Dapoxetine is an on-demand prescription treatment for some men with premature ejaculation. Its short action does not remove the need for careful screening.
Dapoxetine is a short-acting selective serotonin reuptake inhibitor (SSRI) licensed in the UK for premature ejaculation in appropriately diagnosed men aged 18–64. It is taken when needed before anticipated sexual activity, not as a daily treatment. It can cause dizziness, a fall in blood pressure and fainting, so a prescriber must check medical history and other medicines first.
Dapoxetine belongs to the SSRI group. Unlike SSRIs normally taken every day for depression or anxiety, it is absorbed and cleared relatively quickly and was developed for on-demand use in PE. It acts on serotonin signalling involved in ejaculation and can increase the time to ejaculation and improve perceived control in some men.
Dapoxetine manages symptoms; it does not establish why PE has developed. A sudden change still warrants assessment for erectile dysfunction, urinary or prostate symptoms, thyroid disease, psychological strain or another contributor.
The current UK patient information describes Priligy, a dapoxetine product, for adult men aged 18–64 with premature ejaculation. Product prescribing criteria include persistently early ejaculation with minimal stimulation, poor control, marked distress or interpersonal difficulty, and a pattern occurring in most intercourse attempts over the preceding months.
It should not be prescribed simply because someone wants intercourse to last longer. Men younger than 18 or older than 64 fall outside the licensed age range for this product.
The UK patient leaflet states:
These are licensed product instructions, not an individual prescription. Take the dose written by the prescriber and follow the leaflet supplied with the exact product.
Dapoxetine is used one to three hours before anticipated sex, so it does not require the one-to-two-week lead-in associated with daily SSRIs used off-label for PE. Response varies. More is not necessarily better: the incidence and severity of adverse effects are greater with 60 mg, so it should only be considered by the prescriber after reviewing the 30 mg response.
NHS advice recommends a response review after the first four weeks or six doses, and then at least every six months if treatment continues.
Commonly reported effects include:
Dapoxetine can cause postural hypotension—a drop in blood pressure on standing—and syncope, or fainting. The leaflet advises taking it with a full glass of water. If warning symptoms occur, such as light-headedness, nausea, sweating, confusion, blurred vision or weakness, lie down with the head lower than the body or sit with the head between the knees until the symptoms pass. Seek medical advice, particularly after a faint.
Do not drive or use hazardous machinery if sleepy, dizzy, faint, unable to concentrate or experiencing blurred vision.
The patient leaflet says not to take it in several circumstances, including:
The full list is longer. Kidney problems, epilepsy, glaucoma, bleeding disorders, low blood pressure, other mental health conditions and recreational drug use also need discussion before prescribing.
Dapoxetine must not be combined with monoamine oxidase inhibitors, thioridazine, other antidepressants or several other serotonergic medicines within the time windows stated in its leaflet. Examples include lithium, linezolid, tryptophan, St John’s wort, tramadol and certain migraine medicines. Some strong antifungal, HIV and antibiotic medicines also prevent its use.
Other combinations need caution or dose restrictions, including:
This is not a complete interaction checker. The prescriber and dispensing pharmacist need a current list of prescribed medicines, pharmacy medicines, supplements and recreational drugs.
The UK leaflet advises avoiding alcohol. Alcohol can intensify sleepiness, dizziness, slow reactions and the risk of injury from fainting. It also advises avoiding grapefruit juice for 24 hours before a dose because grapefruit can increase dapoxetine exposure. The tablet may be taken with or without food.
Some men have both PE and ED. Specialist guidelines discuss combination evidence, but current UK product information states that dapoxetine should not be used with PDE5 inhibitors such as sildenafil, tadalafil or vardenafil because orthostatic tolerance may be reduced. A clinician should assess both conditions and choose a plan consistent with UK prescribing information.
Dapoxetine is an on-demand treatment, not a permanent cure. Benefits are expected around the doses taken. The EAU notes that the long-term outcomes of pharmacological PE treatment remain uncertain. Acquired PE may improve more durably if an associated problem—such as ED, anxiety, prostatitis symptoms or thyroid disease—is identified and treated.
Stop and obtain urgent medical advice after a seizure, a severe allergic reaction, suicidal thoughts or a manic episode. A faint also needs prompt clinical advice. Report persistent or troublesome adverse effects to the prescriber. Suspected medicine side effects can be reported through the MHRA Yellow Card scheme.
Do not raise the dose yourself and do not give dapoxetine to someone else.
