Dapoxetine: The On-Demand Treatment Option

Consider on-demand use of an SSRI (paroxetine or fluoxetine) for PE refractory to first-line treatments

How RedBox Rx can help

The guidelines were most recently reviewed and revised in 2013. Discussions of the epidemiology and etiology of PE Recommended and optional questions to establish the diagnosis of PE and direct treatment Psychological/behavioral, combined medical and psychological, and educational interventions A flow chart for the management of PE The AUA/SMSNA published joint guidelines on disorders of ejaculation in 2020. Guideline statements regarding the definition of PE were as follows [61] : Lifelong PE is defined as poor ejaculatory control, associated bother, and ejaculation within about 2 100 sex tablet minutes of initiation of penetrative sex that has been present since sexual debut. Acquired PE is defined as consistently poor ejaculatory control, associated bother, and ejaculation latency that is markedly reduced from prior sexual experience during penetrative sex. Other guideline statements on the diagnosis of PE included the following [61] : The diagnosis of PE is based on medical, relationship, and sexual history and a focused physical examination.

Complications of premature ejaculation

Validated patient-reported questionnaires may be useful in diagnosis but are not required. Laboratory testing should not be routinely used for the diagnosis of lifelong PE. Laboratory testing may be useful when clinically indicated for the diagnosis of acquired PE. Patients should be advised that circumcision status is unrelated to PE. Consider referral to a mental health professional with expertise in sexual health; patients should be advised that combination behavioral and pharmacologic therapy is more effective than either therapy alone. and in the absence of psychiatric contraindications, as confirmed by a psychiatric consultation and psychometry.

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Consider daily use of clomipramine or an SSRI (paroxetine or fluoxetine) for PE refractory to first line-treatments or

How Do You Diagnose Premature Ejaculation?

In patients with concomitant PE and erectile dysfunction (ED), the ED should be treated according to AUA guidelines on erectile dysfunction. First-line pharmacologic treatments include daily selective serotonin reuptake inhibitor (SSRI) use, on-demand clomipramine or dapoxetine (where available), and topical penile anesthetics. If first-line pharmacotherapy fails, consider on-demand dosing of tramadol or, possibly, alpha-1 adrenergic receptor blockers. Patients should be advised that there is insufficient evidence to support the use of alternative therapies (eg, intracavernous self-injection, duloxetine, venlafaxine, herbal therapies, acupuncture, botulinum toxin, modafanil, oxytocin antagonists). Patients should be advised that surgical treatments (eg, selective dorsal nerve neurotomy, pulsed radiofrequency ablation of dorsal penile nerves, hyaluronic acid gel glans penis augmentation) are considered experimental and should only be delivered as part of a clinical trial. to on-demand SSRI use, in the absence of psychiatric contraindications, as confirmed by a psychiatric consultation and psychometry.

Treatment Options for Premature or Rapid Ejaculation at UCLA

Antidepressants your provider might prescribe include the tricyclic antidepressant clomipramine (Anafranil®) or selective serotonin reuptake inhibitors (SSRIs), for example: Anesthetic (numbing) creams and sprays you apply to the head and shaft of your penis is another potential first-line medication option to delay ejaculation. Your penis absorbs the anesthetic cream or spray in about 10 to 30 minutes. It causes you to experience less sensitivity in your penis. It’s important to wash your penis before sex to prevent numbness to your partner’s genitals. Erectile dysfunction medications, which include sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Stendra®), may help treat premature ejaculation, particularly in people with underlying erectile dysfunction.

How does Premature Ejaculation Occur?

In certain cases, your provider may prescribe tramadol, an opiate medication. While alternative therapies also exist for PE treatment, there isn’t enough evidence to prove they’re effective. Most people find relief using one or more of the treatments above. Behavioral therapy and using different methods to delay ejaculation tend to be the most helpful. No, it actually worsens the problem because it makes you more sensitive to sexual stimulation. Prescription of an antidepressant without a careful screening for depression and determination of the endogenous or reactive nature of the depression Use

When to seek medical attention

Your healthcare providers can come up with a plan to treat your premature ejaculation. Remember, this is a common problem and you’re not alone. Sign up for our Health Essentials emails for expert guidance on nutrition, fitness, sleep, skin care and more. Learn more about the Health Library and our editorial process. Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.

On this page:

Crowdis M, Leslie SW, Nazir S. Premature Ejaculation ( [Updated 2023 Feb 7]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Accessed 9/27/2023. Guidelines on premature ejaculation (PE) have been published by the following organizations: American Urological Association (AUA) and Sexual Medicine Society of North American (SMSNA) Italian Society of Andrology and Sexual Medicine (SIAMS) The ISSM has developed evidence-based guidelines for patients suffering from lifelong PE. of alpha-1 adrenergic receptor blockers as second-line therapy in men with

Product Name	Active Ingredient	Application Method	Onset of Action	Duration	Potential Side Effects	Regulation	Effectiveness Rate	Price Range (USD)
EMLA Cream	Lidocaine, Prilocaine	Apply to glans penis	10-15 minutes	30-60 min	Numbness, irritation	OTC	70-80%	10-20
Promescent	Lidocaine-based spray	Sprayed before sex	Immediate	15-30 min	Reduced sensation	OTC	75-85%	20-30
Plexus Neo	Lidocaine patch	Applied to penis	10-20 min	Up to 1 hour	Local irritation	Prescription	60-75%	15-25

PE/lower urinary tract symptoms (LUTS) How does treatment for premature ejaculation work?

• Dapoxetine's side effects can include nausea, headache, and dizziness.
• Topical anesthetics include lidocaine and prilocaine-based creams or sprays.
• SSRIs like fluoxetine, sertraline, may also be used off-label for PE.
• Opioid medications require careful medical oversight due to dependency potential.
• Behavioral approaches are first-line treatment for many men with PE.
• Regular exercise can improve overall sexual function and control.
• Some innovations include vibration devices to delay ejaculation temporarily.
• Medical tests may be recommended to exclude underlying causes.
• Education about sexual response stages can improve control strategies.
• Sex therapy often involves both partners to address relational issues.
• Medications may take several weeks to show maximum benefit.
• Lifestyle modifications, like reducing alcohol, can also help manage PE.

All treatments focus on the same thing: how to delay ejaculation.

Remedy	Type	Usage Description	Reported Benefits	Common Side Effects	Notes
Kegel Exercises	Physical activity	Repeatedly contracting pelvic muscles	Improved control	Muscle soreness	No medication involved
Herbal Supplements	Plant-based extract	Taken orally, e.g., ginseng, yohimbe	Possible enhancement of control	Interactions with medications	Evidence varies
Acupuncture	Traditional therapy	Stimulating specific body points	Stress reduction	Mild soreness	Limited scientific evidence

There are several treatments available that work well for PE, especially when used in combination.

• Dapoxetine is contraindicated with certain medications and health conditions.
• Topical creams should be used sparingly to prevent partner numbness.
• SSRI treatment may cause emotional blunting or decreased libido.
• Tramadol's risk of dependency requires careful medical supervision.
• Mechanical devices can provide temporary ejaculation delay.
• Behavioral training involves specific sex exercises for control.
• Mindfulness and relaxation techniques benefit PE management.
• Proper diagnosis is essential to rule out underlying disorders.
• Incorporate partner feedback to improve treatment results.
• Avoid abrupt discontinuation of prescribed medication.
• Lifestyle modifications can include weight management.
• Ongoing research aims to develop more effective PE treatments.

They include psychological approaches, behavioral techniques to control ejaculation during sex,

Drug Name	Approval Year	Primary Use	Recommended Dosage	Prescription Needed	Monitor Required	Typical Side Effects
Dapoxetine	2009	Premature ejaculation	30 mg before sex	Yes	Yes	Nausea, dizziness
Paroxetine	Approved for other uses, off-label for PE	20 mg/day	Yes	Yes	Yes	Fatigue, sexual dysfunction
Sertraline	Approved for depression, off-label for PE	50 mg/day	Yes	Yes	Yes	Insomnia, digestive issues

condom use, topical anesthetics applied directly to the penis, and oral medications.

How to prevent premature ejaculation

Erectile dysfunction can lead to premature ejaculation. This happens because you know you can’t maintain an erection, leading to quick ejaculation so you don’t lose your erection. Because of this connection between these two conditions, your urologist will want to figure out if you have erectile dysfunction and, if so, treat that first. While it’s true that drinking alcoholic beverages can delay orgasm, it’s not a recommended treatment for premature ejaculation. There can be many reasons for premature ejaculation.

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Getting to the root cause of PE is the first step in finding the best treatment. Sometimes, fildena tablet treating the underlying cause — like depression or hormonal disorders — can be all you need to stop ejaculating early. Be sure to discuss all your options with a healthcare provider. Premature ejaculation is often easily treated with a few simple steps, so it’s important to see your provider if you’re experiencing premature ejaculation. Although it may be uncomfortable to talk about sexual problems, know that your providers want you and your partner to have a satisfying sex life. Many men combine 2 or more of these therapies for the best all-around treatment.

Drugs used to treat this and similar conditions

The SIAMS issued guidelines on the management of PE in 2020. [22] In addition to recommendations regarding definitions and diagnosis, SIAMS recommends use of the following medications, which are approved in Europe for treatment of PE: Dapoxetine as first-line on-demand oral therapy for both lifelong and acquired PE; the suggested starting dose is 30 mg, taken with a full glass of water 1–3 h before intercourse, with no titration to 60 mg or addition of other treatment until after at least 6–8 full sexual attempts in a congruous erotic environment Eutectic lidocaine/prilocaine spray as local therapy for lifelong PE SIAMS recommendations regarding off-label therapy include the following: Obtain written and signed informed consent before initiating off-label treatment. Use dapoxetine and a phosphodiesterase type 5 (PDE5) inhibitor to improve ejaculatory control in patients with comorbid erectile dysfunction (ED) and PE (loss of control of erection and ejaculation [LCEE]). Consider the combination of dapoxetine and lidocaine/prilocaine in patients with PE refractory to a single therapy. Use a PDE5 inhibitor in patients with ED or subclinical ED and PE (LCEE). For the time being, we’ll focus on the 2 most common types of premature ejaculation pills available by prescription, SSRIs and PDE5 inhibitors.

Class Summary

By involving your partner and seeing the appropriate healthcare professionals, you may be able to control your ejaculations and enjoy your sex life again. Yes, you can prevent PE depending on what’s causing it. It’s best to discuss your feelings with your healthcare provider so they can help you determine a cause and recommend the appropriate treatment. There are many treatment methods you can use to avoid PE. Premature ejaculation itself isn’t harmful but other health problems may contribute to the development of premature ejaculation.

Intromission time

Erectile dysfunction (you can’t maintain a firm erection for intercourse) Chronic pelvic pain syndrome (long-term pain and cramping in your pelvic area plus long-term urinary tract symptoms and sexual dysfunction) Talk to your healthcare provider if you believe you have premature ejaculation or if ejaculating too soon is affecting your sex life. It’s normal to feel embarrassed about discussing sex with your healthcare provider, but know that PE is a common condition and that your provider isn’t there to judge you. Wearing a condom can decrease sensitivity to your penis and help delay ejaculation. If you have erectile dysfunction, you can’t get or maintain an erection. If you have premature ejaculation, you have an erection, but you reach orgasm and ejaculate earlier than you or your partner would like. Certain prescription meds that can help delay ejaculation are prescribed off-label as premature ejaculation pills.

• Dapoxetine's fast action makes it convenient for on-demand use.
• Topical anesthetics should be used with caution to avoid partner discomfort.
• SSRIs are not approved solely for PE but are widely prescribed off-label.
• Tramadol can interact with other medications, requiring caution.
• Behavioral techniques teach ejaculation control through practice.
• Pelvic exercises improve muscular control over ejaculation.
• Psychological interventions target mental aspects of PE.
• Combining therapies offers the best chance for success.
• Regular monitoring helps track side effects and effectiveness.
• Lifestyle choices, such as diet and exercise, impact sexual health.
• Open dialogue with healthcare providers ensures safe treatment.
• Ongoing research explores novel pharmacological options.

There are 2 main classes of oral premature ejaculation medicine available by prescription: antidepressants, especially SSRIs, and PDE5 inhibitors.