Michael Stewart, MRPharmS

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.

Counseling and Sex Therapy

2009) stated that participants were expected to attempt sexual intercourse 6 or more times each month during the study period. Safety outcomes included pooled data from all 5 studies for adverse events and safety observations of well-recognised selective serotonin reuptake inhibitor (SSRI)-related effects concerning mood, akathisia, anxiety, suicidality or SSRI discontinuation syndrome reported separately from each study. 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. 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.

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. 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.

• Dapoxetine's impact on libido is generally minimal, focusing on ejaculation control.
• Use of dapoxetine should be part of an overall sexual health plan.
• Adherence to prescribed doses maximizes benefits and minimizes risks.
• Side effects usually resolve within a few hours or days.
• Avoid driving or operating heavy machinery after taking dapoxetine if drowsiness occurs.
• Regular discussions with your healthcare provider improve treatment outcomes.

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

• Dapoxetine is marketed under various brand names likePriligy.
• It’s designed specifically for men experiencing premature ejaculation.
• The medication works by increasing serotonin levels in nerve cells.
• Use dapoxetine consistently as prescribed for maximum benefit.
• It is not intended for daily use but as needed before sex.
• Always inform your doctor about other medications to avoid interactions.

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

• Dapoxetine is sometimes used off-label to treat other sexual dysfunctions.
• It is not a cure but a symptom management medication.
• Men should discuss potential side effects thoroughly before starting treatment.
• The medication has been studied and approved in several countries for PE.
• In case of overdose, seek emergency medical help immediately.
• Dapoxetine use requires careful monitoring for long-term safety.

Human ejaculation is primarily mediated by the sympathetic nervous system. 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 tadalafil with dapoxetine online 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. 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. Dapoxetine should not be prescribed to delay ejaculation in men who have not been diagnosed with premature ejaculation. 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. Treatment should not be initiated with the 60 mg dose. 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. 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.

Access options

2006); a 24-week randomised, double-blind, parallel group, placebo-controlled study primarily conducted in Europe and South America (Buvat et al. 2009); a 12-week randomised, double-blind, placebo-controlled, parallel group study in Asia-Pacific countries (McMahon et al. 2010); and a 9-week randomised, double-blind, placebo-controlled, parallel group study from North America (Kaufman et al. Population: the pooled analysis included 6081 men aged 18 years and over (mean age 41; 71% white) who had been in a monogamous heterosexual relationship for at least 6 months and who met DSM-IV-TR criteria for premature ejaculation. In 4 of the studies, participants also had to have an IELT of 2 minutes or less in at least 75% of 4 or more sexual intercourse events at baseline.

Important information about all medicines

Participants in the studies reported having premature ejaculation for an average of 15 years, with 65% of sildenafil dapoxetine tablets participants considered to have lifelong premature ejaculation by the study investigators. In those participants in whom it was recorded (n=4832), average IELT at baseline was 0.9 minutes. Intervention and comparison: in 4 studies (Pryor et al. 2006 [2 studies reported], Buvat et al. 2010) (n=4843), participants were randomised 1:1:1 to placebo, dapoxetine 30 mg or dapoxetine 60 mg to be taken 'on demand' (1 to 3 hours before anticipated sexual intercourse). 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. Dapoxetine tab dapoxetine 30 mg (Priligy) is available in packs of 3 and 6 tablets.

For the 30 mg strength tablet, the costs are £14.71 for a pack of 3 tablets and £26.48 for a pack of 6 tablets. For the 60 mg strength tablet, the costs are £19.12 for a pack of 3 tablets and £34.42 for a pack of 6 tablets (MIMS, March 2014). This evidence summary is based on a pooled analysis of results from 5 phase III randomised controlled trials (RCTs) (McMahon et al. All 5 of the studies were conducted in heterosexual men aged 18 years and over who had been in a monogamous relationship for at least 6 months and who met the DSM-IV-TR criteria for premature ejaculation. In 4 of the studies, participants also had to have an intravaginal ejaculatory latency time (IELT) of 2 minutes or less in at least 75% of 4 or more sexual intercourse events at baseline.

These 4 studies compared 'on demand' placebo, dapoxetine 30 mg and dapoxetine 60 mg over a 12‑ or 24-week period for the primary outcome of IELT, measured by a stopwatch held by the partner. The pooled analysis provides pooled data from these 4 studies for the mean average IELT at week 12. The 5th study compared dapoxetine 60 mg once daily, dapoxetine 60 mg 'on demand' and placebo over a 9-week period. Design: pooled analysis of 5 phase III RCTs: 2 identically designed 12-week randomised, double-blind, placebo-controlled, parallel group studies from the USA (Pryor et al.

Safety Assessments

(2009) (n=1238), participants were randomised 2:2:1 to dapoxetine 60 mg once daily, dapoxetine 60 mg 'as needed' and placebo. 2010) evaluated IELT as the primary outcome, defined as the duration of time from penetration to intravaginal ejaculation and measured by a stopwatch held by the female partner during each episode of intercourse. Secondary outcome measures in these 4 studies included patient-reported outcomes such as the clinical global impression of change in premature ejaculation (where participants were asked to rate their premature ejaculation as 'much worse', 'worse', 'slightly worse', 'no change', 'slightly better', 'better' or 'much better') and items from the Premature Ejaculation Profile (PEP), a validated tool that includes measures of perceived control over ejaculation. Missing post-baseline data were substituted with the last post-baseline observation carried forward. Three of the included studies (Pryor et al. 2006); a 24-week randomised, double-blind, parallel group, placebo-controlled study primarily conducted in Europe and South America (Buvat et al. 2009); a 12-week randomised, double-blind, placebo-controlled, parallel group study in Asia-Pacific countries (McMahon et al.

Is Priligy available through the NHS?

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. 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.

About the authorView full bio

Dapoxetine tab dapoxetine 30 mg (Priligy) is available in packs of 3 and 6 tablets. For the 30 mg strength tablet, the costs are £14.71 for a pack of 3 tablets and £26.48 for a pack of 6 tablets. For the 60 mg strength tablet, the costs are £19.12 for a pack of 3 tablets and £34.42 for a pack of 6 tablets (MIMS, March 2014). This evidence summary is based on a pooled analysis of results from 5 phase III randomised controlled trials (RCTs) (McMahon et al. All 5 of the studies were conducted in heterosexual men aged 18 years and over who had been in a monogamous relationship for at least 6 months and who met the DSM-IV-TR criteria for premature ejaculation.

Authors and Affiliations

In 4 of the studies, participants also had to have an intravaginal ejaculatory latency time (IELT) of 2 minutes or less in at least 75% of 4 or more sexual intercourse events at baseline. These 4 studies compared 'on demand' placebo, dapoxetine 30 mg and dapoxetine 60 mg over a 12‑ or 24-week period for the primary outcome of IELT, measured by a stopwatch held by the partner. The pooled analysis provides pooled data from these 4 studies for the mean average IELT at week 12. The 5th study compared dapoxetine 60 mg once daily, dapoxetine 60 mg 'on demand' and placebo over a 9-week period. Design: pooled analysis of 5 phase III RCTs: 2 identically designed 12-week randomised, double-blind, placebo-controlled, parallel group studies from the USA (Pryor et al. 2010); and a 9-week randomised, double-blind, placebo-controlled, parallel group study from North America (Kaufman et al. Population: the pooled analysis included 6081 men aged 18 years and over (mean age 41; 71% white) who had been in a monogamous heterosexual relationship for at least 6 months and who met DSM-IV-TR criteria for premature ejaculation. In 4 of the studies, participants also had to have an IELT of 2 minutes or less in at least 75% of 4 or more sexual intercourse events at baseline. Participants in the studies reported having premature ejaculation for an average of 15 years, with 65% of sildenafil dapoxetine tablets participants considered to have lifelong premature ejaculation by the study investigators. In those participants in whom it was recorded (n=4832), average IELT at baseline was 0.9 minutes.

Comment in

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. 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).

Priligy side effects

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. 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.

Derivative Synchronous Fluorescence Spectroscopy for the Simultaneous Determination of Dapoxetine Hydrochloride and Vardenafil in Binary Mixtures

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. 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). Intervention and comparison: in 4 studies (Pryor et al. 2006 [2 studies reported], Buvat et al. 2010) (n=4843), participants were randomised 1:1:1 to placebo, dapoxetine 30 mg or dapoxetine 60 mg to be taken 'on demand' (1 to 3 hours before anticipated sexual intercourse). (2009) (n=1238), participants were randomised 2:2:1 to dapoxetine 60 mg once daily, dapoxetine 60 mg 'as needed' and placebo. 2010) evaluated IELT as the primary outcome, defined as the duration of time from penetration to intravaginal ejaculation and measured by a stopwatch held by the female partner during each episode of intercourse. Secondary outcome measures in these 4 studies included patient-reported outcomes such as the clinical global impression of change in premature ejaculation (where participants were asked to rate their premature ejaculation as 'much worse', 'worse', 'slightly worse', 'no change', 'slightly better', 'better' or 'much better') and items from the Premature Ejaculation Profile (PEP), a validated tool that includes measures of perceived control over ejaculation. Missing post-baseline data were substituted with the last post-baseline observation carried forward. Three of the included studies (Pryor et al.

How Premature Ejaculation Telemedicine Works at eSupport Health

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 time to maximum plasma concentration is about 1 to 2 hours after intake. Plasma levels are less than 5% of peak concentrations by 24 hours post-dose. Human ejaculation is primarily mediated by the sympathetic nervous system.

Redefining a sexual medicine paradigm: subclinical premature ejaculation as a new taxonomic entity

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 tadalafil with dapoxetine online 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. 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.

Hear from our customers...

Dapoxetine should not be prescribed to delay ejaculation in men who have not been diagnosed with premature ejaculation. 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. Treatment should not be initiated with the 60 mg dose. 2009) stated that participants were expected to attempt sexual intercourse 6 or more times each month during the study period. Safety outcomes included pooled data from all 5 studies for adverse events and safety observations of well-recognised selective serotonin reuptake inhibitor (SSRI)-related effects concerning mood, akathisia, anxiety, suicidality or SSRI discontinuation syndrome reported separately from each study.

• 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.