Avanafil

Avanafil Brand Name– Stendra

What is Avanafil

Avanafil belongs to the phosphodiesterase type 5 (PDE5) inhibitors drug class, a class of drugs commonly indicated for treatment of erectile dysfunction (ED).

PDE5 inhibitors do not inhibit prostaglandins as do some agents for treating impotence (e.g., alprostadil).

The safety and efficacy of avanafil was studied in three clinical trials; compared to placebo, improved erections were recorded in patients with organic and/or psychogenic ED when avanafil was administered prior to visual sexual stimulation.

Avanafil is taken prior to sexual activity without regard to food. Patients with preexisting cardiovascular disease should discuss the potential cardiac risks associated with sexual activity with their healthcare professional. As with other PDE5 inhibitors, avanafil has systemic vasodilatory proprieties.

In clinical evaluation, avanafil (200 mg) reduced the sitting blood pressure of healthy subjects by 8 mmHg systolic and 3.3 mmHg diastolic, with the maximum decrease observed at 1 hour after dosing.

Patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects, especially in combination with sexual activity.

Avanafil should not be used by men who also take nitrates because the combination can cause a sudden drop in blood pressure that can be dangerous. According to ED treatment guidelines, oral phosphodiesterase type 5 inhibitors (PDE5 inhibitor) are considered first-line therapy.

Stendra (avanafil) was FDA approved in April 2012.

Indications

  • erectile dysfunction (ED)

Side Effects

  1. abdominal pain
  2. angina
  3. arthralgia
  4. back pain
  5. blurred vision
  6. constipation
  7. cough
  8. depression
  9. diarrhea
  10. dizziness
  11. drowsiness
  12. dyspepsia
  13. dyspnea
  14. elevated hepatic enzymes
  15. epistaxis
  16. fatigue
  17. flushing
  18. gastritis
  19. gastroesophageal reflux
  20. headache
  21. hearing loss
  22. hematuria
  23. hyperglycemia
  24. hypertension
  25. hypoglycemia
  26. hypotension
  27. increased urinary frequency
  28. infection
  29. influenza
  30. insomnia
  31. muscle cramps
  32. musculoskeletal pain
  33. myalgia
  34. nasal congestion
  35. nausea
  36. nephrolithiasis
  37. non-arteritic anterior ischemic optic neuropathy
  38. orthostatic hypotension
  39. palpitations
  40. peripheral edema
  41. pharyngitis
  42. priapism
  43. pruritus
  44. rash
  45. sinusitis
  46. syncope
  47. thrombosis
  48. tinnitus
  49. urinary urgency
  50. vertigo
  51. visual impairment
  52. vomiting
  53. wheezing

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • angina
  • aortic stenosis
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • children
  • coagulopathy
  • coronary artery disease
  • dialysis
  • geriatric
  • hearing impairment
  • heart failure
  • hepatic disease
  • human immunodeficiency virus (HIV) infection
  • hypertension
  • hypotension
  • idiopathic hypertrophic subaortic stenosis
  • infants
  • leukemia
  • multiple myeloma
  • myocardial infarction
  • neonates
  • nitrate/nitrite therapy
  • non-arteritic anterior ischemic optic neuropathy
  • penile structural abnormality
  • peptic ulcer disease
  • Peyronie’s disease
  • polycythemia
  • pregnancy
  • priapism
  • renal disease
  • renal failure
  • renal impairment
  • retinitis pigmentosa
  • sickle cell disease
  • stroke
  • tinnitus
  • visual disturbance

Interactions

  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Alfuzosin
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Alpha-blockers
  • Amiodarone
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amobarbital
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amprenavir
  • Amyl Nitrite
  • Apalutamide
  • Aprepitant, Fosaprepitant
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Omeprazole
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Barbiturates
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Boceprevir
  • Bosentan
  • Brigatinib
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Butabarbital
  • Carbamazepine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Phenylephrine
  • Cenobamate
  • Ceritinib
  • Chlophedianol; Guaifenesin; Phenylephrine
  • Chloramphenicol
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Phenylephrine
  • Ciprofloxacin
  • Clarithromycin
  • Cobicistat
  • Codeine; Phenylephrine; Promethazine
  • Crizotinib
  • Dabrafenib
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Desipramine
  • Dexamethasone
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Diltiazem
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Phenylephrine
  • Doxazosin
  • Dronedarone
  • Dutasteride; Tamsulosin
  • Duvelisib
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elagolix
  • Elagolix; Estradiol; Norethindrone acetate
  • Elbasvir; Grazoprevir
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Encorafenib
  • Enzalutamide
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Ethanol
  • Etravirine
  • Fedratinib
  • Fluconazole
  • Fluvoxamine
  • Fosamprenavir
  • Fosphenytoin
  • Glimepiride; Rosiglitazone
  • grapefruit juice
  • Guaifenesin; Phenylephrine
  • Hydralazine; Isosorbide Dinitrate, ISDN
  • Hydrocodone; Phenylephrine
  • Idelalisib
  • Imatinib
  • Indinavir
  • Isavuconazonium
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Isosorbide Dinitrate, ISDN
  • Isosorbide Mononitrate
  • Itraconazole
  • Ivosidenib
  • Ketoconazole
  • Lefamulin
  • Lesinurad
  • Lesinurad; Allopurinol
  • Letermovir
  • Lopinavir; Ritonavir
  • Lorcaserin
  • Lorlatinib
  • Lumacaftor; Ivacaftor
  • Mephobarbital
  • Metformin; Rosiglitazone
  • Methohexital
  • Mifepristone
  • Mitotane
  • Nefazodone
  • Nelfinavir
  • Nevirapine
  • Nicardipine
  • Nifedipine
  • Nitrates
  • Nitroglycerin
  • Nitroprusside
  • Octreotide
  • Ombitasvir; Paritaprevir; Ritonavir
  • Omeprazole
  • Omeprazole; Amoxicillin; Rifabutin
  • Omeprazole; Sodium Bicarbonate
  • Pentobarbital
  • Perindopril; Amlodipine
  • Phenobarbital
  • Phenoxybenzamine
  • Phentolamine
  • Phenylephrine
  • Phenylephrine; Promethazine
  • Phenytoin
  • Posaconazole
  • Prazosin
  • Primidone
  • Quinine
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Riociguat
  • Ritonavir
  • Rosiglitazone
  • Sapropterin
  • Saquinavir
  • Secobarbital
  • Silodosin
  • Tamsulosin
  • Telaprevir
  • Telithromycin
  • Telotristat Ethyl
  • Terazosin
  • Thiopental
  • Ticagrelor
  • Tipranavir
  • Trandolapril; Verapamil
  • Tucatinib
  • Verapamil
  • Vigabatrin
  • Voriconazole
  • Zafirlukast
  • Zanubrutinib
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