Michael Stewart, MRPharmS

The time to maximum plasma concentration is about 1 dapoxetin sildenafil to 2 hours after intake.

Plasma levels are less than 5% of peak concentrations by 24 hours post-dose.

• Dapoxetine can improve confidence and sexual satisfaction.
• It is contraindicated in men with severe heart or liver conditions.
• The optimal dose varies; typically, 30 mg or 60 mg based on tolerance.
• Do not take dapoxetine with other SSRIs or serotonin drugs without medical advice.
• The onset of action is usually within 1-3 hours after intake.
• Dapoxetine is rapidly absorbed and eliminated from the body.

Human ejaculation is primarily mediated by the sympathetic nervous system.

What does Priligy do to your body?

The European guidelines recommend that the diagnosis and classification of premature ejaculation is based on medical and sexual history and that it should include assessment of IELT, perceived control, distress and interpersonal difficulty. It is important to distinguish premature ejaculation from erectile dysfunction. Erectile dysfunction or other sexual dysfunction or genitourinary infection (for example, prostatitis) should be treated first. The European guidelines state that in men for whom premature ejaculation causes few if any problems treatment should be limited to psychosexual counselling and education. Before beginning treatment the guidelines recommend that it is essential to discuss expectations of treatment thoroughly. The mechanism of action of dapoxetine in premature ejaculation is presumed to be linked to the inhibition of neuronal reuptake of serotonin and the subsequent potentiation of the neurotransmitter's action at pre- and postsynaptic receptors (Priligy summary of product characteristics).

It is licensed for the treatment of premature ejaculation in adult men aged 18 to 64 years. Dapoxetine should only be prescribed to men who meet all the following criteria: An intravaginal ejaculatory latency time of less than 2 minutes and An intravaginal ejaculatory latency time of less than 2 minutes and Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the man wishes and Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the man wishes and Marked personal distress or interpersonal difficulty as a consequence of premature ejaculation and Marked personal distress or interpersonal difficulty as a consequence of premature ejaculation and A history of premature ejaculation in the majority of intercourse attempts over the prior 6 months.

• Dapoxetine has been shown to significantly increase ejaculatory latency time.
• It is not intended to treat all aspects of sexual dysfunction.
• Use of dapoxetine may require dose adjustments based on side effects.
• The medication should be stored safely out of children's reach.
• Monitoring response and side effects enhances safe use of dapoxetine.
• Dapoxetine should be used only as part of a broader treatment plan.

A history of premature ejaculation in the majority of intercourse attempts over the prior 6 months. Dapoxetine should be administered only as on demand treatment before anticipated sexual activity.

Ethics declarations

However, always consult with a specialist in sexual medicine for comprehensive insights. Dapoxetine, under the brand name Priligy, has been buy cheap dapoxetine patented in the UK, allowing only certain distributors access. However, more affordable generics are expected to surface post-patent expiry (2024), providing a more cost-effective solution. Certain NHS areas do indeed offer Priligy prescriptions. Connecting with a local GP for details on NHS and private prescription options is always advised.

Development of this evidence summary

Dapoxetine increases the intravaginal ejaculatory latency time, though exact times can vary based on individual responses. Dapoxetine has undergone placebo-controlled clinical trials, with results indicating a high satisfaction rate. Most men reported an improvement in premature ejaculation symptoms and a reduction in personal distress related to ejaculation. The European Association of Urology 2014 guidelines on male sexual dysfunction state that although premature ejaculation is a very common male sexual dysfunction (with prevalence rates of 20% to 30%), its aetiology is poorly understood. In the Diagnostic and Statistical Manual of Mental Disorders IV-Text Revision (DSM-IV-TR), premature ejaculation is defined as 'persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. Dapoxetine should not be prescribed to delay ejaculation in men who have not been diagnosed with premature ejaculation.

Important information about all medicines

Yes, dapoxetine can be taken alongside erectile dysfunction treatments such as sildenafil (Viagra). However, it's vital to be cautious of potential blood pressure fluctuations, as both medications can influence blood pressure. Common adverse reactions include dizziness, headaches, and nausea. To lower these effects, it's advised to: Avoid alcohol, as it can increase specific side effects. Be cautious when standing up from sitting or lying to prevent dizziness.

Statistical analysis

Grapefruit juice is one of the drinks that might increase the level of dapoxetine in the blood, heightening the risk of side effects. Men with significant ischemic heart disease, sick sinus syndrome, a history of mania or severe depression (major depressive disorder), if already on tricyclic antidepressants, or those with severe renal impairment should avoid taking Priligy. Adverse effects associated with dapoxetine range from nausea, dizziness, and headaches to increased blood pressure. While most of these adverse reactions are mild, it's essential to recognize and report any severe adverse reactions immediately. Clinical trials have not conclusively linked dapoxetine to alterations in testosterone levels. Dapoxetine must not be taken more frequently than once every 24 hours (Priligy summary of product characteristics). Dapoxetine is available at 2 different strengths: 30 mg and 60 mg. The recommended starting dose for all men is 30 mg, taken as needed approximately 1 to 3 hours prior to sexual activity.

Types of Premature Ejaculation

The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity'. The major point of debate between the DSM-IV-TR definition of premature ejaculation and other definitions is quantifying the time to ejaculation, which is usually described as the intravaginal ejaculatory latency time (IELT). Premature ejaculation is classified as 'lifelong' (primary) or 'acquired' (secondary). Lifelong premature ejaculation is characterised by onset from the first sexual experience and remaining during life with ejaculation occurring too fast (before vaginal penetration or less than 1 to 2 minutes after). Acquired premature ejaculation is characterised by a gradual or sudden onset - after previous normal ejaculation experiences; time to ejaculation is short but usually not as short as in lifelong premature ejaculation. Treatment should not be initiated with the 60 mg dose.

Why was Priligy discontinued?

Some physicians are comfortable implementing pharmacologic therapy but not behavioral therapy. As with any medical condition, the patient should be offered all available treatment options, and the physician should proceed with referral for any option considered to require more specialized help than the physician can provide. For men who may have a severe emotional disturbance underlying the premature ejaculation, referral to a mental health professional is most appropriate. Diagnosis and treatment of the various psychological factors that manifest partly as premature ejaculation are beyond the scope of this discussion. They offer a promising solution to premature ejaculation.

How does Priligy work?

Dapoxetine (a selective serotonin reuptake inhibitor (SSRI) ) impacts the serotonin levels in the brain. Premature ejaculation is considered a sexual dysfunction. This represents a concern for many adult men. The interpersonal difficulty and personal distress associated with this condition are immense. Studies show that taking Dapoxetine increases the time between ejaculation and ejaculation in the vagina. If the individual response to 30 mg is insufficient and the man has not experienced moderate or severe adverse reactions or prodromal symptoms suggestive of syncope, the dose may be increased to a maximum recommended dose of 60 mg taken as needed approximately 1 to 3 hours prior to sexual activity. The incidence and severity of adverse events is higher with the 60 mg dose.

About dapoxetine

Various behavioural techniques have demonstrated benefit in treating premature ejaculation and are indicated for men uncomfortable with pharmacological therapy. In lifelong premature ejaculation, the European guidelines state that pharmacological treatment should be the first-line option; behavioural techniques are not recommended as first-line treatment because they are time-intensive, require the support of a partner and can be difficult to do. The guidelines recommend that pharmacological treatment options include 'on demand' dapoxetine, daily use of a longer-acting selective serotonin reuptake inhibitor (off-label use), daily use of clomipramine (off-label use), 'on demand' use of topical local anaesthetic agents (off-label use), or 'on demand' tramadol (off-label use). Dapoxetine (Priligy) is the first pharmacological treatment to be licensed in the UK for the treatment of premature ejaculation. Dapoxetine is a short-acting selective serotonin-reuptake inhibitor (SSRI). The summary of product characteristics recommends that a careful appraisal of the individual benefit/risk ratio of dapoxetine should be performed by the clinician after the first 4 weeks of treatment (or at least after 6 doses of treatment) to determine whether continuing treatment is appropriate. Data regarding the efficacy and safety of dapoxetine beyond 24 weeks are limited. The clinical need of continuing and the benefit/risk balance of treatment should be re-evaluated at least every 6 months.

Safety: What People Often Overlook About “Short-Acting” SSRIs

This makes it easier for men to control ejaculation. The recommended starting dose of dapoxetine is 30 mg. Depending on the patient's reaction and potential adverse effects, the dose might increase to dapoxetine 60 mg. It's taken orally, usually 1 to 3 hours before anticipated sexual activity. Yes, but it's crucial to consult a doctor.

Quality assessment

The shift from dapoxetine 30 mg to dapoxetine 60 mg should be based on the individual's response and tolerability. The maximum recommended dose should not be exceeded. One dapoxetine over counter must be careful when it comes to combining dapoxetine with other medicines. Dapoxetine and certain recreational drugs, tricyclic antidepressants, or other selective serotonin reuptake inhibitors can interact. Consultation with a healthcare professional is crucial before initiating therapy with multiple drugs.