What is the recommended dosage and treatment guidelines for avanafil (Stendra) in adult men with erectile dysfunction (ED)?

Avanafil Dosage and Treatment Guidelines for Erectile Dysfunction

The recommended starting dose of avanafil (Stendra) for erectile dysfunction is 100 mg taken approximately 15 minutes before sexual activity, with dose adjustments to 50 mg or 200 mg based on efficacy and tolerability. 1

Dosing Recommendations

• The initial recommended dose is 100 mg taken as needed, approximately 15 minutes before sexual activity 1
• Based on individual response and tolerability, the dose may be:
  • Increased to 200 mg if the response is insufficient 1
  • Decreased to 50 mg if side effects occur 1
• Avanafil should not be taken more than once per day 1
• The medication may be taken with or without food 1

Special Dosing Considerations

• For patients taking moderate CYP3A4 inhibitors, the maximum dose should not exceed 50 mg in a 24-hour period 1
• For patients on stable alpha-blocker therapy, the recommended starting dose is 50 mg 1
• Use with caution at lower initial doses in patients with mild to moderate hepatic or renal impairment 2
• Do not use avanafil in patients with severe renal or hepatic impairment 1

Contraindications

• Avanafil is contraindicated in patients:
  • Using any form of organic nitrate 1
  • With hypersensitivity to any component of avanafil 1
  • Taking guanylate cyclase (GC) stimulators such as riociguat and vericiguat 1

Efficacy Profile

• Avanafil has similar efficacy to other PDE5 inhibitors in the general ED population 2, 3
• Higher doses (200 mg) provide better efficacy than lower doses (100 mg), as demonstrated by improvements in the International Index of Erectile Function-Erectile Function (IIEF-EF) domain scores 4, 5
• Avanafil can work as quickly as 15 minutes after administration, with 64-71% of sexual attempts being successful when taken within this timeframe (compared to 27% with placebo) 6
• Efficacy can last beyond 6 hours after dosing 6

Safety Profile and Adverse Effects

• Most common adverse events include:
  • Headache 1, 6
  • Flushing 1, 6
  • Nasal congestion 1, 6
  • Nasopharyngitis 1, 6
  • Back pain 1, 6
• Avanafil has the lowest rates of dyspepsia among PDE5 inhibitors 2, 7
• Like tadalafil, avanafil has lower rates of myalgia compared to other PDE5 inhibitors 2, 7

Cardiovascular Considerations

• Cardiovascular risk should be assessed for all men with ED before prescribing avanafil 2
• Sexual activity is considered equivalent to walking 1 mile in 20 minutes or climbing 2 flights of stairs in 20 seconds 2
• Men unable to perform this level of exercise without symptoms should be referred to a cardiologist before treatment 2
• Avanafil can potentiate the hypotensive effect of nitrates, alpha-blockers, antihypertensives, and alcohol 1

Optimizing Treatment Success

• Proper patient education is essential, as incorrect use accounts for many treatment failures 2, 3
• Patients should be instructed that sexual stimulation is necessary for the medication to work 2
• Dose titration should be performed to balance efficacy and minimize adverse effects 2, 3
• For patients who fail initial therapy, ensure an adequate trial was conducted before considering alternative treatments 2

Special Populations

• Men with diabetes and post-prostatectomy patients have more severe ED at baseline and may respond less robustly to avanafil 2, 7
• Starting at the higher end of the dosing range may be more effective for these populations 3
• Combining testosterone therapy with avanafil may improve efficacy in men with both ED and testosterone deficiency 2