> ## Documentation Index > Fetch the complete documentation index at: https://docs.hi-doctor.ai/llms.txt > Use this file to discover all available pages before exploring further. # Stendra (avanafil) > Stendra is the US brand name for avanafil, not itself EU-authorised — how avanafil works, dosing and side effects under its EU brand. Stendra is the United States brand name for avanafil and holds no EU marketing authorisation itself. In the European Union the same active substance is authorised as **Spedra**, held by Menarini. Avanafil is a prescription tablet for erectile dysfunction, authorised across the EU since 2013 and the most recently approved of the tablets in this group. In the US, Stendra is labelled by Metuchen Pharmaceuticals, LLC in 50 mg, 100 mg and 200 mg tablets. No doctor in the EU can prescribe "Stendra" by that US brand name. The active substance it contains, avanafil, is a different matter — it has been authorised across the EU since 2013 under the brand name Spedra, and a licensed doctor can assess it under that authorisation. **Form** oral tablet · **Frequency** on demand · **Results** acts in \~15–30 minutes · **Status** prescription only · **Active ingredient** avanafil · **Dosages** 50 / 100 / 200 mg on demand ## What avanafil is Avanafil is a prescription tablet for erectile dysfunction, authorised across the EU since 2013 and the most recently approved of the tablets in this group. It works like the others in its class by keeping the blood vessels in the penis relaxed so blood can flow in during sexual arousal. The EU product information says the usual 100 mg dose is taken about 15 to 30 minutes before sex. As with the rest of this group, it must never be taken with nitrate heart medicines. ## How it works Avanafil blocks the PDE5 enzyme that normally ends an erection, letting the blood vessels in the penis stay relaxed and fill with blood when a man is sexually aroused. Onset as fast as 15–30 minutes. The most recently approved PDE5 molecule of the group. The doctor starts from the dose that fits your case. ## What the studies reported Trial evidence is registered as [NCT00790751](https://clinicaltrials.gov/study/NCT00790751) and [NCT00809471](https://clinicaltrials.gov/study/NCT00809471). The 15-minute and 6-hour onset figures come from small subsets of attempts (300 and 80 respectively) inside a 12-week trial, so they are much less precise than the overall 12-week results. ## Safety, in full | Effect | Frequency | | ---------------- | ------------------------------------------------------------------------------------------------------------------------------------ | | Headache | Common (1 in 100 to 1 in 10) — named among the most frequently reported reactions across a safety database of 2,566 exposed subjects | | Flushing | Common (1 in 100 to 1 in 10) | | Nasal congestion | Common (1 in 100 to 1 in 10) — sinus congestion is uncommon | | Back pain | Uncommon (1 in 1,000 to 1 in 100) — though named among the most frequently reported reactions in the safety summary | | Dizziness | Uncommon (1 in 1,000 to 1 in 100) | | Blurred vision | Uncommon (1 in 1,000 to 1 in 100) | Contraindicated with nitrate medicines and nitric-oxide donors, and in men with serious cardiovascular conditions such as recent heart attack, stroke or unstable angina. ## How to take it Take it about 15–30 minutes before sexual activity. The doctor starts from the dose that fits your case. Never combine with nitrates. If there's no response, the doctor reassesses — don't self-adjust. Not suitable if you take nitrates for chest pain, have unstable cardiovascular disease, or have been advised against sexual activity for cardiac reasons. ## Common questions Avanafil is a PDE5 inhibitor that blocks the enzyme that normally ends an erection, letting the blood vessels in the penis stay relaxed and fill with blood when a man is sexually aroused. It is authorised across the EU since 2013 as Spedra. The EU product information says the usual 100 mg dose is taken about 15 to 30 minutes before sex. Onset as fast as 15 minutes has been reported, but this figure comes from a small subset of attempts inside a 12-week trial. Stendra is the US brand name for avanafil and holds no EU marketing authorisation. In the European Union the same active substance is authorised as Spedra, held by Menarini. No doctor in the EU can prescribe Stendra by that US brand name. Headache, flushing and nasal congestion are common — between 1 in 100 and 1 in 10 men. Back pain, dizziness and blurred vision are less common, occurring in between 1 in 1,000 and 1 in 100 men. These figures come from a safety database of 2,566 exposed subjects. Avanafil is contraindicated with nitrate medicines and nitric-oxide donors, and in men with serious cardiovascular conditions such as recent heart attack, stroke or unstable angina. ## How Hi-Doctor handles it An EU-licensed doctor reviews your case and, if eligible, issues an electronic prescription valid at any EU pharmacy under Directive 2011/24/EU. See [pricing](/essentials/pricing) for the consultation fee — the medicine is paid separately at the pharmacy. For a different PDE5 option, see [sildenafil (Viagra)](/library/medicines/viagra), and for the eligibility checks that apply, see [safety](/essentials/safety). ## Start a consultation Answer the sexual health questionnaire and a registered doctor reviews it. They decide whether treatment is appropriate, which one, and at what dose — and declining is a normal outcome. See [what it costs](/essentials/pricing) and [how the review works](/essentials/how-it-works). This page is reference information, not medical advice and not a prescription. Whether a medicine is appropriate for you is decided by a registered doctor after reviewing your consultation.