Stendra (Avanafil)
Stendra is the brand of avanafil, the newest PDE5 inhibitor for erectile dysfunction (FDA 2012). It offers faster onset than sildenafil and a more selective enzyme profile that may reduce some class side effects, with on-demand tablet dosing.
- Active ingredients
- Avanafil
- Manufacturer
- Metuchen Pharmaceuticals
- Dosage forms
- tablet
- Available dosages
- 50mg, 100mg, 200mg
- Category
- Erectile Dysfunction (ED)
What is it?
Stendra is the US brand name for avanafil (sold as Spedra in Europe), the most recently approved PDE5 inhibitor for erectile dysfunction. FDA-approved in 2012 and now marketed in the US by Metuchen Pharmaceuticals, Stendra was developed by Mitsubishi Tanabe and originally licensed to Vivus. It is positioned in the marketplace as a faster-onset alternative to Viagra and Cialis, with on-demand dosing 15–30 minutes before sexual activity.
Active ingredients
Each Stendra tablet contains 50mg, 100mg or 200mg of avanafil. Avanafil is a second-generation PDE5 inhibitor with higher selectivity for PDE5 over PDE6 (retina) and PDE11 (testicular) than sildenafil or vardenafil, which may translate into less colour-vision disturbance and possibly fewer back-pain or muscle-ache effects. Authorised generic avanafil has limited availability outside the US compared with the older PDE5 inhibitors.
Forms and dosages
Stendra is supplied as oral tablets in 50, 100 and 200mg strengths. The recommended starting dose is 100mg taken 15–30 minutes before sexual activity, with adjustment up to 200mg or down to 50mg based on response and tolerability. No more than one dose per 24 hours. Tablets can be taken with or without food, although a high-fat meal may delay onset by ~30 minutes.
Indications
Stendra is approved for erectile dysfunction in adult men. Unlike sildenafil and tadalafil it has not been studied for pulmonary arterial hypertension, prostate symptoms, or daily-use indications. According to current ED guidelines, all four PDE5 inhibitors are first-line oral therapy and the choice between them is based on patient preference, onset/duration profile, side-effect profile and cost.
How it works
Avanafil selectively inhibits phosphodiesterase type 5 (PDE5) in the corpus cavernosum, increasing cGMP and enhancing nitric-oxide-mediated vasodilation in response to sexual stimulation. Its higher selectivity for PDE5 versus other phosphodiesterase isoforms compared with sildenafil and vardenafil is the proposed pharmacological basis for a slightly different side-effect profile. Onset is faster than other PDE5 inhibitors, and the half-life of 6–17 hours supports on-demand dosing.
Frequently asked questions
How does Stendra compare with Viagra and Cialis? ▾
Stendra (avanafil) acts faster than Viagra (sildenafil) at 15–30 minutes vs 30–60 minutes, and has a shorter window than Cialis (tadalafil) at 6–17h half-life vs 17.5h. Avanafil is also more selective for PDE5 vs PDE6 and PDE11. Efficacy is broadly comparable across all four PDE5 inhibitors; choice is based on preference and tolerability.
Can Stendra be taken with food? ▾
Stendra can be taken with or without food, although a high-fat meal may delay onset by about 30 minutes. According to the prescribing information, food does not substantially reduce overall efficacy — unlike Viagra where a heavy meal can blunt the effect more noticeably. A light meal does not require any timing adjustment.
Is Stendra safer than older PDE5 inhibitors? ▾
Stendra has a more selective enzyme profile than sildenafil or vardenafil, which may produce fewer visual disturbances and some other side effects, but the overall cardiovascular safety profile is similar to other PDE5 inhibitors. According to current guidelines, contraindications (nitrates, severe cardiovascular disease) apply equally to all PDE5 inhibitors regardless of generation.
Why is Stendra more expensive than other ED medications? ▾
Stendra is a newer molecule with limited authorised generic competition compared with sildenafil, tadalafil and vardenafil, which are all available as low-cost generics in most markets. Out-of-pocket cost is therefore typically higher for Stendra. Insurance and prescriber considerations of cost vs the modest onset advantage drive selection.
Is Stendra the same as generic avanafil? ▾
When authorised generic avanafil is available, it contains the same active ingredient at the same strengths and is bioequivalent to Stendra by regulatory standard. Generic availability is more limited than for other PDE5 inhibitors, particularly outside the US, so Stendra-branded tablets are still common.
Related medications
The information on this website is provided for reference and educational purposes only. It does not replace consultation with a qualified healthcare professional.