specific situations — yes. Avanafil has faster onset (15 min vs 30–60 min for Sildenafil), causes no visual colour disturbances (blue tinge), has a safer cardiac profile (no QT prolongation concern), and can be taken after a standard meal without significant impact. Sildenafil remains the more cost-effective option for first-time users or men comfortable with a 30-minute wait. For men who experienced visual side effects with Sildenafil or who need the fastest possible onset — Avanafil is the superior choice.

Can I take Avana with food in Canada? Yes — Avanafil absorption is minimally affected by standard meals, unlike Sildenafil (Viagra) which is significantly delayed by high-fat meals. Taking Avana after a regular dinner still produces onset within 15 to 30 minutes. Very high-fat meals may modestly slow absorption but the clinical impact is minimal.

Why does Avana not cause the blue tinge that Viagra does? Sildenafil cross-reacts with PDE6 — the enzyme in retinal photoreceptors. This is why some men see a blue tinge with Viagra. Avanafil has approximately 100-fold greater selectivity for PDE5 over PDE6 than Sildenafil, eliminating this visual side effect. Canadian men who have experienced visual disturbances with Sildenafil should consider Avanafil as a direct alternative.

What is the difference between Avana 50 mg, 100 mg, and 200 mg? 100 mg is the standard recommended starting dose for most Canadian men. 50 mg is recommended for men over 65, those on moderate CYP3A4 inhibitors, or those with hepatic impairment. 200 mg is the maximum — use only if 100 mg is consistently insufficient and well-tolerated. Clinical trials showed the strongest 15-minute onset results with 200 mg.

Is Stendra available in Canada without a prescription? Stendra (the US brand) is not registered with Health Canada. Generic Avanafil (Avana) is available through international online pharmacies under the personal importation grey area. Canadian pharmacies cannot dispense any ED medication without a prescription. A Canadian prescription is required at regulated Canadian pharmacies.

How long does Avana last in Canada? 4 to 6 hours — the same as Sildenafil and Vardenafil. For a longer duration, Tadalafil (Cialis Generic) with up to 36 hours is more appropriate. Avanafil's advantage over other ED medications is onset speed, not duration.

How long does delivery to Canada take? Standard delivery to all Canadian provinces takes 4 to 9 business days. All orders are delivered in plain, unmarked packaging with no reference to the contents or sender. A tracking number is included with every order.