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For patients with severe renal impairment, Avana (brand name: Stendra) should be used with caution, and adjustments in the dosage may be necessary. Specifically:

For severe renal impairment (creatinine clearance <30 mL/min), the recommended dose of avanafil is typically 50 mg, which should be taken at least 24 hours apart from other doses.

Avoid higher doses: Avana Doses greater than 100 mg or more frequent dosing should be avoided in such patients due to the increased risk of adverse effects.

Always consult a healthcare provider before starting or adjusting any medication, as individual factors (like the type and severity of renal impairment) can affect the best approach to treatment.