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Avanafil, sold under the brand name Stendra, is a prescription medication used to treat erectile dysfunction (ED) in adult men. It’s a PDE5 inhibitor that works by increasing blood flow to the penis when sexually aroused, helping men achieve and maintain an erection suitable for sexual activity.

Avanafil works by blocking an enzyme called phosphodiesterase type 5 (PDE5). This enzyme normally breaks down a substance called cGMP, which helps relax blood vessels in the penis. By blocking PDE5, avanafil allows cGMP levels to remain higher, promoting increased blood flow to the penis during sexual stimulation.

Avanafil was approved by the FDA in April 2012 for the treatment of erectile dysfunction. It was the fourth PDE5 inhibitor to receive FDA approval, following sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).

Avanafil is known for its rapid onset of action. It can start working in as little as 15 minutes for some men, though the typical onset is 15-30 minutes. This makes it one of the fastest-acting ED medications available. The effects can last up to 6 hours.

Avanafil (Stendra) is available in three strengths:

Take avanafil 15-30 minutes before sexual activity. Swallow the tablet whole with water. It can be taken with or without food, though high-fat meals may delay absorption. Do not take more than one dose in a 24-hour period. The medication only works when you are sexually stimulated.

Yes, avanafil can be taken with or without food. However, consuming a high-fat meal before taking the medication may delay its absorption and onset of action. For fastest results, consider taking it on an empty stomach or with a light meal.

Avanafil is taken as needed before sexual activity, not on a regular schedule. If you plan to have sexual activity and haven’t taken your dose, take it 15-30 minutes beforehand. Never take more than one dose in 24 hours, even if you missed your intended timing.

Common side effects may include: Most Common: Headache, flushing (warmth/redness in face, neck, or chest), nasal congestion, cold symptoms

Less Common: Back pain, dizziness, nausea, upper respiratory tract infection, bronchitis

Most side effects are mild and temporary, typically resolving within a few hours.

What are serious side effects I should watch for?

Seek immediate medical attention if you experience:

• Priapism: Erection lasting more than 4 hours
• Sudden vision loss in one or both eyes
• Sudden hearing loss or ringing in ears
• Chest pain, dizziness, or nausea during sexual activity
• Severe allergic reactions: Rash, swelling, difficulty breathing

Priapism is a painful erection that lasts more than 4 hours and occurs without sexual stimulation. It’s a medical emergency because prolonged erection can damage penile tissue and lead to permanent erectile dysfunction. If you experience an erection lasting more than 4 hours, seek immediate emergency medical care.

Rarely, avanafil may cause vision changes including sudden vision loss, blurred vision, or changes in color vision (difficulty distinguishing between blue and green). These effects are usually temporary, but sudden vision loss requires immediate medical attention as it could indicate a serious condition called NAION (non-arteritic anterior ischemic optic neuropathy).

NEVER take Avanafil with nitrates

Combining avanafil with nitrate medications can cause a dangerous drop in blood pressure that could be life-threatening. Nitrates include nitroglycerin, isosorbide mononitrate, isosorbide dinitrate, and recreational drugs called “poppers” (amyl nitrite, butyl nitrite).

You should consult your doctor before taking avanafil with blood pressure medications. Avanafil can lower blood pressure, and combining it with certain blood pressure medications (especially alpha-blockers like doxazosin or terazosin) may cause excessive blood pressure reduction. Your doctor may need to adjust dosages or timing.

No. Never combine avanafil with other ED medications such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra). Taking multiple ED medications together can cause dangerous drops in blood pressure and increase the risk of side effects.

Limit alcohol consumption when taking avanafil. Moderate alcohol use (1-2 drinks) is generally acceptable, but excessive alcohol can increase the risk of side effects like dizziness, headache, and low blood pressure. Heavy drinking can also make it more difficult to achieve an erection.

Grapefruit and grapefruit juice may increase the levels of avanafil in your blood, potentially increasing the risk of side effects. While this interaction is less significant with avanafil compared to some other medications, it’s best to avoid grapefruit products when taking this medication.

This depends on your specific heart condition. Sexual activity itself puts strain on the heart, so your doctor needs to determine if you’re healthy enough for sexual activity. Avanafil may not be safe if you have:

•  Recent heart attack or stroke (within 6 months)
•  Severe heart failure
• Unstable angina
• Severe low blood pressure
• Uncontrolled high blood pressure

If you have mild to moderate kidney or liver disease, your doctor may prescribe a lower dose of avanafil. For severe kidney disease (dialysis patients) or severe liver disease, avanafil is not recommended. The medication is processed by the liver and eliminated by the kidneys, so impaired function can lead to higher drug levels and increased side effects.

Yes, diabetics can generally take avanafil safely. In fact, diabetes is a common cause of erectile dysfunction, and many diabetic men benefit from PDE5 inhibitors like avanafil. However, diabetics often have other health conditions (heart disease, high blood pressure) that need to be considered. Discuss with your doctor to ensure it’s appropriate for your overall health situation.

Men with Peyronie’s disease (abnormal curvature of the penis) should use avanafil with caution. While the medication may help with erectile function, the underlying structural changes from Peyronie’s disease remain. Consult with a urologist who specializes in sexual medicine for the best treatment approach.

If avanafil isn’t working effectively:

• Try the medication 4-6 times before deciding it’s ineffective
• Ensure you’re sexually stimulated (the medication won’t work without arousal)
• Avoid heavy meals or excessive alcohol before taking it
• Consider if anxiety or stress might be interfering
• Discuss with your doctor about adjusting the dose or trying a different ED medication
• Address underlying health issues that might be contributing to ED

Clinical studies show that avanafil is effective for approximately 60-85% of men with erectile dysfunction, depending on the underlying cause and severity. The medication tends to be most effective in men with mild to moderate ED and may be less effective in cases of severe ED or significant underlying health conditions.

Avanafil is designed for “as-needed” use, not daily continuous use. The maximum recommended frequency is once per day. Unlike tadalafil (Cialis), which has a daily low-dose option, avanafil is only approved for on-demand use before sexual activity.

Yes! Healthy lifestyle habits can significantly improve avanafil’s effectiveness:

• Regular exercise improves blood flow and cardiovascular health
• Healthy diet helps maintain good circulation
• Weight management reduces ED risk factors
• Quit smoking – smoking damages blood vessels
• Limit alcohol consumption
• Manage stress and get adequate sleep
• Control chronic conditions like diabetes and high blood pressure

Store avanafil tablets at room temperature between 68-77°F (20-25°C). Keep them in the original container, away from moisture, heat, and direct light. Do not store in the bathroom or kitchen where humidity levels are high. Keep all medications out of reach of children and pets.

The cost of avanafil varies depending on dosage, quantity, pharmacy, and insurance coverage. Without insurance, it can be quite expensive (often $40-60 per pill). Many insurance plans cover ED medications with prior authorization. Generic versions are not yet available in the US, but patient assistance programs and pharmacy discount cards may help reduce costs.

Yes, avanafil requires a prescription from a licensed healthcare provider. It’s not available over-the-counter. You’ll need to consult with a doctor who will evaluate your health history, current medications, and determine if avanafil is safe and appropriate for you.

Only purchase avanafil from legitimate, licensed pharmacies that require a valid prescription. Many online pharmacies are not properly regulated and may sell counterfeit or contaminated medications. Reputable online pharmacies will require prescription verification and will be licensed in your state. Always verify the pharmacy’s credentials before ordering.

This FAQ is for educational purposes only and does not replace professional medical advice. Always consult your cardiologist before taking any ED medication.

For medical emergencies, call 911 immediately.

For medication questions, contact your pharmacist or healthcare provider.