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Sexual health · Lisbon

Avanafil 50/100/200mg in Lisbon, online

An EU-licensed doctor reviews your case and, if eligible, issues an electronic prescription you can collect at a pharmacy in Lisbon.

€35once

Consultation price. The medicine is paid at your pharmacy.

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  • Collect at any EU pharmacy
  • Full refund if not approved
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Avanafil 50/100/200mg

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Valid across the EU

E-prescription accepted at EU pharmacies.

Local facts

Avanafil 50/100/200mg consultations in Lisbon

Available toResidents of Portugal
LanguagesSpanish and English
Doctor replyUnder 2 hours on average
Collected atPharmacies in Portugal · e-prescription (PDF)
About the medicine

What it is and how it works

Avanafil is the most recent PDE5 inhibitor, with fast onset (15–30 minutes) and a somewhat narrower side-effect profile in some studies. It's useful when timing flexibility matters.

It's prescribed at 50, 100 or 200 mg on demand, around 15–30 minutes before sexual activity. If there's no response, the doctor reassesses: dose adjustment, a switch to another PDE5, or evaluation of underlying causes, never a self-prescribed change.

Who it is for

  • Adult men with erectile dysfunction; sexual stimulation is still required
  • One tablet 15 to 30 minutes before sex, at most one dose in 24 hours

Safety summary

Nitrates and poppers are contraindicated: blood pressure can fall dangerously

Read the safety summary
Pricing

One consultation, one clear price

You pay for the doctor's consultation. If a prescription is issued, the medicine is paid at your own pharmacy.

  • Consultation reviewed by an EU-licensed doctor
  • Private follow-up in the in-app chat
  • Full refund if the doctor does not approve
One-off

Sexual health

One-offNo subscription€35once
  • Consultation reviewed by an EU-licensed doctor
  • Electronic prescription if approved
  • Private follow-up chat
Start consultation

Full refund if a review is not approved

FAQs

Your questions answered

Avanafil 50/100/200mg16 questions
What are avanafil's advantages?
It is the most recent PDE5, with fast onset (15–30 min) and a somewhat narrower side-effect profile in some studies. Useful when timing flexibility matters.
50, 100 or 200 mg on demand, around 15–30 minutes before sexual activity. The doctor tailors the dose to your response and current medication.
More questions
All PDE5s are safe under medical supervision and without nitrates. Avanafil may produce fewer vasomotor effects in some profiles, but the choice is individualised in consultation.
The doctor reassesses: dose adjustment, switch to another PDE5, or evaluation of underlying causes (cardiovascular, hormonal, psychological). The change is not self-prescribed.
About 15 to 30 minutes before sexual activity, according to the EU product information. That is the recommended window for the usual 100 mg dose, and the maximum is one dose in any 24 hours. A high-fat meal slows absorption, delaying the peak by about 1.25 hours on average, so a heavy meal beforehand can push the onset back. Sexual stimulation is still needed, because the tablet extends a signal that arousal has to start. Your prescriber decides the right strength and timing for you.
The EU product information records that avanafil reaches peak blood levels 0.5 to 0.75 hours after a dose taken on an empty stomach, and the EAU guideline table lists that as the shortest time to peak of the four PDE5 inhibitors it compares. In one onset study, about 24.7% of attempts roughly 15 minutes after a 100 mg dose ended in successful intercourse, against 13.78% on placebo. These are separate measurements rather than a head-to-head trial, and they do not mean avanafil suits any individual better. A prescriber weighs onset against duration, other medicines and health conditions.
That comes from enzyme selectivity in the label, not from a proven clinical advantage. The EU product information states avanafil is more than 100-fold more potent against PDE5 than against PDE6, the enzyme in the retina responsible for converting light into nerve signals. Blurred vision is still listed as an uncommon side effect, meaning it affected between 1 in 1,000 and 1 in 100 people in trials. Serious eye events such as non-arteritic anterior ischaemic optic neuropathy have been reported with PDE5 inhibitors as a class. Any sudden change in vision means stopping the tablet and seeking medical advice immediately.
Write to your doctor in the private chat in your account: describe what you notice and when it started. The doctor can adjust the plan, pause it or suggest another option. If you have severe symptoms such as difficulty breathing, swelling of the face or chest pain, call 112 or go to an emergency department straight away.
It depends on what you take. List every medicine, supplement and herbal product in the questionnaire, including ones you use only occasionally. The doctor checks for interactions before prescribing, and your pharmacist checks again when you collect Avanafil 50/100/200mg.
Depending on your case, the doctor can consider a different medicine or dosing pattern, or recommend an in-person urologist, a sexual health clinic or psychosexual therapy. If a heart condition or another health issue needs checking first, the doctor tells you before prescribing anything.
If the medicine does not work as expected or causes side effects, write to your doctor in the private chat. The doctor can review the dose or the option chosen. Tell the doctor about any new health condition or new medicine before you use it again.
Yes. Hi-Doctor runs 100 % online across the EU, so if you live in Lisbon you can fill in the questionnaire and receive the medical review without travelling. The electronic prescription issued by the licensed doctor is valid in any EU pharmacy under Directive 2011/24/EU; outside Spain, the pharmacist dispenses the locally marketed equivalent of the same active ingredient.
Yes. All communication happens in the private chat of your account, GDPR-compliant. The doctor treats discretion as a core of the service and there is no history visible outside your consultation.
The private electronic prescription (Receta Médica Privada Electrónica) is issued by a licensed doctor in Spain. It is a PDF carrying every field required by EU Directive 2011/24/EU (patient, prescriber with country of registration, active ingredient, dose), which makes it legally recognised across all 27 EU member states. In Spanish pharmacies it is dispensed from the QR; outside Spain, the pharmacist dispenses the locally marketed equivalent of the same active ingredient.
1) Fill in an online medical questionnaire in about 4 minutes. 2) The plan is €25/month for weight loss or €15/month (billed €45 every 90 days) for hair growth; sexual health is €35 per consultation and a skin consultation is €40. 3) An EU-licensed doctor reviews your case and, if appropriate, issues an electronic prescription. 4) Collect it at any EU pharmacy. If the review is not approved, the applicable fee is refunded in full.
The plan is €25/month for weight loss or €15/month (billed €45 every 90 days) for hair growth; a one-off sexual-health consultation is €35 and a skin consultation covering acne, rosacea, melasma and ageing skin is €40. Each includes a licensed doctor's review and an electronic prescription if approved. If the review is not approved, the applicable fee is refunded in full. Medication is paid for separately at the pharmacy at the price it sets.
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How your doctor decides

Your answers

A licensed doctor reads your full questionnaire.

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The decision is clinical, never an algorithm.

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Medicine information and safety

How does Avanafil 50/100/200mg work?

Arousal releases nitric oxide. Avanafil does nothing on its own. When you are sexually aroused, nerves and blood-vessel lining in the penis release a gas called nitric oxide. That release is the trigger for everything that follows, which is why the EU product information states that sexual stimulation is required for the tablet to work.

Nitric oxide raises cGMP. Nitric oxide switches on an enzyme that makes cyclic guanosine monophosphate, usually shortened to cGMP. cGMP is the chemical messenger that tells the smooth muscle inside the erectile tissue to relax. As that muscle relaxes, blood flows into the penis faster than it drains away, and an erection builds.

Avanafil blocks the cGMP breaker. An enzyme called phosphodiesterase type 5, or PDE5, normally breaks cGMP down and ends the erection. Avanafil is described in the EU label as a highly selective, potent, reversible inhibitor of PDE5, so cGMP lasts longer and an erection is easier to reach and to keep.

How to use Avanafil 50/100/200mg

Take it 15 to 30 minutes ahead. Swallow one tablet by mouth roughly 15 to 30 minutes before sexual activity. That is the timing given in the EU product information for the usual 100 mg dose, and the same window applies to the 50 mg and 200 mg strengths.

Arousal is still required. The tablet does not cause an erection by itself. The label is explicit that sexual stimulation is needed for a response, because avanafil only extends a chemical signal that arousal starts in the first place.

One dose in 24 hours. The maximum recommended dosing frequency is once per day. Taking a second tablet because the first seemed not to work is outside the licence and raises the risk of low blood pressure, dizziness and fainting.

Food is allowed, fat slows it. You can take avanafil with or without food. A high-fat meal delays the peak blood level by about 1.25 hours on average and lowers it by about 39%, so a heavy meal beforehand can push back the onset.

Avoid grapefruit juice. Grapefruit juice inhibits the CYP3A4 enzyme that clears avanafil, which would raise the amount in your blood. The label advises avoiding grapefruit juice in the 24 hours before a dose.

Be careful with alcohol. Alcohol combined with avanafil made the drop in diastolic blood pressure significantly larger than either alone in a crossover study. Drinking raises the chance of dizziness, light-headedness or fainting after a dose.

Report back to your prescriber. Tell the prescriber whether the dose worked, how it was tolerated and what else you take. Any change of strength, or a decision to stop, is theirs to make with you rather than something to try alone.

Common side effects

Stop and get urgent medical help if (seek medical help immediately): An erection lasts 4 hours or more, which is priapism and can permanently damage penile tissue, Sudden loss or disturbance of vision in one or both eyes, Sudden reduction or loss of hearing, sometimes with ringing in the ears and dizziness, Chest pain or chest tightness during or shortly after sex, Fainting, near-fainting or severe light-headedness after a dose, Swelling of the face, lips, tongue or throat, a rash, or difficulty breathing

Common (common (≥1/100 to <1/10)): Headache, Flushing, a warm reddening of the face and neck, Blocked nose

Uncommon (uncommon (≥1/1,000 to <1/100)): Dizziness or drowsiness, Sinus headache, Blurred vision, Palpitations, a noticeable heartbeat, Hot flushes, Blocked sinuses, or breathlessness on exertion, Indigestion, nausea, vomiting or stomach discomfort, Back pain or muscle tightness, Tiredness, Raised liver enzymes, a faster heart rate or an abnormal heart tracing on testing

Rare (rare (≥1/10,000 to <1/1,000)): Chest pain or angina, a fast heartbeat, High or low blood pressure, Runny nose, congested airways or nosebleed, Dry mouth, gastritis, lower abdominal pain or diarrhoea, Rash, Flank pain, muscle aches or muscle spasms, Passing urine more often, Penile discomfort, an unprompted erection or genital itching, Weakness, swollen ankles or a flu-like feeling, Insomnia, premature ejaculation or restlessness

Do not use Avanafil 50/100/200mg if

  • You use organic nitrates or nitric oxide donors in any form, including glyceryl trinitrate spray and amyl nitrite
  • You take riociguat or another guanylate cyclase stimulator, because blood pressure can fall dangerously
  • You take a potent CYP3A4 inhibitor such as ketoconazole, itraconazole, ritonavir, atazanavir, clarithromycin, indinavir, nefazodone, nelfinavir, saquinavir or telithromycin
  • You have had a heart attack, a stroke or a life-threatening abnormal heart rhythm in the last 6 months
  • Your resting blood pressure is below 90/50 mmHg or above 170/100 mmHg
  • You have unstable angina, angina brought on by sex, or heart failure of New York Heart Association class 2 or above
  • You have severe liver impairment (Child-Pugh class C) or severe kidney impairment (creatinine clearance below 30 mL/min)
  • You have lost vision in one eye from non-arteritic anterior ischaemic optic neuropathy, or you have an inherited degenerative retinal disorder
  • You are allergic to avanafil or to any of the tablet's other ingredients
  • Do not combine it with other PDE5 inhibitors or other erectile-dysfunction treatments, because the combination is unstudied and raises the risk of prolonged erection; caution also applies if the penis is anatomically deformed, for example by angulation, cavernosal fibrosis or Peyronie's disease, or if you have a condition that predisposes to priapism such as sickle cell anaemia, multiple myeloma or leukaemia

Medicines and substances that interact

  • Nitrates and nitric oxide donors (e.g. GTN spray, amyl nitrite): Avanafil amplifies the blood-pressure-lowering effect of nitrates, which can become dangerous. Absolute contraindication; the prescriber will not issue avanafil alongside nitrates.
  • Riociguat and other guanylate cyclase stimulators: Additive lowering of systemic blood pressure with no demonstrated clinical benefit. Absolute contraindication; the prescriber chooses a different route for erectile dysfunction.
  • Potent CYP3A4 inhibitors (ketoconazole, ritonavir and similar): Ketoconazole raised avanafil exposure about 14-fold and lengthened its half-life to roughly 9 hours. Absolute contraindication; the prescriber checks every current medicine before issuing.
  • Moderate CYP3A4 inhibitors (erythromycin, diltiazem, verapamil, fluconazole): Erythromycin roughly tripled avanafil exposure and lengthened its half-life to about 8 hours. Caps the dose at 100 mg and no more than once every 48 hours.
  • Alpha-blockers (doxazosin, tamsulosin): Additive widening of blood vessels can cause symptomatic low blood pressure in some men. Starts avanafil at 50 mg, and only once you are stable on the alpha-blocker.
  • Other blood-pressure-lowering medicines (e.g. amlodipine, enalapril): Small additive falls in blood pressure; amlodipine also raised avanafil exposure by about 60%. Monitors blood pressure and warns you about dizziness on standing.
  • CYP3A4 inducers (rifampicin, carbamazepine, phenobarbital, efavirenz, bosentan): May clear avanafil faster and reduce how well it works; this has not been studied. Concomitant use is not recommended, so the prescriber reviews alternatives.
  • Grapefruit juice and alcohol: Grapefruit juice raises avanafil levels; alcohol deepens the fall in diastolic blood pressure. Advises no grapefruit juice for 24 hours beforehand and caution with alcohol.

References

  1. Spedra (avanafil): EPAR medicine overview European Medicines Agency, 2026
  2. Spedra: EU Product Information (Summary of Product Characteristics and package leaflet) European Medicines Agency, 2026
  3. Spedra 100 mg tablets: Summary of Product Characteristics electronic medicines compendium (Datapharm), 2026
  4. A randomized, double-blind, placebo-controlled evaluation of the safety and efficacy of avanafil in subjects with erectile dysfunction The Journal of Sexual Medicine 9(4):1122-33, 2012
  5. EAU Guidelines on Sexual and Reproductive Health: Management of Erectile Dysfunction European Association of Urology, 2026
  6. Viagra (sildenafil): EPAR medicine overview European Medicines Agency, 2026
  7. Cialis (tadalafil): EPAR medicine overview European Medicines Agency, 2026
  8. Levitra (vardenafil): EPAR medicine overview European Medicines Agency, 2025
  9. CIMA: Spedra 50/100/200 mg comprimidos, authorised and marketed, prescription-only AEMPS (Spanish Agency for Medicines and Medical Devices), 2026
  10. Avanafil, human medicines with a currently valid German authorisation: 28 entries, Spedra 50, 100 and 200 mg tablets (Menarini International Operations Luxembourg S.A., EU/1/13/841) and parallel-distributed packs, all prescription-only BfArM AMIce, public part, via PharmNet.Bund, Germany, 2026
  11. § 34 Abs. 1 SGB V: medicines used predominantly to improve sexual potency are excluded from statutory health insurance Bundesministerium der Justiz, Germany, 2026
  12. Base de données publique des médicaments: SPEDRA 50/100/200 mg, autorisation active, commercialisée, no reimbursement rate listed ANSM / Ministère de la Santé (France), 2026
  13. Banca Dati Farmaci: Spedra (avanafil), packs in classe C a totale carico dell'assistito and classe A with a therapeutic plan AIFA (Italian Medicines Agency), 2026
  14. Farmacotherapeutisch Kompas: avanafil (Spedra, Menarini Benelux), marked XGVS, not included in the GVS reimbursement system Zorginstituut Nederland, 2026
  15. INFOMED: Spedra (avanafil) 50/100/200 mg, Autorizado, at least one presentation marketed INFARMED (Portuguese National Authority of Medicines), 2026
  16. Geneesmiddelendatabank: Spedra 200 mg tabl., EU/1/13/841, availability recorded per pack, medisch voorschrift FAGG / AFMPS (Belgian Federal Agency for Medicines and Health Products), 2026
  17. Human Medicines authorised list: Spedra 50/100/200 mg tablets, registration status AU, supply through pharmacies only HPRA (Health Products Regulatory Authority, Ireland), 2026
  18. Medikamente Info Austria: Spedra 50/100/200 mg Tabletten, no discontinuation of marketing reported, repeat prescription, pharmacy supply BASG (Austrian Federal Office for Safety in Health Care), 2026
  19. Rejestr Produktów Leczniczych: Spedra (Avanafilum) 50/100/200 mg tabletki, centralised procedure, ATC G04BE10 Ministry of Health / e-Zdrowie (Poland), 2026

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All content on this page has been medically reviewed by: Dr. Alejandro Infante, General medicine, on 27 July 2026. Registration: 080869277 View profile

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