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The safety and warning information outlined below is crucial for understanding the risks and necessary precautions when using this medication. Always consult with your healthcare provider if you have any concerns or questions.

• Cardiovascular Risks: Do not use Stendra (avanafil) if you've experienced a heart attack, stroke, or symptoms of heart failure within the last six months, or if you have abnormal blood pressure or chest pain. The safety of this medication under these conditions has not been established. Consult your cardiologist or healthcare professional, especially if advised to limit physical activities due to heart conditions.

• Blood Pressure Concerns: Stendra (avanafil) can cause a significant drop in blood pressure, particularly when combined with alpha blockers or other hypertension medications. Discuss your current medication regimen with your healthcare provider before starting or stopping any treatments. Monitor your blood pressure regularly and be cautious when standing up. Limit or avoid alcohol, as it can further lower blood pressure.

• Drug Interactions: Inform your prescriber of all medications you are taking to avoid serious interactions. Do not combine Stendra (avanafil) with nitrates, as this can dangerously lower blood pressure. Be cautious when using with oral azole antifungals and ritonavir (Norvir), as these can increase the risk of side effects such as headaches, flushing, and vision changes.

• Alcohol Consumption: Refrain from drinking alcohol while using Stendra (avanafil), as it can exacerbate side effects like dizziness and headaches, increasing the risk of falls or injuries. Alcohol can also reduce the effectiveness of the medication in treating erectile dysfunction.

• Priapism Warning: Rare cases of prolonged or painful erections lasting more than four hours (priapism) have been reported. Seek immediate medical attention to prevent permanent damage to the penis, including impotence. Individuals with conditions such as sickle cell anemia, multiple myeloma, or leukemia should be particularly cautious.

• Vision Changes: If you experience sudden changes in vision, seek emergency medical assistance immediately, as Stendra (avanafil) can cause irreversible eye damage. Those with a "crowded" optic disc may be at higher risk for vision alterations.

• Hearing Issues: Report any sudden hearing loss or symptoms like tinnitus and dizziness to your healthcare provider promptly, as these have been associated with Stendra (avanafil) use.

• Contraindications: Avoid using this medication if you are taking soluble guanylate cyclase (sGC) stimulators such as riociguat or any nitrate medications, as this may result in serious health risks.

Please ensure you fully understand these warnings and consult your healthcare provider for personalized advice before using Stendra (avanafil).

Common side effects:

• Headaches
• Flushing
• Nasal congestion
• Sore throat
• Runny nose
• Back pain

Less common but important to monitor:

• High blood pressure
• Nausea
• Stomach upset
• Constipation
• Rash

Serious side effects:

• Erection lasting longer than four hours
• Sudden vision loss
• Sudden hearing loss
• Dangerously low blood pressure
• Severe dizziness
• Swelling of the face, tongue, or throat
• Difficulty breathing
• Severe dizziness during sexual activity
• Fainting during sexual activity
• Chest pain during sexual activity

Interactions with high risk of serious adverse effects and should be avoided:

• Nitrates (such as Nitroglycerin, isosorbide dinitrate, Isosorbide Mononitrate)
• Recreational drugs (poppers containing amyl or butyl nitrite)
• Riociguat

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Alpha-blockers (such as Doxazosin, Tamsulosin)
• Itraconazole
• Ketoconazole
• Ritonavir
• Clarithromycin
• HIV protease inhibitors (such as indinavir, tipranavir)
• Abametapir
• Atazanavir
• Boceprevir
• Cobicistat
• Conivaptan
• Darunavir
• Duvelisib
• Efavirenz
• Etravirine
• Fosnetupitant
• Ivosidenib
• Larotrectinib
• Lefamulin
• Lopinavir
• Lorlatinib
• Nefazodone
• Nelfinavir
• Netupitant
• Nevirapine
• Posaconazole
• Saquinavir
• Telaprevir
• Telithromycin
• Voriconazole

Interactions with low risk that usually do not require a change in therapy:

• Erythromycin