Stendra (Avanafil): Patient-Friendly Guide for Australian Patients
Basic Product Information
| International Non-Proprietary Name (INN) | Avanafil |
|---|---|
| Brand Names (Australia) | Stendra®, Spedra® |
| Anatomical Therapeutic Chemical (ATC) Code | G04BE10 |
| Available Forms | Film-coated tablets |
| Available Strengths | 50 mg, 100 mg, 200 mg |
| Manufacturers | VIATRIS Pty Ltd, Menarini Australia Pty Ltd |
| Prescription Status | Prescription only (Schedule 4, S4) |
Mechanism of Action
For Patients: Stendra (Avanafil) helps improve blood flow to the penis, making it easier for men with erectile dysfunction (ED) to get and maintain an erection when sexually stimulated.
For Healthcare Professionals: Avanafil is a selective phosphodiesterase type 5 (PDE5) inhibitor. By blocking the activity of PDE5, it prevents the breakdown of cyclic guanosine monophosphate (cGMP), resulting in smooth muscle relaxation in the corpus cavernosum and allowing for increased blood inflow during sexual arousal.
Pharmacokinetics
- Absorption: Rapidly absorbed; maximum plasma concentrations reached in approximately 30–45 minutes after dosing.
- Metabolism: Metabolised mainly in the liver by the cytochrome P450 enzyme CYP3A4.
- Elimination: Eliminated primarily via faeces and, to a lesser extent, in urine.
- Duration of Action: Effects may last 4–6 hours on average. Some men report efficacy up to 6 hours post-dose.
Use in Everyday Life and Best Practices
- Stendra is used on an as-needed basis to manage erectile dysfunction. It is not intended for daily use unless directed by your prescriber.
- Typically, the starting dose for most men is 100 mg, taken approximately 15–30 minutes before anticipated sexual activity.
- Tablets should be swallowed whole with water.
- Sexual stimulation is required for Stendra to work.
- Do not take more than one dose in a 24-hour period.
- Follow your prescriber’s instructions, especially if you are using other medicines or have other medical conditions.
In Australia, most prescriptions for Avanafil are provided by general practitioners or urologists specialising in male sexual health, often after discussion of lifestyle and psychological factors.
Dosing: Morning vs Evening Intake
- Morning: Less common unless specifically directed by your doctor, as sexual activity is typically anticipated rather than regular. If used, be mindful of possible interactions with other morning medications.
- Evening: Most men prefer taking Stendra in the evening before anticipated sexual activity. This aligns with social and lifestyle patterns in Australia, such as after work or dinner.
- Advantage of evening dosing includes improved privacy and flexibility. The short onset time (15–30 minutes) allows for spontaneous scheduling.
Taking with Food or on an Empty Stomach
- Stendra can be taken with or without food.
- Taking Avanafil with a high-fat meal may delay the onset of action slightly, but does not reduce the overall effect.
- For Australian patients, common meals such as steak, BBQ, or hearty dinners may slow onset by 30–45 minutes.
- If quick results are desired, take on an empty stomach or after a light meal.
Interaction Warnings
| Medication/Food/Drink | Possible Interaction/Effect |
|---|---|
| Nitrates (GTN, isosorbide) | May cause dangerous drops in blood pressure; use is strictly contraindicated. |
| Alcohol | Large amounts increase the risk of dizziness, headache, and low blood pressure. |
| Other PDE5 inhibitors (e.g. sildenafil, tadalafil, vardenafil) | Do not combine; may increase risk of side effects and is not more effective. |
| CYP3A4 Inhibitors (e.g. ketoconazole, ritonavir, clarithromycin) | May increase avanafil levels, raising risk of side effects; dosage adjustment may be required. |
| Antihypertensives | Risk of low blood pressure when combined. |
| Grapefruit juice | Can increase risk of side effects by affecting metabolism. |
Indications
| Indication | Status in Australia |
|---|---|
| Treatment of erectile dysfunction in adult men | Approved |
| Pulmonary arterial hypertension | Not approved (off-label not recommended) |
| Female sexual arousal disorder | Not approved; insufficient evidence |
Dosing According to Clinical Indication
| Patient Group | Recommended Dose |
|---|---|
| Most adult men | Initial: 100 mg taken ~15–30 min before sexual activity; may adjust to 50 mg or 200 mg depending on tolerance and efficacy |
| Older adults (≥65 years) | Start with 50 mg; increase if well tolerated |
| Hepatic/renal impairment | Use with caution; consult specialist for dose adjustment |
| Children (<18 years) | Not indicated |
Safety Profile and Side Effects
| Likelihood | Possible Side Effects |
|---|---|
| Common (1–10%) | Headache, flushing (warmth, redness in the face, neck, or chest), nasal congestion, back pain |
| Less common (0.1–1%) | Dizziness, nausea, increased heart rate, blurred vision |
| Rare (<0.1%) | Priapism (painful, prolonged erection), sudden vision loss, hearing changes, allergic reactions |
- Stop taking Stendra and seek medical attention if you experience chest pain, sudden vision loss, or a prolonged erection lasting more than 4 hours.
- If you experience side effects, consult your pharmacist or GP for advice.
Guidelines for Proper Use
- Only take Stendra as prescribed by a registered medical practitioner; do not share with others.
- If you miss a planned dose (for anticipated activity), take it when needed. Do not double dose.
- Store in a cool, dry place (<25°C), away from direct sunlight and out of reach of children and pets.
- Do not purchase from non-registered, unverified sources, as fake medicines are a significant safety risk in Australia.
- Discuss openly with your doctor or pharmacist about all medications and supplements you are taking.
- Maintain a healthy diet and lifestyle to enhance efficacy (regular physical activity, moderation with alcohol, balanced meals).
- Appropriate for men over 18 years; not recommended for women or persons under 18.
Alternative Treatment Options
- Sildenafil (Viagra®): Most established; longer experience, similar side effect profile, requires ~1 hour for full effect, can be less expensive.
- Tadalafil (Cialis®): Longer duration (up to 36 hours), can be used for daily dosing; preferred for men desiring more spontaneity over the weekend.
- Vardenafil (Levitra®): Similar to sildenafil, quick onset; less affected by food.
- Other non-drug therapies (e.g. vacuum pumps, penile injections, counselling): can be suitable for specific patients or in combination.
All listed PDE5 inhibitors are available in Australia and may be subsidised in specific clinical circumstances, though PBS coverage is generally limited. Avanafil was developed for faster onset and fewer food interactions but may be higher in price compared to generics.
Legal, Registration, and Reimbursement Status in Australia
- Avanafil (Stendra®) is registered by the Therapeutic Goods Administration (TGA; Australian Government Department of Health).
- Available only with a doctor’s prescription (Schedule 4/S4 medicine).
- Not widely reimbursed by the Pharmaceutical Benefits Scheme (PBS); typically requires private or out-of-pocket payment.
- Available through community pharmacies, subject to stock and dispensing practices in each state/territory.
Latest Research & Clinical Guidance (2022–2025)
- Recent international guidelines (e.g. European Association of Urology, American Urological Association) continue to recommend Avanafil as a first-line therapy for appropriately selected men with ED.
- Meta-analyses (2023–2024) confirm the rapid onset, favourable tolerability, and high patient satisfaction rates compared with other PDE5 inhibitors (European Urology, 2023).
- Emerging Australian research indicates high preferences among younger and middle-aged men for Avanafil due to its short waiting time and lower likelihood of meal interactions.
- Ongoing studies are assessing combined approaches (lifestyle + medication) for improved outcomes in the Australian setting.
Availability and Delivery
| Pack Size (tablets) | Indicative Price Range (AUD$) | Estimated Delivery (Business Days) |
|---|---|---|
| 4 | $65–$100 | Sydney: 1–2; Melbourne: 1–2; Brisbane: 2–3; Perth: 2–4; Adelaide: 1–3 |
| 8 | $120–$180 | As above |
| 12 | $165–$245 | As above |
Prices and delivery may vary between pharmacies. Please check with your local pharmacy for current availability, stock, and delivery arrangements (including click & collect or home delivery options).
Frequently Asked Questions (FAQ)
- Is Stendra safe to use regularly?
Yes, when used as prescribed. Stendra is intended for use prior to anticipated sexual activity. Do not take more than one dose within 24 hours, and always use under your current doctor’s supervision. - Can I drink alcohol while taking Stendra?
Moderate drinking (e.g., one standard glass of wine or beer) is generally acceptable, but large amounts increase the risk of side effects such as dizziness or low blood pressure. - What if Stendra doesn’t work for me?
Some men may not respond to the first dose. Try up to eight separate attempts at different times. If there is still no effect, discuss with your doctor—adjustment of dose or an alternative treatment may be suitable. - Are there any medical conditions that mean I shouldn’t use Stendra?
Yes. Do not use if you have severe heart or liver problems, use nitrates for angina, or have been advised against sexual activity for health reasons. Always discuss your full medical history with your doctor. - Can women or young people use Stendra?
No. Avanafil is approved only for men aged 18 and older with erectile dysfunction. It is not suitable for women, children, or adolescents.
Further Information: For additional questions, Australian patients can consult their community pharmacist or call Healthdirect Australia on 1800 022 222 for free, reliable health advice.
