Dapoxetine

Dapoxetine and Premature Ejaculation

Premature ejaculation (PE) is one of the most common male sexual problems. Doctors generally diagnose it when ejaculation always or nearly always happens within about one minute of penetration (lifelong PE), or when a man who used to last longer now typically lasts three minutes or less (acquired PE). The other key features are little or no ability to delay ejaculation, and distress, frustration or avoidance of intimacy as a result. Contributing factors include anxiety, relationship difficulties, differences in serotonin signaling, erectile dysfunction, thyroid problems and prostate inflammation.

What Is Dapoxetine?

Dapoxetine is a selective serotonin reuptake inhibitor (SSRI), the same broad family as several antidepressants, but it was developed specifically for PE. It is absorbed and cleared quickly, so it is taken only before sex rather than every day. By increasing serotonin activity in the nerve pathways that control ejaculation, it delays climax and improves the sense of control. In clinical trials, average time to ejaculation roughly doubled to tripled compared with before treatment. Dapoxetine (original brand Priligy) is licensed for men aged 18 to 64 in the UK, many European countries and elsewhere, but it is not approved in the United States.

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How to Take Dapoxetine

• The starting dose is 30 mg, taken 1–3 hours before sexual activity. Swallow it whole with a full glass of water, with or without food.
• If 30 mg isn't effective enough and side effects are acceptable, a doctor may increase it to 60 mg, the maximum dose.
• Take no more than one dose in 24 hours. Dapoxetine is not intended for continuous daily use.
• Before you start, a doctor should check your blood pressure and pulse lying down and then standing. Treatment should be reviewed after the first four weeks (or six doses) to make sure it is worthwhile.

Side Effects and the Risk of Fainting

The most common side effects are nausea, dizziness, headache, diarrhea, difficulty sleeping and tiredness. Dapoxetine can also cause a drop in blood pressure on standing (orthostatic hypotension) and, uncommonly, fainting. This is more likely with the first doses, at 60 mg, or when you are dehydrated.

Warning signs include nausea, light-headedness, sweating, palpitations and confusion. If they occur, lie down with your legs raised, or sit with your head between your knees, until they pass, and don't drive or use machinery. Avoid alcohol and recreational drugs, which make dizziness, drowsiness and fainting more likely.

Who Should Not Take Dapoxetine

• Men with significant heart problems, including heart failure, heart rhythm or conduction disorders, significant coronary artery or valve disease, or a history of fainting
• Anyone with a history of mania, bipolar disorder or severe depression
• Men taking MAOIs, thioridazine, other SSRIs or SNRIs, tricyclic antidepressants, lithium, linezolid, tramadol, triptans or St John's wort, or who have taken any of these in the past 14 days
• Men taking strong CYP3A4 inhibitors such as ketoconazole, itraconazole, ritonavir, saquinavir, nelfinavir or atazanavir
• Men with moderate or severe liver impairment

Extra caution is needed with epilepsy, glaucoma, bleeding disorders or blood thinners. Moderate CYP3A4 inhibitors, such as erythromycin, fluconazole, diltiazem or verapamil, restrict the dose to 30 mg.

Combination Tablets: ED Medicine Plus Dapoxetine

Several products here pair dapoxetine with a PDE5 inhibitor such as sildenafil or tadalafil, for men with both ED and PE. These combinations are not licensed in the UK, EU or US, and most contain 60 mg of dapoxetine, the maximum dose, rather than the 30 mg starting dose. Both medicines can lower blood pressure, so dizziness and fainting are more likely, and every restriction for each medicine applies, including the absolute ban on nitrates. Consider one only if a doctor has confirmed both conditions. If PE is your only concern, start with a dapoxetine-only tablet.

Products that pair sildenafil with fluoxetine or duloxetine are different. Those antidepressants are designed for daily use, are not licensed for on-demand PE treatment, and must never be taken with dapoxetine.

Non-Drug Options

• Stop-start and squeeze techniques: pausing stimulation, or gently squeezing the head of the penis, when you feel close to climax, to build control over time
• Pelvic floor exercises, which strengthen the muscles involved in ejaculation
• Psychosexual counseling, alone or as a couple, especially when anxiety or relationship issues play a part
• Topical anaesthetics: lidocaine or lidocaine–prilocaine sprays and creams applied shortly before sex reduce sensitivity. Follow the product instructions to avoid numbing your partner.

Frequently Asked Questions

Can I take dapoxetine every day?

No. It is licensed for on-demand use, no more than once in 24 hours, and is not intended as a daily medicine.

Does dapoxetine help with erections?

No. It delays ejaculation but does not improve erections. If you also have ED, a doctor can advise whether adding a PDE5 inhibitor is safe for you.

This guide provides general information and is not a substitute for advice from your own doctor. Dapoxetine and combination ED/PE products are prescription medicines with important safety restrictions. Always have a doctor confirm the diagnosis and check that treatment is safe for you before use.