US license includes recommendations related to using dapoxetine and shows its benefits compared to other drugs with similar ingredients in the identical drug family. The patent is active till 2022. More than 45 countries in the world, including leading and emerging markets, have been sending grants to Furiex for equal patent claims.

Janssen-Cilag (Alza’s partner) presently produces dapoxetine under the brand name Priligy ™ and sells it in numerous markets outside America. The preparation has been distributed among leading members of European Union (Germany, Sweden, Austria, Spain, Italy, Finland, Portugal), South Korea, New Zealand, and Mexico.

Scientific research clearly showed that serotonin played a central role in the timing of ejaculation. Thusly, the method represented in the dapoxetine patent is valuable. Unlike other drugs, which dapoxetine belongs to, its effect on PE is evident even after the first use, allowing to take it on an as-needed basis.

What Is Dapoxetine HCL?

Dapoxetine hydrochloride is a fast-acting serotonin reuptake inhibitor, which is widely used to cure PE and ED in males. This active ingredient can be used by males of 18 to 64 years of age. Inhibitors of this class of drugs are usually used to treat depressive states and multiple psychiatric illnesses.

Dapoxetine is the active ingredient of the Priligy (the brand name of the drug). It is used for chronic and sudden cases of PE. It belongs to SSRI (Selective Serotonin Reuptake Inhibitor) drug class, which has mainly been used for depressive conditions treatment. The tests showed that this medical preparation is highly effective for curing PE in males. Over 50 countries have approved Dapoxetine HCL for sale.

The table represents the trade names by which dapoxetine is known in the following countries of manufacture.

Brand name	Country	Foreign name	Generic name
Priligy (dapoxetine)	Latvia, Romania, Poland, Lebanon, Lithuania, Slovakia, Singapore, Bosnia and Herzegovina, Croatia, Switzerland	Dapoxetinum (Latin)	Dapoxetine
Priligy (dapoxetine hydrochloride)	Belgium, Denmark, Finland, Germany, Austria, Bulgaria, Estonia, France, Hong Kong, Ireland, Malaysia, Mexico, Hungary, Italy, Malta, Netherlands, Portugal, Spain, Switzerland, United Kingdom, New Zealand, South Korea, Thailand	Dapoxétine (French)	Dapoxetine hydrochloride
Dasutra, Kutub, Xydap, Sustinex	India	Dapoxetin (German)	LY-210448
Joypox	Egypt		LY 210448 HCl
Lagose, Extensil, Prolongal, Precoce	Argentina	Dapoxetina (Spanish)	UNII-GB2433A4M3
TD-Pill (dapoxetine and tadalafil combination)	India		UNII-U4OHT63MRI

Due to its revolutionary action, an international society does not have a unanimous opinion about it. That is why dapoxetine is not approved for sale in every country. In the countries where it is not certified patients have to buy it overseas.

Is It Approved by FDA?

The drug was submitted for the Food and Drug Administration (FDA) approval in the USA in December 2004, but it has not been approved yet. It has been in phase III development.e.

In October 2005 FDA rejected the medicine. Two more clinical tests were done over the next two years. Nevertheless, dapoxetine has not appeared on the US market to date. Complicating issues of approving the procedure are still incomprehensible. The most obvious ones are adverse symptoms and a lack of long-term human testing.

The third phase is a groundbreaking one: the clinical analyses are usually gathered into a big document, which contains extensive information about the approaches and outcomes of all studies, production process and stages, formulation data and expiration date. Passing this stage successfully gives rights to the sponsor to market the drug.

The trials in this phase are the most expensive ones. They demand a lot of time for implementation, especially for chronic illnesses. If the drug is lifesaving, it can be prescribed to some patients on an individual basis until it is approved for public purchasing.

The question, how soon dapoxetine may appear on the US market, is open It is very likely that dapoxetine will not be available in the US in the coming years. It may never receive FDA approval for sale. It should be noted that in most European countries this drug has been successfully selling as of today. Its approval depends on the government politics, especially if the supervisors find more advantages than potential health risks.

Dapoxetine can be the first drug specifically targeted for PE in patients in the USA, where it should be distributed by Ortho-McNeil Pharmaceutical, Inc. Alza press release says that the producers plan to work on the problem mentioned in the FDA document regarding dapoxetine. The process of introducing dapoxetine onto the US Pharmaceutical Market is underway.

Its generic versions have already been successfully produced and are selling today. Those who do not want to wait for the FDA approval may order generic dapoxetine from foreign producers in the countries where dapoxetine has already been certificated.

Dosages

Dapoxetine tablets come in doses of 30 mg, 60 mg and 90 mg.

30 mg is the most suitable dose for beginners. Minimal dose helps estimate the effectiveness of the remedy in each individual and the influence of side effects on a patient. It may be increased up to 60 mg depending on response and tolerability.

60 mg is the optimal dose. Trials showed that administering the drug in these doses showed the best results in PE treatment with moderate adverse events. It is the most common and successful dosage among patients, and they can tolerate the drug well.

90 mg includes the highest concentration of dapoxetine available at the pharmaceutical market. It can be taken for more powerful effect in PE cure, if the lower doses showed weak effect. Adverse symptoms should be considered as well. If, despite the dapoxetine effectiveness, a patient suffered from severe side effects, he should consult the doctor to seek other solutions.

To get sufficient efficacy from the drug and avoid adverse symptoms, a patient should discuss with his physician the schedule of treatment.

In males with PE concurrent with ED problems dapoxetine can be combined with PDE5 inhibitors. Combination of dapoxetine with such active ingredients as sildenafil, vardenafil, tadalafil show excellent therapeutic effect. Multiple clinical tests proved the feasibility of these substances with dapoxetine. Different ratio of the two active ingredients are designed for better problem solving in a patient. Individual medical consultation before the start of the treatment course is highly recommended.

What Forms Does Dapoxetine Come In?

Dapoxetine is widely available in firm tablet drug form. The rigid tablet contains dapoxetine as a single ingredient. This is a classic tablet form which should be used with water without chewing.

Liquid one is sold for laboratory research only. The bottle of liquid dapoxetine contains 30 mg of the active ingredient. Consumption of this product by human may be harmful if ingested.

Generic dapoxetine is available in other drug forms in combination with different active ingredients, for example Super P Force oral jelly (sildenafil 100mg and dapoxetine 60mg).

For curing ED problems accompanied with PE dapoxetine is highly used as a compound. A few popular drug names and their ratio with dapoxetine are represented in the table.

Dapoxetine and sildenafil	Dapoxetine and Vardenafil	Dapoxetine and tadalafil
Sildigra Super power (60 mg / 100 mg)	Snovitra Power (60 mg / 40 mg)	Tada Plus (30 mg / 20 mg)
Dapoxile (30 mg / 50 mg)	Snovitra Super Power (60 mg / 20 mg)	Tadapox (60 mg / 20 mg)
Super P Force (60 mg / 100 mg)	Super Valetra (20 mg / 60 mg)	Tadapox Super (60 mg / 40 mg)
Suhagra Force (30 mg / 50 mg)	Super Zhewitra (60mg / 20 mg)	Extra Super Tadarise (60 mg / 40 mg)

Patients should receive a proper medical consultation before using any other drugs listed above. They may cause unwanted reactions and side effects. Individual schedule of treatment is highly suggested.

How to Use Dapoxetine Tablets?

Dapoxetine tablets are very easy to use. The pills can be taken at any time on an as-needed basis. Fat food may delay the absorption of the tablet, but it does not affect its efficacy. Here are a few simple steps how to use dapoxetine:

1. It is necessary to have a complete medical examination before starting dapoxetine treatment course. A healthcare provider should estimate the patient’s health condition, prescribe the correct dosage of the drug, explain in detail what is dapoxetine, and give detailed instructions on how to take it.
2. Be sure to inform the healthcare provider about other drugs or other treatments you have been using. Dapoxetine highly interacts with several drug groups, therefore detailed medical consultation is highly recommended. Several medical conditions demand special medical attention. Be sure to inform the medical representative if you experience one of these conditions:
   • fainting tendency;
   • heart diseases;
   • bleeding or clotting problems;
   • epilepsy;
   • psychological disorders (mood swings, dismal mood, obsessiveness, bipolar illness);
   • eye pressure (glaucoma);
   • liver problems;
   • kidney illnesses;
   • dermatological reactions on medical preparations.

3. Read carefully the medical annotation inside the package. It contains complete information about dapoxetine with the list of possible negative symptoms which might occur during the treatment.
4. Strictly follow the scheme prescribed by the doctor. The correct dosage should be used 1-3 hours before sexual intercourse. Wash down the tablet with 250 ml of water.
5. If the prescribed dose appeared weak and ineffective during several days of consumption, a patient should come for medical consultation. Increasing a dose on one’s own initiative is not recommended because bigger dose also increases the risks of side effects.
6. Dapoxetine should be taken only once in a 24-hour period. The drug should be used on an as-needed basis before planned sex.
7. Dapoxetine has a bitter taste. There is no need to chew it. It can be taken regardless of the meal time.

Failure to follow medication direction can ruin the drug effect, cause a negative reaction, or even have serious health consequences. In case of any unwanted reaction a patient must see his health care provider immediately.

How and When to Take Dapoxetine for the Best Results?

Dapoxetine is an effective remedy. However, to get the best results from the treatment course, remember the important tips:

1. After beginning of the treatment course continue seeing your physician to inform him about your health condition, progress, and to monitor side effects if any. Alcohol increases the risk of adverse symptoms like fainting, therefore its consumption with dapoxetine is not recommended.
2. Recreational drugs may cause serious side effects in combination with dapoxetine. Never use them together!
3. Due to risk of fainting symptoms after taking dapoxetine, driving and other activities, which demand high concentration, should be postponed for patient’s safety.
4. Make sure to get a detailed consultation before mixing dapoxetine with other medical preparations.
5. In case of overdosing call an ambulance or local hospital department immediately. Bring the pack with you, even if the box is empty.
6. Before your surgery (including dental surgery), inform the specialist that you consume dapoxetine.
7. Taking expired dapoxetine is not recommended. Contact local pharmacy for utilization of the expired drug.
8. Never share dapoxetine with other people. The drug should be used individually, even if someone has approximately the same condition.
9. Keep the tablets out of reach and sight of children in cool dry place away from direct sun rays.
10. Contact your physician to discuss any problem which occurred during dapoxetine treatment course.
11. There are many ways how to avoid mild side effects of the drug. Get detailed instructions at the medical center. Stay in touch with your doctor during the whole therapy for successful treatment.

These simple rules will help you receive maximum effect from the tablet and prolong sexual intercourse.

Can Dapoxetine and Sildenafil Be Taken Together?

Sometimes ED and PE are concomitant conditions. The question is whether dapoxetine and sildenafil can be taken together. It can not be answered simply because PE may be caused by various reasons: relationship issues or erectile problems.

Some scientific works claim that sildenafil and dapoxetine can not be used together. It is explained by the combined effect, which reduces blood pressure to a low level enough to cause dizziness, fainting and lightheadedness. Medical scientists suggest treating ED first, assuming that during that time PE will be treated by itself as well.

If sildenafil improves erectile function but PE problem still exists, health professionals recommend using non-drug practices for overcoming it. These are preferably relaxation, squeezing techniques, and psychological methods, which include avoiding stressful situations and overcoming lack of communication between partners.

Exercising can be effective but does not always help. A patient may use sildenafil with dapoxetine under a strict doctor’s control only. Both ingredients have a lot of common features. Working with natural mechanisms, they make impact only on the selective brain areas. The latest clinical researches showed a perfect compatibility that can create a new medication. As a result, pharmaceutical market can offer the drug, which contains two active substances: sildenafil and dapoxetine.

Today this combination is manufactured under various names with different ratio of both ingredients. While sildenafil works to achieve and maintain erection, dapoxetine releases tension. A male becomes more comfortable and can have sexual intercourse without unnecessary anxiety.

Preceding concerns were not without a reason, the new drug does have side effects. Though, as tests showed, the conflict of contraindications and damages to the man’s health were not life threatening. Taking two drugs may lessen the combined effect of the substances.

The treatment scheme may include separate drugs with sildenafil (like Viagra) and dapoxetine (like Priligy) or their mix in one tablet (like Viagra Super Force). Regardless of the brand names a patient may use, the combination of sildenafil and dapoxetine shows excellent results in treating ED and PE. Nevertheless, preliminary medical consultation and health care provider’s assistance during the whole treatment course are necessary.

If PE problem is connected with ED problem, then sildenafil should possibly become one and the best remedy for this particular clinical case. The decision about mixing the preparations should be made by doctors based on patient’s medical history.

Is It Safe?

Effectiveness and safeness of dapoxetine in PE therapy has been investigated by such reputable institutions as EMBASE (world’s most comprehensive biomedical literature database), MEDLINE, Web of Science, and PICA. Primary scientific community represented by international and local foundations confirmed that dapoxetine is indeed a strong and safe medical preparation. The approbations showed that dapoxetine in doses of 30 and 60 mg were positively sustained with minimal possibility of severe side effects manifestations. More than half males reported mild forms of gastrointestinal and central nervous system problems.

A careful attention over the whole period of dapoxetine course was given to cardiovascular changes in patients, since the syncope case had been recited. Throughout all five tests, loss of consciousness happened in 0.06% and 0.23% of cases after using dapoxetine 30 mg and dapoxetine 60 mg respectively. With high probability this adverse event may occur after taking the first dose of the drug. The tests showed 0.19% cases which happened after the first dose, and 0.08% after subsequent ones. Findings of dapoxetine developmental program demonstrate that the ingredient is related to vasovagal-mediated (neurocardiogenic) syncope. Other crucial vascular cardiac negative reactions were not diagnosticated.

Most drugs of SSRI class may cause neurocognitive unwanted changes in patients with psychosocial disabilities. Clinical tests showed that dapoxetine does not affect the mood, and it does not cause anxiety and self-destructive streaks. Dapoxetine on-demand doses for PE may minimize the risk of withdrawal symptoms.

Thusly, all this evidence shows safeness of dapoxetine. But the final word on that is given to FDA, which has not approved this preparation yet. Only due to this reason the medics of the USA, Canada and United Kingdom (the countries where dapoxetine is not approved for sale yet) may disapprove it to patients.

The quality of generic versions depends on how reputable the producer is and if its product was certificated by the local government. It is highly suggested to buy generic versions of dapoxetine only from trusted sources who sell high quality medications. Using mislabeled drugs may be dangerous for your health.

Is It Used for Depression?

Created in 2003, dapoxetine was initially aimed for depression and mental disorders treatment. The preparation did not show positive results in depression therapy and was shelved until its PE effect was discovered. During clinical trials the results in ejaculation problems treatment were awesome.

Dapoxetine may potentially cause side effects peculiar to SSRI drugs as far as it belongs to this class. But this preparation is mostly obtained for treating PE only.

Even more, dapoxetine is contraindicated for people who suffer from such psychological disorders as:

• bipolar and related disorders;
• mania and hypomania;
• major depressive episode;
• schizophrenia and other psychiatric illnesses.

Dapoxetine is a specific remedy created for solving PE problem in males. Using it for other purposes is not recommended.

How Does Dapoxetine Work?

The clear biochemical mechanism of dapoxetine action is still ill-defined. With a high probability in PE case it is attributed to the breakage of the serotonin reuptake by the neuronal cells with the forthcoming neurotransmitter enhancing on pre- and postsynaptic receptors.

The ejaculation mechanism is mostly manipulated by the excitatory system or, more precisely, by the part of the nervous system that accelerates the heart rate, constricts blood vessels, and raises blood pressure (sympathetic nervous system). The ejaculatory trajectory sets in from a spinal reflex center, mediated by the cerebral trunk, which is influenced initially by a number of nuclei in the brain. Postganglionic sympathetic nervous fibers innervate gone cysts, deferent duct, prostate gland, urethra muscles and neck of urinary bladder, calling their synchronized cutdown for ejaculation achievement.

Dapoxetine definitely impacts ejaculation reflex, prolonging the latency period and reducing the duration of the reflector impulse. The stimulation pulse, which activates ejaculation, is generated in cerebrospinal nerve center, which is controlled by a few niduses of the brain cord through the cerebral trunk.

The function of dapoxetine consists in preventing the reuptake of serotonin and the subsequent action enhancement of the neurotransmitter receptors. Dapoxetine inhibits the ejaculatory expulsion reflex by acting at a supra spinal level with the lateral paragigantocellular nucleus as a necessary brain structure for the effect. Postganglionic sympathetic fibres that innervate the seminal vesicles, prostate, bulbourethral muscles, and bladder neck cause them to contract in a coordinated fashion to achieve ejaculation. Dapoxetine modulates this ejaculatory reflex, causing an increase in pudendal motoneuron reflex discharge (PMRD) latency and a reduction in PMRD duration.

It relieves tension and improves patient’s general mood. It works only with the brain cells which are responsible for PE, without affecting the whole brain.

This unique formula distinguishes dapoxetine from other drugs of SSRI family group, which are used for mental disorders. Working precisely on ejaculation mechanism it prolongs the time of emission of seminal fluid, which is the main purpose of dapoxetine.

How Long Does It Stay in Your System?

Dapoxetine is quickly absorbed. Maximal concentration is achieved within 1-2 hours after consumption. Absolute bioavailability is 42% raging from 15% to 76%.

Fattening food may affect dapoxetine concentration depending on how long it stays in your system. High fat meals frugally reduce dapoxetine concentration without affecting the total absorption level. Dapoxetine can be used regardless of the meal time.

Dapoxetine is metabolized by the multiple ferments of liver and kidneys. The metabolites of dapoxetine are moved out with urine. Unconverted substance in urine has not been discovered. The low concentration of dapoxetine in blood (5%) within 24-hours period testifies that it is egested quickly out of the body. Every usage allows minimal accumulation of dapoxetine, the terminal half-life is about 19 hours.

Single usage of dapoxetine 60 mg has not showed any statistically authentic distinction between Caucasian, Black, Hispanic and Asian races. Although, Japanese race is characterized by higher plasma levels (20%) comparing to Caucasian (10%) due to lower body weight. This fact is not expected to have a meaningful clinical effect.

There is no significant difference between using dapoxetine by different age groups. Patients with severe renal impairment were not thoroughly tested, doses should be used carefully.

Side Effects of Dapoxetine

Medical preparations may cause side effects, and dapoxetine is not an exception. The most frequent adverse events known after taking dapoxetine is dizziness, headache and sickness. Adverse effects is the main reason why this preparation has not been approved in the USA, so let’s examine this point more carefully. The table represents the names and statistics of side effects in patients.

Very common (1 in 10 people)	Common (1 in 10 and 1 in 100 people)	Uncommon (1 in 100 and 1 in 1000 people)	Rare (1 in 1000 and 1 in 10 000 people)
Vertigo	Disturbance	Lightheadedness	Sleep attacks
	Nervousness
	Excitation
	Unrest	Faint
	Concentration troubles
	Sleeplessness	Mood swings
	Parasomnia
	Low libido	Depressive states
Migraine	Erectile problems		Dizzy feeling after physical overwork
	Tiredness	Anxiety
	Drowsy feeling
	Oscitation	Disconcerted feeling
	Shaking
	Pricky sensation	Weakness
	Ear ringing or buzzing
	Blurred vision	Panic
Sick feeling	Nasal congestion		Urgent need for toilet
	Stomach upsets	Tumultuous dreams
	Emesis
	Costiveness	Irregular heartbeat
	Abdominal discomfort
	Flatulence	Enlarged pupils
	Thirst
	Hyperhidrosis	Bruxism
	Blushing
	Hypertension

The list of adverse events is incomplete. To avoid adverse symptoms manifestations it is important to follow the treatment schedule and abide by the following rules:

1. Reduce driving and operating hazardous machinery, especially in case of dizzy feeling after taking dapoxetine. Check out first how the body reacts to the new preparation.
2. Avoid alcoholic beverages because they increase the risks of the side effects.
3. Always drink a full glass of water along with the tablet and stand up slowly if you have been sitting or lying for a long time.
4. If dizziness becomes annoying, a patient should lie down or sit down, put his head between his legs until the symptoms pass.
5. Do not take dapoxetine with recreational drugs (ecstasy, LSD, amyl nitrate, narcotics or benzodiazepines).

Always consult with a healthcare provider regarding any abnormal conditions during the treatment. If the risks overweigh the benefits, a healthcare provider will suggest giving up the medicine or switching to a different drug.

Important note: in case of sudden reducing SSRI drugs they may cause the following symptoms:

• dysphoria;
• irritation;
• agitation;
• dizziness;
• sensory impairment (for example, paraesthesia);
• anxiety;
• confusion of consciousness;
• migraine;
• lethargy;
• emotional lability;
• insomnia;
• hypomania.

Dapoxetine belongs to an SSRI class group, and its reaction to sudden reducing was clinically tested. Researches showed that after 62 days of taking the preparation (or longer) the most frequent symptoms were sleeplessness and dizziness in mild and moderate form. Therefore, sudden reducing should go smoothly.

What If I Take Dapoxetine with …

The medical annotation for dapoxetine includes strict admonitions against consuming it with herbal remedies that prevent the activity of the Cytochrome P450 (CYP) 3A4 ferment.

The effect of the daily intake of grapefruit and pomegranate juice on the work of dapoxetine was tested during a 3-way crossover study. It appeared that grapefruit increases the dapoxetine plasma concentration and prolonged its elimination half-life. Slight, but not statistically significant changes were discovered after pomegranate juice intake.

The impact of juices is mild. Many more concerns call their parallel usage with dapoxetine into question. Therefore, grapefruit and pomegranate are not recommended due to the accumulation of the active ingredient and difficult elimination of it from the organism. Such processes may become a reason for overdose and provoke side effect manifestations.

Consult with medics in private regarding the usage of caffeine, herbal supplements, and nutraceuticals.

Alcohol

The combination of dapoxetine with alcohol may intensify the ethanol activity on the central nervous system and increase neurocardiogenic side effects, like syncope which, in turn, increases the risk of sudden traumatic accidents. Thus, patients should avoid using alcohol during the dapoxetine curing course.

One-time consumption of ethanol (0.5 g/kg which is about 2 units) did not affect the pharmacokinetics of dapoxetine 60 mg. Simultaneous consuming of dapoxetine and alcohol caused drowsy feelings, reduced the vigil level, delayed reflexes, and changed judgment.

Food

High fat meals make a modest impact on an organism in conjunction with dapoxetine which actually consist in a delay of the working time. It is explained by the complicated digestion process which takes more time. Trials showed that the tablet started working within 30 minutes after the patient ate the food which slowed absorption. However, the general work of dapoxetine goes without significant changes.

A few examples of high fat food which delay the digestion process are below:

• fried chicken;
• bacon cheeseburger;
• french fries;
• fried cheese sticks;
• pizza;
• Caesar salad;
• nachos;
• cheesecake;
• hot dogs;
• beef burrito;
• chicken nuggets;
• taco.

Other Medications

Dapoxetine drastically interacts with a few medication groups. The list below shows the largest drug families and the outcome of their cooperation with dapoxetine. It is far from complete. For the detailed info regarding every particular drug and how does it work in combination with dapoxetine, a patient should refer to a healthcare provider:

1. Monoamine oxidase inhibitors (MAOIs). Patients who received SSRI and MAOIs simultaneously had serious and sometimes lethal reactions, for example hyperthermia, rigidity, myoclonus, mental health changes including distraction which leads to delirium and coma. These reactions may appear in those who reduced the SSRI course and started an MAOI cure recently. In some cases the symptoms were similar to neuroleptic malignant syndrome. These two drugs increase blood pressure and caused agitated behavior. Dapoxetine is strictly forbidden for usage during the 14-day period after stopping the MAOI course. MAO inhibitors are forbidden for 7 days after stopping dapoxetine.
2. Thioridazine. SSRI inhibit CYP2D6 ferment and delay thioridazine metabolism. Dapoxetine is forbidden for parallel consumption with dapoxetine and within 14 days after stopping a thioridazine course. Thioridazine is forbidden for a week after dapoxetine rejection.
3. Drugs with serotoninergic activity: L-tryptophan, triptan, tramadol, linezolid, lithium, preparations on the base of hypericum perforatum (St John’s wort). Their combination with dapoxetine increases the frequency of serotonergic side effects. Dapoxetine can be used 2 weeks after reducing these family drugs. Serotoninergic remedies should be taken not earlier than 1 week after dapoxetine rejection.
4. CYP3A4 inhibitors: ketoconazole, itraconazole, ritonavir, saquinavir, telithromycin, nefazodone, nelfinavir, atazanavir. Simultaneous treatment of dapoxetine with these drugs is forbidden. Moderate inhibitors of CYP3A4 (erythromycin, clarithromycin, fluconazole, amprenavir, fosamprenavir, aprepitant, verapamil, diltiazem) increase the level of dapoxetine systemic exposure. Maximal dose of dapoxetine should be bordered to 30 mg.
5. CYP2D6 inhibitors. Dapoxetine 60 mg should be cautiously used in people with low CYP2D6 activity level.
6. A-adrenergic receptors (tamsulosin) should be used carefully in combination with dapoxetine due to low tolerance of patients to orthostatic hypotension.

Dapoxetine Alternatives

Alternative of dapoxetine should be considered any drug from the SSRI drug group. However, it must be noted that similar is only their mechanism of action, while they are different in strength, duration, working start, and side effects.

The most famous analogues of dapoxetine are:

• sertraline;
• fluvoxamine;
• fluoxetine (Prozac);
• paroxetine;
• escitalopram;
• citalopram;
• indalpine;
• zimelidine;
• panuramine;
• cericlamine;
• femoxetine.

A remarkable place take PDE5 inhibitors which can be a decent alternative of dapoxetine, too. They are:

• Sildenafil;
• Cialis;
• Levitra;
• Super P-Force.

They have similar pharmacological properties and therapeutic effects. Along with PE, they treat ED problems, normalizing the potency and genital abnormalities in men.

Remember that dapoxetine is an active ingredient which is produced under multiple brand names. All drugs with the same active ingredient may be considered as alternatives, as well.

Dapoxetine Vs Viagra (Sildenafil)

Viagra (sildenafil) is a brand drug for treating ED problems. While dapoxetine belongs to the SSRI family of drugs, sildenafil belongs to PDE5 inhibitors. The data about successful treatment of PE by sildenafil is very limited.

Some users inform that after taking Viagra, PE problems stopped bothering them. But this information needs more research. Doctors say that delayed ejaculation may be an adverse reaction of sildenafil which is not far enough to say that Viagra treats PE. Dapoxetine is a drug designed especially for PE recovery, and its action is directed to solve this particular problem.

Across one clinical trial, it was found that 50 mg of sildenafil is more effective for curing PE as compared to 20 mg of paroxetine. During half a year, 180 healthy males divided into 3 groups took sildenafil, dapoxetine, and used squeezing techniques, respectively. Sildenafil showed significantly different results, proving its efficacy comparing to paroxetine and squeezing methods. This curious fact demands more research and scientific proof regarding effectiveness of Viagra for PE treatment.

Being preparations for different purposes, dapoxetine and sildenafil perfectly complete each other. Across another clinical test, dapoxetine, sildenafil, and their combination were all thoroughly checked. 150 males without ED were tested from March 2015 to May 2016. The groups of men received 30 mg of dapoxetine, 50 mg of sildenafil citrate, and a combo of dapoxetine (30 mg) with sildenafil citrate (50 mg) for 6 weeks.

All groups significantly improved their satisfaction score after treatment. The combo group showed the best result. This means that combining sildenafil with dapoxetine therapy can perfectly improve patients with PE without ED problems, comparing to a single usage of dapoхetine alone or sildenafil with tolerated adverse events.

Cialis (Tadalafil)

Cialis is a brand drug with the active ingredient tadalafil which is used for ED, pulmonary hypertension, and benign prostatic hyperplasia treatment. Its action is similar to such PDE5 inhibitors as Viagra and Levitra. This drug was approved by the FDA in the USA in 2003 as an ED cure. It can be used daily or on an on-demand basis. The approval for the treatment of pulmonary arterial hypertension was given by the FDA in 2009.

This drug has received the name «weekend pill» for its prolonged activity time: up to 36 hours while other medical preparations of this drug family work only 5 hours.

The main condition for drug work is preliminary the sexual stimulation of the phallus. This condition makes brain cells pass signals to blood vessels in the penis area and enlarge them. Massive bloodflow provides a perfect erection. The dosage should be taken once in a 24-hour period. It also may cause side effects (fainting, sickness, long-lasting erection, and many more). It also interacts with several drug groups. Therefore, this is a prescription drug which should be used under strict doctor’s control.

Cialis generic tabs are available, too. They contain the same active ingredient, tadalafil. The price for generics is very cheap which allows regular usage without significant expenses.

The effectiveness of this drug has been checked for many years of practice. It is not weird as the remedy has been known in the USA for more than 10 years. It is the third pill after Viagra and Levitra represented for ED cure. This preparation is awesomely popular among ED patients and has gathered a lot of positive reviews.

This preparation is available in our drug store BuyEDTab in different dosages: 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg, and 60 mg. Different amounts of tabs inside the package helps to choose the best option for individual cure. Visit our catalogue for more information.

Dapoxetine Vs Paroxetine

Paroxetine, manufactured under the brands Brisdelle, Paxil, Paxil CR, and Pexeva, is an antidepressant drug used for the treatment of various depressive conditions, panic states, social anxiety problems, and many other psychological deviations. Like dapoxetine, it belongs to the SSRI class. During FDA checking, this paroxetine has received the black box warning which means that side effects may be dangerous for patients’ health and increase suicidal thoughts and behavior.

Unlike dapoxetine, paroxetine was initially created for the treatment of physiological disorders. Delayed ejaculation is a side effect of this antidepressant which is used in therapeutic purposes for PE sufferers. There is much scientific data regarding the comparison of the two preparations. During the first one, 150 married males from 30-36 y.o. with stable relations and constant PE were divided into 3 groups. The first one received 30 mg dapoxetine, the second one got 60 mg of dapoxetine, and the third one had 20 mg paroxetine once a day 1-3 hours before planned sexual intercourse for a month.

Within 30 days, the IELT index (intravaginal ejaculatory latency time) increased in all groups: 117% after dapoxetine 30 mg, 170% after dapoxetine 60 mg, and 117% after paroxetine 20 mg. This means that the low doses of dapoxetine and paroxetine work approximately equally, but the best results were achieved after using dapoxetine 60 mg.

During another clinical research, aimed to estimate the efficiency and safeness of dapoxetine and paroxetine, 40 males with PE were involved. The groups of men received 30 mg of dapoxetine, 60 mg of dapoxetine, and 20 mg of paroxetine for 12 weeks, and the results were checked every 2 weeks.

The tests showed increased IELT index (see the table):

Dapoxetine 30 mg		Dapoxetine 60 mg		Paroxetine 20 mg
Before trial	After trial	Before trial	After trial	Before trial	After trial
IELT (seconds)	46.1±23.2	100.2±24.5	43.5±20.6	118.2±40.8	45.2±31.6

It proved higher efficiency of paroxetine, though not without adverse effects (see the diagram).

Fluoxetine Versus Dapoxetine

Fluoxetine is an antidepressant which belongs to the SSRI drug family and is used for the treatment of depressive states and obsessive-compulsive problems in adults.

During clinical trials, fluoxetine in dose 20 mg was compared to 20 mg of paroxetine and 30 mg of dapoxetine in usage by 170 men of 36 y.o. who suffer from PE. Within 1 month, the tests showed global improvement in all groups, although, the dapoxetine and paroxetine results were better than in the fluoxetine test group. Adverse effects were estimated, too:

• paroxetine: 8 patients;
• fluoxetine: 9 patients;
• dapoxetine: 0 patients.

Across a single test of fluoxetine, 17 patients with PE were examined. The dosage of 20 mg of fluoxetine daily for 1 week and 40 mg afterward showed a good IELT index with such side effects as sickness, migraines, and sleeplessness. Generally this drug was assumed as a safe and effective remedy for the cure of PE. But in the battle of dapoxetine vs fluoxetine the last one fails.

The use of SSRI drugs which control and regulate ejaculation processes may cause negative reactions in other sexual functions in males such as suppressing the libido. In order to smooth both effects, fluoxetine is often used in combination with PDE5 inhibitors. This helps to eliminate unwanted reactions of SSRI antidepressants on males sexual functioning and prolong sexual intercourse. Mixing therapy provides significantly more powerful effects than a single usage of an SSRI drug.

Dapoxetine Reviews & User’s Experience

There are plenty of controversial dapoxetine reviews on the Internet. They include a lot of positive feedback. The perfect effect of the drug makes people order it even from overseas.

Negative reviews take place, too. Ethan Green from the UK writes that the preparation is not easily available in his country. 30 mg of Dapoxetine appeared effective for him, even the small dose taken for several weeks 2 hours before planned intercourse increased the time of sex by 2-8 minutes. Constant headaches were quite bothersome during the treatment course and that was the reason why he did not desire to increase the dose for a more powerful effect. His conclusion is a big concern about the future dapoxetine purchase. Firstly, because of trouble buying the drug, and secondly because of its weak effect and adverse symptoms.

Other patients shared different kinds of problem. After long-lasting tortures with PE, he chose dapoxetine for a cure. The drug helped to prolong the sexual act up to 90 minutes, though he could not ejaculate at all afterward.

One patient who tried to increase intake to 60 mg had nausea afterwards. He enjoyed the powerful effect but continued the cure in standard dose.

The curious thing is that female partners find the dapoxetine effect excellent and often insist on their men using it or place it surreptitiously in their man’s meal. Females often buy dapoxetine as a present for their partners and enjoy extra sensations during sex. Males without severe forms of PE also use it to bring more pleasure to their female partners.

Dapoxetine appeared very effective for people who suffer from lifelong PE, ending sexual acts in 5-7 seconds. While other preparations appeared absolutely ineffective, dapoxetine has prolonged sexual acts by up to 20 minutes.

PE may affect a man at any age. Dapoxetine is the first chemical substance that was designed to specifically target this problem in men. It is assumed to be an effective and safe remedy if a patient follows the recommended dose. Most patients are satisfied with the achieved results. With this medicine, they have overcome PE problems which accompanied them for many years.

Where Can I Buy Dapoxetine in USA?

Dapoxetine has many pros and cons, but nevertheless it stays awesomely popular among users. Due to an absence of FDA approval, it is not allowed to be listed for sale in local USA pharmacies, therefore online orders are the only way to get it. Those who want to buy this preparation should order it from foreign countries where it is licensed and authorized for sale.

Cheap prices for Indian dapoxetine makes it convenient for regular treatment. The table represents the costs for the most popular brands of the generic drug.

Indian trade mark	Producer	Amount of tabs in the package	Price in India for the package in USD (converted from rupee)	The value of 1 tab in USD (converted from rupee)
Dasutra (30 mg)	Hetero Healthcare Ltd	4	1.23	0.3
Dapox (30 mg)	Ranbaxy Laboratories Ltd	6	2.25	0.38
Prilyxet (30 mg)	Sun Pharmaceutical Industries Ltd	4	1.5	0.38
Ejalong (30 mg)	Emcure Pharmaceuticals Ltd	6	2.27	0.38
Sustinex (30 mg)	Emcure Pharmaceuticals Ltd	6	2.27	0.38
Xydap (30 mg)	Cilpa Limited	4	1.63	0.41
Duralast (30 mg)	Sun Pharmaceutical Industries Ltd	4	1.72	0.43
Kutub (30 mg)	Hetero Healthcare Ltd	4	3.13	0.78
Sustinex (60 mg)	Emcure Pharmaceuticals Ltd	6	3.21	0.54
Dasutra (60 mg)	Hetero Healthcare Ltd	4	2.33	0.58
Kutub (60 mg)	Hetero Healthcare Ltd	4	2.33	0.58
Duralast (60 mg)	Sun Pharmaceutical Industries Ltd	4	2.38	0.59

The prices listed above are submitted for information purposes only and may not match the factual price at which they are sold. The tabs value may vary depending on many factors, such as manufacturer, local taxes, and the rupee / dollar exchange rate.

Those, who want to purchase dapoxetine abroad should ask Google «where can I buy dapoxetine». For most chemists, prescribing information is not needed. A purchaser should be sure that the drug store is reputable and sells qualitative product. Always check the legitimacy of the drug store and the drug certificate.

How to Get Dapoxetine Without Prescription?

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