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Stendra

Stendra
Stendra or avanafil, is a powerful medication used to treat erectile dysfunction in men of all ages.

Brand: Avanafil

Availability: In Stock
Average Delivery Time: 9 Days
Exp. Date: April 2024
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Package Price Per pill Save Order
Stendra 200 mg
120 pills - 200 mg
+ 12 free Viagra 100 mg, 7% discount for future orders
$563.25 $4.69 $223.25 Add to cart
92 pills - 200 mg
+ 12 free Viagra 100 mg, 7% discount for future orders
$435.79 $4.74 $167.19 Add to cart
60 pills - 200 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$287.99 $4.80 $105.26 Add to cart
36 pills - 200 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$175.95 $4.89 $60.00 Add to cart
24 pills - 200 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$125.99 $5.25 $31.31 Add to cart
12 pills - 200 mg $78.65 $6.55 No Add to cart
Stendra 100 mg
120 pills - 100 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$292.55 $2.44 $237.35 Add to cart
92 pills - 100 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$234.01 $2.54 $172.25 Add to cart
60 pills - 100 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$169.55 $2.83 $95.40 Add to cart
36 pills - 100 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$113.39 $3.15 $45.58 Add to cart
24 pills - 100 mg $83.59 $3.48 $22.39 Add to cart
12 pills - 100 mg $52.99 $4.42 No Add to cart
Stendra 50 mg
120 pills - 50 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$249.99 $2.08 $229.91 Add to cart
92 pills - 50 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$212.69 $2.31 $155.23 Add to cart
60 pills - 50 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$154.55 $2.58 $85.40 Add to cart
36 pills - 50 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$103.59 $2.88 $40.38 Add to cart
24 pills - 50 mg $76.56 $3.19 $19.42 Add to cart
12 pills - 50 mg $47.99 $4.00 No Add to cart

Product description

Drug Title

Stendra (Avanafil)

Pharmacological action

It is an inhibitor of FDE type 5 (FDE5). It has specificity towards cyclic guanosine monophosphate (cGMP). After local release of nitric oxide occurs as a result of sexual stimulation, inhibition of FDE5 by Stendra (Avanafil) causes increase of cGMP concentration in cavernous bodies of the penis. This leads to relaxation of smooth muscles and blood flow to the tissues of the penis, thus causing an erection. The action of Stendra (Avanafil) does not develop in the absence of sexual stimulation.


In in vitro studies, Stendra (Avanafil) has been shown to be highly selective with respect to FDE5. It has a more pronounced effect on FDE5 than other known phosphodiesterases (more than 100 times stronger than on FDE6; more than 1000 times stronger than on FDE4, FDE8 and FDE10; more than 5000 times stronger than on FDE2 and FDE7; more than 10000 times stronger than on FDE1, FDEZ. FDE9 and FDE11).


Stendra (Avanafil) is more than 100 times stronger on FDE5 than on FDE6, which is found in the retina and is responsible for transmitting the light signal. Also importantly, Stendra (Avanafil) is about 20,000 times more selective against FDE5 than against FDEZ (an enzyme found in the heart and blood vessels that is involved in controlling myocardial contractility).


In a study with penile plethysmography (RigiScan) in some men, avanafil (200 mg dose) induced an erection already 20 min after ingestion that was considered sufficient for penetration (60% hardness as assessed by RigiScan). The overall response to avanafil administration in these individuals was statistically significant, compared to placebo, between 20 and 40 min.


Pharmacokinetics

Stendra (Avanafil) is rapidly absorbed after oral administration. Cmax in plasma is reached within 0.5-0.75 h after ingestion. When avanafil is taken together with fatty food, the rate of absorption is reduced, the average delay in Tmax is 1.25 h, and the average Cmax reduction is 39%. No effect on the amount of exposure (AUC) was observed. Small changes in Cmax of Stendra (Avanafil) are considered to be of minimal clinical significance.


Pharmacokinetics of avanafil in the recommended dose range is dose proportional. It is excreted mainly by metabolism occurring in the liver, mainly with the participation of CYP3A4 isoenzyme. Concomitant use of strong CYP3A4 inhibitors (e.g., ketoconazole and ritonavir) is accompanied by increased plasma exposure of avanafil.


Binding of avanafil to plasma proteins is approximately 99% and does not depend on the concentration of the active substance, age, liver and kidney function. When taking avanafil at a dose of 200 mg 2 times per day for 7 days, there was no cumulation of the drug in plasma. Taking into account the data of measuring the concentration of Stendra (Avanafil) in the semen of healthy volunteers in 45-90 min after taking avanafil, less than 0.0002% of the administered dose may appear in the sperm


Metabolized primarily with the participation of the hepatic microsomal isoenzymes CYP3A4 (main pathway) and CYP2C9 (additional pathway). The plasma concentrations of the main circulating metabolites M4 and Ml6 were 23% and 29% of the starting substance concentration, respectively. The selectivity of metabolite M4 against FDE was similar to that of avanafil, and the in vitro inhibitory activity against FDE5 was 18% of that of avanafil. Thus, metabolite M4 provides about 4% of the total pharmacological activity of the drug. Metabolite Ml6 has no activity against FDE5.


Stendra (Avanafil) is excreted as metabolites, mainly in the feces (about 63%), to a lesser extent in the urine (about 21%).


Terminal T1/2 of Stendra (Avanafil) is about 6-17 hours.


Contraindications to use

Hypersensitivity to avanafil, concomitant use with any form of organic nitrates or nitric oxide donators (e.g., amyl nitrite), myocardial infarction, stroke or life-threatening arrhythmic episodes within the last 6 months, resting hypotension (BP<90/50 mm Hg) or hypertension (BP>170/100 mm Hg) ), unstable angina pectoris, angina associated with sexual intercourse, congestive heart failure II functional class or higher according to NYHA, liver function disorders of severe degree (class C according to Child-Pugh scale), severe renal impairment (CK<30 ml/min), loss of vision in one eye due to anterior nonarteritic ischemic optic neuropathy, whether or not the episode was associated with prior use of FDE5 inhibitors, confirmed hereditary retinal degenerative diseases, concomitant use with guanylate cyclase stimulators such as riociguat (potential risk of symptomatic hypotension), concomitant use of strong CYP3A4 inhibitors (including ketoconazole, ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir and telithromycin).


Caution: In patients with left ventricular outflow tract obstruction (e.g., aortic stenosis, idiopathic hypertrophic subaortic stenosis); in patients with anatomic deformity of the penis (angular curvature, cavernous body fibrosis, or Peyronie's disease) In patients with diseases predisposing to the development of priapism (sickle cell anemia, multiple myeloma or leukemia); in patients with blood clotting disorders; in patients with peptic ulcer in the active phase; simultaneous use with alpha-adrenoblockers.


Administration during pregnancy and lactation

Not intended for use in women.

Special Precautions

Before using avanafil, the doctor should take into account the potential risk of cardiac complications from sexual activity in patients with cardiovascular disease. Avanafil has the properties of a vasodilator, causing a slight and transient decrease in BP. and thus potentiates the hypotensive effect of nitrates. Patients with left ventricular outflow tract obstruction, such as aortic stenosis and idiopathic hypertrophic subaortic stenosis, may be particularly sensitive to the action of vasodilators, including FDE5 inhibitors.


Patients in whom an erection lasts for 4 hours or more (priapism) should be advised to seek medical advice immediately.


Avanafil should be used with caution in patients with anatomical deformation of the penis (angular curvature, fibrosis of the cavernous bodies or Peyronie's disease) and in patients with diseases that may predispose to the development of priapism (sickle cell anemia, multiple myeloma or leukemia).


There are reports on visual impairment and cases of development of anterior nonarteritic ischemic optic neuropathy due to the use of other FDE5 inhibitors. In case of sudden visual impairment, the patient should be advised to stop taking avanafil immediately and consult a physician.


There is no information on the safety of avanafil use in patients with blood clotting disorders and peptic ulcer in the active phase. Therefore, avanafil should be administered to such patients only after a careful comparison of benefits and risks.


In patients with signs of hemodynamic instability during therapy with alpha-adrenoblockers only, there is an increased risk of symptomatic hypotension if avanafil is taken simultaneously. In patients with stable hemodynamic parameters against the background of therapy with alpha-adrenoblockers, the administration of avanafil should be started at a minimum dose of 50 mg. In patients already receiving avanafil in an optimally selected dose, therapy with alpha-adrenoblockers should be started at the minimum dose. A stepwise increase in the dose of alpha-adrenoblockers may be associated with an additional decrease in BP after receiving avanafil. The safety of the combined use of avanafil and alpha-adrenoblockers may be affected by insufficient intravascular fluid volume and the use of other antihypertensive medications.


Safety and effectiveness of combinations of avanafil with other FDE5 inhibitors or other drugs for the treatment of erectile dysfunction have not been studied. Patients should be advised to avoid taking avanafil in such combinations.


When using ethanol (alcohol) in combination with avanafil, the risk of symptomatic arterial hypotension may increase. Patients should note that concomitant use of avanafil and ethanol (alcohol) may be accompanied by an increased likelihood of arterial hypotension, dizziness or fainting. Physicians should advise patients regarding interventions if postural hypotensive symptoms occur.


Effects on the ability to drive and operate vehicles and machinery


Avanafil has minimal effect on the ability to drive vehicles and engage in other potentially dangerous activities. Because the possibility of dizziness and visual disturbances has been reported in clinical trials of avanafil, patients should know how they react to taking avanafil before starting to drive or operate machinery.

Indications of the active substance AVANAPHIL

Treatment of erectile dysfunction in adult men.


Dosage regimen

Sexual stimulation is necessary for the development of the effect.


For oral administration. The recommended dose of 100 mg is taken as needed, approximately 15-30 min before sexual activity.


Depending on individual effectiveness and tolerance, the dose may be increased to a maximum of 200 mg or reduced to 50 mg. The maximum recommended frequency of use is 1 time per day.


In patients with mild to moderate hepatic dysfunction (Child-Pugh grades A or B), start treatment with the lowest effective dose and adjust it according to tolerability.