avanafil
Stendra (avanafil) is a phosphodiesterase 5 (PDE5) inhibitor that's used to treat erectile dysfunction (ED). Stendra (avanafil) is taken by mouth as needed, at most once a day. It works best if you take it about 15 to 30 minutes before sexual activity. Some of the more common side effects of Stendra (avanafil) include headache and flushing. Stendra (avanafil) is brand name only and isn't available as a lower-cost generic.
What is Stendra (avanafil)?
What is Stendra (avanafil) used for?
How Stendra (avanafil) works
Stendra (avanafil) is a phosphodiesterase 5 (PDE5) inhibitor, meaning it blocks a protein called PDE5. This relaxes certain blood vessels, which improves blood flow to the penis to help with an erection.
Drug facts
Side effects of Stendra (avanafil)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Headache (5-11%)
- Flushing (3-4%)
- Stuffy nose (2-3%)
- Sore throat, runny nose, and other symptoms of a common cold (1-3%)
- Back pain (1-3%)
Less Common Side Effects
- High blood pressure
- Nausea
- Stomach upset
- Constipation
- Rash
Stendra (avanafil) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Erection lasting for more than 4 hours
- Vision loss
- Hearing loss
- Dangerously low blood pressure: feeling faint or weak, dizziness, blurry vision, feeling confused
More on Stendra (avanafil) side effects
The following Stendra (avanafil) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Blurred vision
dizziness
headache
nervousness
pounding in the ears
slow or fast heartbeat
Rare
Arm, back, or jaw pain
bladder pain
bloating or swelling of the face, arms, hands, lower legs, or feet
bloody or cloudy urine
chest pain or discomfort
chest tightness or heaviness
difficult or labored breathing
difficult, burning, or painful urination
fast, irregular, pounding, or racing heartbeat or pulse
frequent urge to urinate
increased erection
lower back or side pain
pain in the groin or genitals
pain, redness, or swelling in the arm or leg
rapid weight gain
sharp back pain just below the ribs
sweating
tightness in the chest
tingling of the hands or feet
unusual tiredness or weakness
unusual weight gain or loss
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Feeling of warmth
muscle aches
redness of the face, neck, arms, and occasionally, upper chest
stuffy or runny nose
Less common
Acid or sour stomach
belching
body aches or pain
change in color vision
chills
cough producing mucus
difficulty having a bowel movement (stool)
difficulty with moving
ear congestion
indigestion
joint pain
loss of appetite
loss of voice
muscle pain or stiffness
pain or tenderness around the eyes and cheekbones
rash
shivering
sweating
trouble sleeping
Rare
bloody nose
bone pain
burning feeling in the chest or stomach
confusion
cool, pale skin
feeling of constant movement of self or surroundings
increased hunger
itching skin
muscle aching or cramping
nightmares
seizures
sensation of spinning
shakiness
sleepiness or unusual drowsiness
slurred speech
swollen joints
tenderness in the stomach area
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Stendra (avanafil)
Pros
- Works faster than some other medications in its class (can be taken 15 minutes before sex)
- Take it only when needed
- Can be taken with or without food
Cons
- Can cause dangerously low blood pressure if you've recently taken nitrates, such as nitroglycerin (Nitrostat)
- Can't take if you have serious heart problems, such as heart attack or stroke in the past 6 months
- Not available as a lower-cost generic
Pharmacist tips for Stendra (avanafil)
- You can take Stendra (avanafil) with or without food.
- Take Stendra (avanafil) only as needed, and not more than once in a 24-hour period. Taking this medication more often than recommended can raise your risk of serious side effects, such as dangerously low blood pressure and vision loss.
- If you're taking the 100 mg or 200 mg tablet of Stendra (avanafil), you can take it 15 minutes before sexual activity. If you're taking the 50 mg tablet of Stendra (avanafil), you can take it 30 minutes before sexual activity.
- If you have an erection for more than 4 hours, go to the emergency department (ED) or call your prescriber right away as this can lead to permanent damage to the penis.
- Stendra (avanafil) doesn't stop the spread of sexually transmitted infections (STIs) like human immunodeficiency virus (HIV). Practice safe sex by using a latex or polyurethane condom.
- Taking Stendra (avanafil) with alcohol can raise your risk for low blood pressure, which can lead to side effects such as dizziness and headache. If possible, it's best to avoid or limit drinking alcohol while you're taking this medication. If you drink alcohol regularly, let your healthcare team know; they can talk with you about what's a safer amount of alcohol to drink.
Common questions about Stendra
How long it takes for Stendra to work can depend on what dose you're prescribed. If your healthcare professional (HCP) prescribed you the 100 mg or 200 mg Stendra tablet, you should take it about 15 minutes before sexual activity. But if you're taking the 50 mg Stendra tablet, you should take the dose about 30 to 45 minutes before sexual activity. Keep in mind Stendra might work faster for some people, but it can take longer to kick in for others.
The effects of Stendra can last up to 6 hours after a dose. This means that you'll still be able to have an erection with the help of Stendra up to 6 hours after you take the medication. But the duration of Stendra can differ from person to person. In general, the effect of Stendra doesn't last as long as some other PDE 5 inhibitors, such as tadalafil (Cialis).
In studies, male participants were asked if taking Stendra allowed their erection to last long enough to have successful intercourse. Nearly half of participants who took Stendra experienced successful intercourse compared to about a quarter of participants who took a placebo pill (no active medication). Results will vary from person to person. Talk with your healthcare team if you've concerns with how well Stendra works for you.
Don't take Stendra more than once in a 24-hour period. Taking it more often can raise the risk of side effects, such as headache and flushing. Taking more than one Stendra dose a day can also raise your risk for more serious problems, like dangerously low blood pressure and vision loss.
The manufacturer of Stendra doesn't say whether this medication can be cut in half. But Stendra doesn't have a score line down the middle. And typically, this type of medication shouldn't be split, but you can double check with your HCP or pharmacist. Keep in mind that Stendra comes in three different pill strengths. If appropriate, your HCP might be able to prescribe a lower strength of Stendra for you.
No, don't take Stendra and sildenafil (Viagra) together. Both medications are PDE 5 inhibitors. Taking more than one medication is this class together can raise your risk for serious side effects, like low blood pressure and priapism. In addition, more research is needed to understand whether doing so will provide added benefit in treating ED.
There aren't many studies that compare Stendra directly with sildenafil (Viagra), so it's hard to say if one is better than the other. In one small study, participants reported that Stendra worked faster than sildenafil (Viagra) for ED based on a questionnaire. In general, Stendra can start to work in as quickly as 15 minutes after a dose, but it might take sildenafil (Viagra) about 30 minutes to kick in. Stendra can be taken with or without food, but sildenafil (Viagra) should be taken on an empty stomach. In addition, Stendra is brand name only, but sildenafil (Viagra) comes as a lower-cost generic. Typically, your healthcare professional (HCP) will help you pick the option that best fits your lifestyle and preference.
Stendra is only FDA-approved for people who are diagnosed with erectile dysfunction (ED). If you don't have ED, you shouldn't take Stendra or other PDE 5 inhibitors without first discussing it with your HCP. Taking Stendra when you don't have ED can put you at risk for serious side effects, like vision loss of priapism.
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Risks and warnings for Stendra (avanafil)
Stendra (avanafil) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of heart attack or stroke
- Risk factors: Very high or very low blood pressure | Existing heart conditions | Recent heart attack or stroke in past 6 months
Just like with other PDE 5 inhibitors, you're not recommended to take Stendra (avanafil) if you've had a heart attack, stroke, or symptoms of heart failure in the past 6 months, abnormal blood pressure, or chest pain. The safety of Stendra (avanafil) hasn't been studied in these situations. In addition, your prescriber might ask you to limit or avoid sexual activities (thus, limit or avoid taking Stendra (avanafil)) if you have certain heart-related conditions. Talk to your heart specialist or healthcare professional (HCP) if you have any of these health conditions.
Dangerously low blood pressure
- Risk factors: Taking alpha blockers | Taking nitrates | Taking medicines for high blood pressure | Drinking alcohol
Your blood pressure can drop very low if you take Stendra (avanafil) along with alpha blockers or other medications for high blood pressure. Talk to your prescriber about your current treatments and before you start or stop any treatments. Check your blood pressure regularly and be careful getting up from a sitting or lying down position. Drinking alcohol while taking Stendra (avanafil) can also lower blood pressure, so avoid or drink less alcohol while taking Stendra (avanafil).
You should never take Stendra (avanafil) when taking nitrate medication for chest pain (angina) or when taking a soluble guanylate cyclase (sGC) stimulator for heart failure or pulmonary arterial hypertension (PAH). These combinations can cause your blood pressure to drop suddenly to unsafe levels.
Interactions with other medications
- Risk factors: Age 65 years or older | Liver problems | Kidney problems | Taking nitrate medications | Taking blood pressure medications | Taking alpha blockers | Taking certain antifungals or antivirals
Similar to other PDE 5 inhibitors, Stendra (avanafil) can have serious interactions with certain medications. It's important that you let your prescriber know about all the medications you're taking before you start Stendra (avanafil). For example, you shouldn't take Stendra (avanafil) with nitrate medications because this combination can cause your blood pressure to drop dangerously low. If you're taking other blood pressure medications, your HCP might not recommend Stendra (avanafil) until your blood pressure is under control. Taking Stendra (avanafil) with medications, like oral azole antifungals and ritonavir (Norvir), can put you at higher risk for side effects, such as headaches, flushing, and vision changes.
Avoid drinking alcohol
You should avoid drinking alcohol when taking Stendra (avanafil). Doing so can worsen side effects of both alcohol and this medication, including dizziness and headache. This can raise your risk for falls or injury. Drinking alcohol can also worsen symptoms of ED and cause Stendra (avanafil) to not work as well. If you drink alcohol regularly and it's difficult for you to stop, talk with your healthcare team. They can talk with you about resources to help you quit drinking or recommend a safer amount to drink.
Prolonged or painful erection (priapism)
- Risk factors: Medical conditions that affect the penis | Sickle cell anemia | Multiple myeloma | Leukemia
Some people reported having an erection that lasted for more than 4 hours (priapism) after taking medications similar to Stendra (avanafil). This is rare, but if it's not treated in time, it can cause permanent damage to your penis, including permanent impotence (not able to get an erection). Get medical help right away if this happens.
Vision loss
If you suddenly notice changes in your vision in one or both eyes, go to the emergency room or call your HCP right away. Although this is rare, Stendra (avanafil) can cause permanent eye damage. If your HCP has told you that you have a "crowded" optic disc, you might be at higher risk for vision changes with Stendra (avanafil).
Hearing loss
Some people who took Stendra (avanafil) reported experiencing hearing loss. Sometimes, they also experience other symptoms, such as ringing in the ears (tinnitus) and dizziness. Go to the emergency room or call your prescriber right away if you notice changes in your hearing in one or both ears.
Stendra (avanafil) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 50mg | 30 tablets | $484.26 | $16.14 |
| 100mg | 10 tablets | $161.10 | $16.11 |
| 200mg | 10 tablets | $160.91 | $16.09 |
Typical dosage for Stendra (avanafil)
Your healthcare professional (HCP) will prescribe the lowest dose of Stendra (avanafil) that works for you.
- Adults: The typical starting dose of Stendra (avanafil) is 100 mg by mouth about 15 minutes before sexual activity. The typical dose can range between 50 mg taken 30 minutes before sexual activity, to 200 mg taken 15 minutes before sexual activity. You shouldn't take more than one dose in a day.
Interactions between Stendra (avanafil) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Amyl Nitrite
- Erythrityl Tetranitrate
- Isosorbide Dinitrate
- Isosorbide Mononitrate
- Itraconazole
- Nitroglycerin
- Pentaerythritol Tetranitrate
- Propatyl Nitrate
- Riociguat
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Atazanavir
- Boceprevir
- Clarithromycin
- Cobicistat
- Conivaptan
- Darunavir
- Duvelisib
- Efavirenz
- Etravirine
- Fosnetupitant
- Indinavir
- Ivosidenib
- Ketoconazole
- Larotrectinib
- Lefamulin
- Lopinavir
- Lorlatinib
- Nefazodone
- Nelfinavir
- Netupitant
- Nevirapine
- Posaconazole
- Ritonavir
- Saquinavir
- Telaprevir
- Telithromycin
- Voriconazole
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
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Stendra (avanafil) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Stendra (avanafil) will not be safe for you to take.
- Taking sGC stimulators (e.g., riociguat)
- Taking nitrate medication(s)
What are alternatives to Stendra (avanafil)?
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