Stendra – the newest drug for ED + Tips on sexual health

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Stendra – the newest drug for ED. And what to do.


Yesterday, a pharmaceutical rep for Vivus Inc. introduced me to a relatively new erectile dysfunction (ED) drug,  Avanafil (Stendra is the trade name). Stendra passed FDA approval in April 2012.
This is now the fourth oral drug for ED. The others include:  tadalafil (Cialis), vardenafil (Levitra), and sildenafil (Viagra ). Viagra is still the king of ED drugs as it was the first one FDA approved for this category in 1998 and still holds a majority of the market share.  Cialis is second most popular.

How does Stendra stack up with the rest?
Stendra, is also a PDE-5 inhibitor – so how it works biologically similarly to its competitors. Supposedly, however, Stendra works faster than its competitors. It’s also tiny i size (about the size of a grain of rice) which can be useful to those preferring smaller pills. So which works best? The reality is that there is no conclusive answer without a head-to-head human trial, which is unlikely to happen.

Comparison table among PDE-5 inhibiting drugs


Time it takes to work

Amt of time half of the drug stays in your system


15 to 30 minutes

5.5 to 10.5 hours


30 minutes to 2 hours

3 to 5 hours


30 minutes to 12 hours

17.5 hours


30 minutes to 2 hours

4 to 5 hours

*Table is obtained from a research paper by Uckert et al. 2013.

Side effects of Stendra are similar to the other PDE-5 inhibitors: headaches, redness (flushing) of the face, flu-like symptoms, nasal congestion and back pain.


My Take On This
Do we need another ED drug? Probably not.
As a natural medicine first type of doctor, I don’t have a problem with PDE-5 inhibitors. I think they bring great psychological benefit to men who have sexual problems. That’s right. I personally think the psychological benefits are greater than the physical ones.
Many men experience intolerable headaches from PDE-5 inhibitors, however. Also, many patients have complained of erections feeling “unnatural” – almost like if their penis is detached from their body’s.  So what is one to do?

7 ways to improve your sexual health
1.    Always address the cause of ED. Viagara, Cialis, Stendra and Levitra are “Band-Aids” – not a cure.
2.    The top two causes of ED are stress and fatigue. Another top on the list is bad circulation often due to other conditions like heart disease and diabetes.
3.     Take action. Exercise and eat sensibly. This will help lose weight (if necessary) and improve circulation.
4.     *Take the herb Rhodiola. This is an herb that has been shown to fight stress, lower stress fatigue and provide gradual energy.
5.    Think penile health first. Feed the pelvic arteries (and those of the heart as well) with nutrients and antioxidants. *The best studied are pomegranate and resveratrol.
6.    Arginine is a good supplement for sexual health. *L-Citrulline is better. Arginine is a necessary to produce Nitric Oxide (NO), a chemical produced in your arteries to help open blood vessels for proper circulation. Open arteries in the penis is what produces an erection. The problem with arginine supplementation is that;
A. It takes a lot of arginine to work, about 5000mg a day.
B. It’s metabolized too quickly by the body so you need to take it often. L-Citrulline continually     makes     arginine     in the kidney. In fact, you get more arginine in the blood from oral intake of L-Citrulline than from Arginine itself.
7.    Try the herb *Epimedium, AKA “Hornygoat weed.”

Here’s a secret – don’t tell anyone: Epimedium contains a chemical called Icarrin which works as     a PDE-5 inhibitor but because   it’s an herb with hundreds of other components,  it does not produce the same side effects as PDE-5’s.

What if I want to try a dietary supplement  with Rhodiola, L-Citrulline, Resveratrol, Pomegranate and Epimedium?
Individually, these nutritional agents can be found in any reputable health food store.

** They can be found in THIS formula. This product has clinically shown to be effective in steadily helping men build their sexual health. It’s not an event driven product. Another words, if you are looking to take a substance only on an “as needed” basis this product is not for you. Instead THIS product builds with time when taken daily and nourishes key tissues of penile tissues along with the rest of the body. In about 8 days men have reported to see a significant sexual difference.

Lastly, as it relates to sexual supplements the buyer should be cautious. Most “natural” sexual supplements are not natural and often contain PDE-5 inhibiting drugs in them. If a “natural” supplement works in an “as needed” basis or a company advertises it doing so, then you should assume it has a drug in it until proven otherwise. THIS is an example of such occurrence where the FDA stepped in and removed a sexual enhancement supplement from the market for containing Tadanafil.

Dietary supplements are not event driven. If it sounds too good to be true….

Do you have any experiences in improving your sexual health? Let me know.


** As frequent readers of this blog know, is a platform for unbiased information to help men (and women with bladder problems) find options to rebuilding and reclaiming their health. However, sometimes I write a timely blog post where I am financially associated with a product I suggest. The recommended male product I suggested above is a product that I have formulated and tested clinically. As a result, I am financially associated with that product. I ( and we) are big on transparency.

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by Dr. Geo

1 comment… add one
  • Dr Elijah Bell 03/20/2014, 3:39 AM

    Great advice and insight.

    As a prostate cancer survivor that has used Viagra, Cialis, and Levitra, prior to my robotic prostatectomy, I have found several caveats to their efficaciousness.
    Generally, there has to be some planning involved in using the products. One of the first considerations is timing your sexual encounter. Each medication has a stated onset to effectiveness. Therefore, a man has to gauge how much time, prior to engaging in a sexual act, that has to be accounted for.
    Secondly, is the timing of taking the medication in relationship to eating. The medication usually will have better success when taken on an empty stomach. As well I have found that eating directly after taking the medication will interfere with its effectiveness.
    A man is going through enough emotional turmoil after hearing the diagnosis, after surgery, during the recovery process, that also having a ED medication not work when and how he thought it should, can be demeaning, a source of anxiety, and depressing.
    Many men do not think about it however, there is a level of performance anxiety prior to engaging in sex. Will I be able to satisfy my partner? Will I prematurely ejaculate? Will I be able to maintain my erection as long as I want? These and many more questions are sources of anxiety for the average man. Compound those concerns with the recovery process. Not knowing when or worst if you will be able to have sex again, can cause angst that can also lead to depression.
    Having a supportive partner that will be understanding of your healing process, can reduce anxiety. Knowing that if you are not able to achieve or sustain an erection, that your partner will not chastise you, will not laugh at you, or demean you in some way can be extremely comforting. That level of comfort will generally translate into reduced anxiety thus, not allowing depression to set in.
    Plan to eat early enough that you can allow at least two hours to past before you ingest the ED medication. Allow enough time prior to actually engaging in sex for the medication to release its effects on your body. Remember, the labeling may indicate a certain amount of time however, your metabolism may shorten or lengthen the effective time of the medication. It may take several attempts with the individual medication before you become knowledgeable about the timing of the medication with your body.
    You may also find that you will have to try more than one medication to achieve the results that you want. Try the medication, using the above suggestions, following the directions of the manufacturer, and your doctor, for the duration of your prescription. If you have not gained the results that you were looking for, consult your physician and see if there is another medications or strength that might be recommended.
    Lastly, remember the medication should not be thought of as a “magic pill”. The medication is more so an additive. Coupled with the attraction you have for your partner can lead to stimulation, arousal, and the desired erection.
    Yes, ED can take some of the spontaneity out of the sexual act however, learning the new approach to your health and your partner’s satisfaction can be well worth the learning curve.
    Dr E. Bell


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