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Stendra (Avanafil) Dosage & Effects

Kelly Brown MD, MBA

Reviewed by Kelly Brown MD, MBA

Written by Geoffrey C. Whittaker

Published 06/23/2019

Updated 06/03/2024

If you struggle with erectile dysfunction (ED), there are plenty of ways to manage this particular medical condition. One of the medications out there for it, Stendra® (and the generic version, avanafil), has a special trick up its sleeve: It can work in as little as 15 minutes. 

Stendra can be an incredibly effective option for many men, though it’s important to dial in the dosage and understand the potential Stendra side effects associated with each. There are a range of Stendra dosages on the market, and which one is right for you will be determined by a conversation with a healthcare professional. 

But before you take this ED medication for the first time, it’s helpful to understand what to expect from each Stendra dosage. Keep reading to learn more about the different avanafil dosages you could get prescribed.

One of the newest FDA-approved medications for erectile dysfunction, Stendra is the brand name of avanafil. In other words, avanafil is the main ingredient in Stendra.

The drug typically comes as an oral tablet, and there are three different Stendra dosages:

  • 50 milligrams

  • 100 milligrams

  • 200 milligrams

As for how it works, Stendra is part of a group of ED medications known as PDE5 inhibitors. This type of medication blocks the enzyme phosphodiesterase-5, which is found in the smooth muscle cells of blood vessels. PDE5 inhibitors, along with sexual stimulation, increase blood flow for better erectile function.

You might be familiar with other common PDE5 inhibitors, such as Viagra® (which contains the active ingredient sildenafil), Cialis® (tadalafil), or Levitra® (vardenafil).

Not only is Stendra a faster-acting drug than other PDE5 inhibitors, but several clinical trials have found the medication to be effective in those with diabetes and those who have had a prostatectomy (prostate surgery). This makes it among the safest ED medications on the market.

Still, like other medications used to treat erectile dysfunction, it can take some time to work out the right dose of avanafil.

Most often prescribed to treat erectile dysfunction, the recommended starting dose of Stendra is usually 100 mg.

Taking a Stendra 100 mg dose is highly effective for preventing ED. Most men who take this dose typically find it easier to get an erection when aroused and to maintain their erection during sexual activity.

In a study of men affected by ED, patients randomly received a dosage of either 50 mg, 100 mg, or 200 mg of avanafil for use over a 12-week period. The men given the 100-mg dose showed a 57 percent average improvement in erectile function.

Like other dosages of Stendra, a 100 mg dosage isn’t affected by your food intake or moderate alcohol consumption. So you won’t have to worry about when to take this particular ED medication on your next dinner date.

At a dose of 100 mg, the most common Stendra side effects are:

  • Headaches

  • Nasal congestion

  • Flushing

  • Back pain

The highest dose of Stendra available for the treatment of erectile dysfunction is 200 mg. Your healthcare provider might prescribe Stendra 200 mg if you haven’t experienced satisfactory results from the 100-mg dose.

Like the 100-mg dose of Stendra, the 200-mg dose typically starts working within about 15 minutes of taking the medication.

Studies typically show that the 200-mg dose of Stendra is just as effective as the 100-mg dose of the medication for treating ED. For example, in the same study mentioned above, the researchers found no significant difference between 100-mg and 200-mg doses of Stendra for men with ED.

Another study of 182 Chinese men also found that both the 100-mg and 200-mg avanafil dosages were effective in treating ED. These doses were generally well-tolerated by participants, though this was a much smaller study than the others.

Something worth noting is that the Stendra 200 mg dose has a slightly higher risk of causing certain side effects than the standard 100-mg dose. Around 10 percent of men experience headaches at this dose, compared to about 7 percent of men prescribed the Stendra 100-mg dose.

Interestingly, some side effects — such as back pain and nasal congestion — appear to be slightly less common in men who use Stendra at this dose than in those prescribed Stendra at lower doses of 50 or 100 mg.

The downside of this higher dose is that it can further increase the already high cost of Stendra.

As mentioned, Stendra is also available in a 50-mg dose — currently the lowest Stendra dosage used to treat ED. You might be prescribed this dose if you have mild ED, are relatively young, or experienced side effects from Stendra at a standard 100-mg dose.

But you don’t have to worry about whether a lower Stendra dosage will work for you if you have mild ED. The study mentioned above found that, compared to a placebo, all doses (even the lowest avanafil dosage) helped men with ED during sexual activity.

So, a 50-mg dose of Stendra could be enough to help you get hard, stay hard, and improve your sexual performance.

However, this dose of Stendra takes slightly longer to start working than higher doses of the medication. On average, it takes about 30 minutes to feel the effects of Stendra at a 50-mg dose, compared to just 15 minutes for the 100 and 200-mg doses.

One advantage of using Stendra at this lower dose is that your risk of experiencing side effects is significantly lower.

Only about 5 percent of men who use a 50-mg dose of Stendra experience headaches, compared to roughly 7 percent of men at a 100-mg dose and 10.5 percent at a 200-mg dose.

Other side effects, such as nasal congestion, are also more common at a 100-mg dose. That said, back pain appears to be slightly more common with a 50-mg dosage than with the 200-mg Stendra dose.

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Find answers to some of the most frequently asked questions about Stendra below.

Can You Use Stendra More Than Once Per Day?

You should not take Stendra more than once a day, as this can increase your risk of experiencing serious side effects. For longer-acting relief from ED, medications like Cialis, which lasts up to 36 hours, may be more suitable.

How Long Does Stendra Last?

A standard dose of Stendra 100 mg lasts approximately five hours, although the effects might start to decline earlier than that. Like other ED medications, Stendra produces the most significant improvements in ED within the first few hours after taking the pill.

Should Older Men Use a Higher Dose of Stendra?

Many issues can contribute to erectile dysfunction, ranging from high blood pressure and cardiovascular medical conditions like heart disease, to psychological factors, such as depression and performance anxiety. Depending on your symptoms and medical history, if you’re around 65 or older, your doctor may adjust your starting dose.

Should Heavier Men Use a Higher Dose of Stendra?

The recommended starting dose of Stendra is 100 mg, regardless of weight. Based on your results, a healthcare provider might recommend adjusting your dosage of Stendra to 50 mg or 200 mg after you’ve had time to assess the efficacy of the treatment and any Stendra side effects.

If Stendra Doesn’t Work, Can You Increase Your Dosage?

If you find that Stendra isn’t fully effective at the dose you’re prescribed, seek medical advice from your healthcare provider about changing your dosage. Don’t increase your dosage of Stendra without consulting your doctor.

Choose your chew

Besides dosage, there’s other critical information to know about this medication so you understand what to expect when taking avanafil.

As mentioned, common side effects of Stendra include headaches, muscle pain, sore throat, and flu-like symptoms, but more serious side effects are possible as well. These can include:

  • Retinitis pigmentosa (blurred vision), or sudden loss of vision

  • Painful erections

  • Chest pain

  •  Loss of hearing

These more severe side effects also can occur with other PDE5 inhibitors aside from just Stendra. If you experience any of these side effects or a prolonged erection lasting more than four hours, seek immediate medical attention from a healthcare provider.

Also note that if you’ve been advised not to participate in sexual activity due to an underlying cardiovascular medical condition, like heart failure or angina, this medication is not safe for you. It’s also not safe for those being treated for leukemia, heart attack, and other serious heart problems, or those with sickle cell anemia.

Stendra Interactions

If you’re taking medication for certain health conditions, you should be aware of potential drug interactions with Stendra. 

For instance, antihypertensive medications, like alpha-blockers for high blood pressure (hypertension), can affect which Stendra dosage you take, due to the fact that the drug interactions can cause hypotension (dangerously low blood pressure).

Stendra also can have negative drug interactions with other compounds found in food or prescription drugs. This includes nitrates like poppers, antifungal medications, CYP3A4 inhibitors, and grapefruit, as well as medications including:

  • Atazanavir

  • Ketoconazole

  • Ritonavir

  • Indinavir

  • Clarithromycin

  • Saquinavir

  • Itraconazole

  • Riociguat

  • erythromycin

  • nitroglycerin

  • amyl nitrate

  • doxazosin

If you use a CYP3A4 inhibitor, for instance, a healthcare provider may recommend taking no more than the 50-mg dose of Stendra. 

It’s critical to talk to a healthcare professional before taking Stendra about all the medications you take, including prescription medicines, over-the-counter drugs, vitamins and herbal supplements. Also make sure to disclose any history of Peyronie’s disease, sexually transmitted diseases, or ulcers.

For more information about Stendra, including exactly how this drug works, check out our full Stendra 101 guide.

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When looking for erectile dysfunction treatments, men have quite a few medication options. One popular choice is Stendra (avanafil), an ED medication that can work in as little as 15 minutes. Here’s what to know about it: 

  • Known as a PDE5 (short for phosphodiesterase type 5) inhibitor, Stendra (and the generic version avanafil) treats erectile dysfunction in men by blocking the enzyme phosphodiesterase-5 that affects whether your penis becomes erect.

  • Stendra is prescribed in three dosages: 50 mg, 100 mg, and 200 mg. All three Stendra dosages are effective at treating ED and are generally well-tolerated by men, even those with underlying conditions like diabetes.

  • There are some side effects associated with taking Stendra. The most common are headaches, back pain, nasal congestion, and flushing. The severity of these side effects can vary depending on which avanafil dosage you take. There’s also a small risk of more serious side effects and adverse reactions with Stendra.

While Stendra is a great option for treating ED, it’s not the only one out there. You might also consider other PDE5 inhibitors like Viagra or Cialis. (Here’s a breakdown of how Stendra vs. Viagra, for comparison.)

You can learn more about this Stendra and explore other erectile dysfunction treatments through an online consultation with a healthcare provider.

4 Sources

  1. Burke, R. M., & Evans, J. D. (2012). Avanafil for treatment of erectile dysfunction: review of its potential. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433322/
  2. Jiang, H., et. al. (2021). Efficacy and Safety of Avanafil in Chinese Subjects With Erectile Dysfunction: A Multi-Center, Randomized, Double-Blinded, Placebo-Controlled Phase III Clinical Trial. https://www.sciencedirect.com/science/article/pii/S2050116121000179
  3. Katz, E. G., et. al. (2014). Avanafil for erectile dysfunction in elderly and younger adults: differential pharmacology and clinical utility. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155803/
  4. STENDRA® (avanafil). (n.d.). https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/202276s018lbl.pdf.
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Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kelly Brown MD, MBA
Kelly Brown MD, MBA

Dr. Kelly Brown is a board certified Urologist and fellowship trained in Andrology. She is an accomplished men’s health expert with a robust background in healthcare innovation, clinical medicine, and academic research. Dr. Brown is a founding member of Posterity Health where she is Medical Director and leads strategy and design of their Digital Health Platform, an innovative education and telehealth model for delivering expert male fertility care.

She completed her undergraduate studies at University of North Carolina at Chapel Hill (go Heels!) with a Bachelor of Science in Radiologic Science and a Minor in Chemistry. She took a position at University of California Los Angeles as a radiologic technologist in the department of Interventional Cardiology, further solidifying her passion for medicine. She also pursued the unique opportunity to lead departmental design and operational development at the Ronald Reagan UCLA Medical Center, sparking her passion for the business of healthcare.

Dr. Brown then went on to obtain her doctorate in medicine from the prestigious Northwestern University - Feinberg School of Medicine and Masters in Business Administration from Northwestern University - Kellogg School of Management, with a concentration in Healthcare Management. During her surgical residency in Urology at University of California San Francisco, she utilized her research year to focus on innovations in telemedicine and then served as chief resident with significant contributions to clinical quality improvement. Dr. Brown then completed her Andrology Fellowship at Medical College of Wisconsin, furthering her expertise in male fertility, microsurgery, and sexual function.

Her dedication to caring for patients with compassion, understanding, as well as a unique ability to make guys instantly comfortable discussing anything from sex to sperm makes her a renowned clinician. In addition, her passion for innovation in healthcare combined with her business acumen makes her a formidable leader in the field of men’s health.

Dr. Brown is an avid adventurer; summiting Mount Kilimanjaro in Tanzania (twice!) and hiking the incredible Torres del Paine Trek in Patagonia, Chile. She deeply appreciates new challenges and diverse cultures on her travels. She lives in Denver with her husband, two children, and beloved Bernese Mountain Dog. You can find Dr. Brown on LinkedIn for more information.

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