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About Priligy

Premature ejaculation

Studies suggest premature ejaculation (PE) affects up to 30% of men. Only about 10% of these men seek medical help. It is an under-detected and under-treated medical condition.

The causes of PE are multiple, although significant physical disease is not likely to be the reason. Stress and psychological factors are more likely to play a big part.

PE typically has the following features:

• Ejaculatory latency time (time from vaginal penetration to ejaculation) of less than 2 minutes
• Lack of control over ejaculation
• Negative personal consequences related to the condition

Priligy

The active ingredient in Priligy is dapoxetine. It works by increasing the levels of a chemical in the brain called serotonin. Increases in serotonin levels, in turn, delay ejaculation.

After a single tablet, Priligy will reach maximum levels in 1 to 3 hours, and only 5% will still be in the circulation after 24 hours.

Priligy was originally researched as an SSRI (Selective serotonin reuptake inhibitor) antidepressant, but its short action time made it unsuitable. However, some men taking similar antidepressants complained of delayed ejaculation as a side effect, and Priligy was further investigated and developed as a medication for men with premature ejaculation. Priligy does not work by affecting mood, but by working on the serotonin nerve pathways it slows the time to ejaculation.

Taking Priligy tablets

Priligy tablets are for men 18 to 64 years only. Priligy tablets are not licensed for use in older men.

The starting dose is one 30mg tablet 1 to 3 hours before intercourse. The dose can be increased to one 60mg tablet, as required, providing the 30mg dose has been well tolerated (no significant side effects are experienced).

Priligy tablets can be taken with or without food. Tablets should be swallowed whole with a glass of water. Do not drink grapefruit juice in the 24 hours before taking Priligy.

Do not take daily on a regular basis, or repeat a dose within 24 hours.

Low blood pressure

Priligy can, in some men, cause a reduction in blood pressure with dizziness and even blackouts. Men who feel lightheaded should sit with their head between their knees or lie down until symptoms resolve. They should take no further tablets without consulting a doctor. Increasing from a 30mg tablet to a 60mg would be inadvisable.

Cautions for Priligy tablets

Some men with underlying medical conditions should not take Priligy, without first consulting their doctor. These include men with any of the following:

• History of low blood pressure and symptoms caused by falls in blood pressure, such as dizziness and blackouts when standing up.
• Heart disease.
• Significant liver disease.
• Kidney disease.
• Susceptibility to angle closure glaucoma (a rare form of glaucoma).
• Bleeding or blood clotting problems.
• Epilepsy.
• Other sexual problem, e.g. erectile dysfunction.
• Severe lactose intolerance.

Dr Fox online consultations check for these contraindications.

A number of prescription medications also interact with Priligy. In the Dr Fox online consultation there are checks for interacting medication. Some interacting medication needs to be stopped 14 days before starting Priligy and not re-started for 7 days afterwards. Do not stop prescribed medicine without first consulting a doctor or pharmacist.

Men taking Priligy should read the manufacturers patient information leaflet before starting treatment.

Recreational drugs and alcohol

There is a potential for an increase in side effects, some serious, in men who take Priligy whilst using ketamine, MDMA, ecstasy, LSD, heroin, or sedatives such as benzodiazepines or other sleeping tablets.

Priligy may increase the effects of alcohol and alcohol increases the risk of low blood pressure problems.

Side effects of Priligy

As with any medication, side effects are possible. See the manufacturers patient information leaflet for details.

Most side effects are not medically significant and are tolerated, but some side effects can be more serious.

Stop taking Priligy and see your doctor straight away if:

• You have fits (seizures)
• You faint or feel lightheaded when you stand up
• You notice any changes in your mood
• You have any thoughts of suicide or harming yourself

Emotional distress

Premature ejaculation can be distressing. It can lead to an avoidance of intercourse and come between men and their partners. A doctor's consultation may help to get to the bottom of associated psychological problems.

A doctor might ask some of the following questions:

• What is the time between penetration and ejaculation ('coming')?
• Can you delay ejaculation?
• Do you feel bothered, annoyed, and/or frustrated by your PE?
• When did you first experience PE?
• Have you experienced PE since your first sexual experience and on every/almost every attempt and with every partner?
• Is your erection hard enough to penetrate?
• Do you have difficulty in maintaining your erection until you ejaculate during intercourse?
• Do you ever rush intercourse to prevent loss of your erection?
• How upset is your partner with your PE?
• Does your partner avoid sexual intercourse?
• Is your PE affecting your overall relationship?
• Have you received any treatment for your PE previously?

Priligy may be available on the NHS but not in all areas of the UK. Some doctors prescribe SSRI antidepressant medication to treat PE. This is effective, but it is 'off label' prescribing as it is outside the licence for the use of those medications.

Other treatments for PE

Priligy is recommended for many men with PE but it can be used alongside non-tablet treatments, such as masturbation prior to intercourse or focussed breathing, or distraction techniques. Reducing the sensitivity of the penis by wearing a thick condom or using anaesthetic gel available without prescription from a pharmacy may also help.

A disposable patch has recently been marketed which provides direct electrical stimulation to the perineal muscles just behind the testes. This new device helps control PE by increasing perineal muscle activity, but has not undergone extensive UK medical trials. Nerve stimulation has been used in trials in the past with some success.

For further information see NHS - Can premature ejaculation be controlled? and FAQs: Priligy (dapoxetine) and premature ejaculation.