Premature Ejaculation and Dapoxetine (Priligy) in Hong Kong

The evening has gone well, and then it is over sooner than either of you wanted. Once in a while that is ordinary: premature ejaculation is common, and occasional episodes are no cause for concern. The words around it in Hong Kong searches are 早洩 for premature ejaculation and 必利勁 for Priligy, alongside dapoxetine, Poxet and Super P-Force.

Those tablets share one ingredient, dapoxetine, an SSRI designed for premature ejaculation rather than depression. It is taken on demand, an hour or more before sex. It can help, and it can make you faint if you take it dehydrated or after a drink.

In short

• Premature ejaculation means ejaculating sooner than you or your partner wants. Lifelong means before or within about a minute of penetration from your first sexual experiences; acquired means a bothersome drop, often to about three minutes or less.
• Dapoxetine 30 mg is taken 1 to 3 hours before sex, once in 24 hours at most, with a full glass of water. Five phase 3 trials took the average time to ejaculation from 0.9 minutes to 3.1 minutes on 30 mg and 3.6 minutes on 60 mg, against 1.9 minutes on placebo.
• Dizziness, headache and nausea are the usual effects. Fainting is the one to respect: drink the water, skip the tablet when you are dehydrated, avoid alcohol.
• Men with heart failure, rhythm problems, a history of fainting or other antidepressants should not take it. Most combination tablets carry 60 mg of dapoxetine.

What counts as premature ejaculation, and what kind do you have?

You have timed it, roughly, and want to know whether the number counts. The definition rests on three things: time, control, and how much it bothers you.

Lifelong premature ejaculation means ejaculation always or nearly always happens before or within about one minute of penetration, from the first sexual experience onwards. Acquired means a clinically significant, bothersome fall in that time, often to about three minutes or less. Both need an inability to delay on nearly all penetrations and negative consequences such as distress, frustration or avoiding intimacy (ISSM unified definition, 2014). Men with the acquired pattern tend to be older, with more erectile difficulty and more cardiovascular risk factors.

Causes divide into two rough groups. Psychological ones include depression, stress, relationship problems and performance anxiety. Physical ones include prostate problems, thyroid problems and recreational drugs. Where it has been there from the start, the NHS lists conditioning, an earlier traumatic sexual experience and a strict upbringing.

European guidance diagnoses it from history alone: your estimate of the time, your sense of control, the distress it causes. Erectile dysfunction, another sexual problem or an infection such as prostatitis is treated first. For the acquired pattern, behavioural or psychological therapy alongside drugs is the suggested approach.

Which pattern you have changes the advice, so be honest with yourself about the timing and how long it has been going on.

How do you take dapoxetine, and how much does it help?

Timing is the part to get right: it is an as-needed tablet, not a daily one. The label window is 1 to 3 hours before sexual activity, never more than once every 24 hours. Swallow it whole with at least one full glass of water, with or without food.

The usual dose is 30 mg. Sixty milligrams is for men whose 30 mg did not work well enough and caused no moderate or severe side effects or fainting symptoms; men should not start on 60 mg. The EU labelling covers men aged 18 to 64, with a review after four weeks or six doses, then at least every six months.

Five phase 3 trials followed 6,081 men in more than 25 countries, double-blind and placebo-controlled, with on-demand dosing 1 to 3 hours before intercourse for 12 or 24 weeks. Average time to ejaculation rose from 0.9 minutes at baseline to 3.1 minutes on 30 mg and 3.6 minutes on 60 mg, against 1.9 minutes on placebo.

Averages of five phase 3 trials, 12 to 24 weeks. IELT is the time from penetration to ejaculation.

A Cochrane review of SSRIs, 31 trials and 8,254 men, reports that more men improved and more were satisfied with intercourse, with moderate certainty for the improvement and an average gain of a little over three minutes on low certainty. More men had side effects, and more stopped because of them.

These are averages across many men, so an individual result can sit well above or below them.

What are the side effects, and how do you avoid fainting?

Some men notice effects with the first tablets. More than 1 in 10 men get dizziness, headache or nausea. Between 1 and 10 in 100 get irritability, tingling, difficulty getting or keeping an erection, sweating or flushing, diarrhoea, sleep problems, tiredness, a dry mouth, blurred vision or indigestion, among others.

Fainting is the effect worth planning around, because it is the one that causes injuries. The tablet lowers blood pressure in some men, and dehydration or alcohol makes that worse. Take it with at least one full glass of water. Skip it if you have had nothing to drink for 4 to 6 hours, have been sweating heavily, or have a feverish illness with diarrhoea or vomiting. If you feel faint, lie down with your head lower than the rest of your body, or sit with your head between your knees, and do not stand up quickly. Do not drive or use tools while faint. The labelling says a doctor should check that your blood pressure does not drop too much when you stand before treatment starts.

Avoid alcohol that day. It adds dizziness, sleepiness, slow reactions, fainting and injury on top of the tablet.

Stop and get help straight away for fits, fainting or light-headedness on standing, a mood change, or thoughts of suicide or self-harm.

Who should not take dapoxetine?

Some of these are hard stops. Others need checking first.

Do not take dapoxetine if you have:

• heart failure or a heart-rhythm problem
• a history of fainting
• mania or severe depression
• moderate or severe liver problems

Do not take it with:

• MAOIs, thioridazine, other antidepressants including other SSRIs, lithium, linezolid, tryptophan, St John's wort, tramadol or migraine medicines
• ketoconazole, itraconazole, ritonavir, saquinavir, nelfinavir, atazanavir, telithromycin or nefazodone

After stopping one of those medicines, wait 14 days before dapoxetine. After dapoxetine, wait 7 days before starting one.

The leaflet asks men to check first if any of these apply: recreational drugs such as ecstasy, LSD, narcotics or benzodiazepines; kidney problems; epilepsy; a history of dizziness from low blood pressure; warfarin or NSAIDs; blood-pressure medicines such as verapamil and diltiazem; sildenafil, tadalafil or vardenafil, which lower blood pressure and can do it on standing.

The EU labelling is clear that it is not for women, not for men under 18, and not for men of 65 and over.

Do the sildenafil or tadalafil combination tablets add anything?

You may have no erectile difficulty at all and still be looking at Super P-Force. Two problems in one tablet sounds efficient. Whether the second ingredient earns its place depends on whether erections are also a problem.

European guidance supports PDE5 inhibitors alone or with other therapies in premature ejaculation without erectile dysfunction. Where the ejaculation problem follows erectile dysfunction, the erectile problem is treated first or at the same time.

One single-blind trial of 150 men with premature ejaculation and no erectile dysfunction split them into five groups of 30 for six weeks of on-demand treatment: placebo, paroxetine 30 mg, dapoxetine 30 mg, sildenafil 50 mg, and dapoxetine 30 mg plus sildenafil 50 mg. All improved. The combination scored best for time to ejaculation, satisfaction and symptom severity. Small and single-blind, so a signal rather than proof.

A crossover study in 24 men looked at interactions instead. Tadalafil 20 mg left dapoxetine levels unchanged. Sildenafil 100 mg raised dapoxetine exposure by 22%, judged not clinically important, and dapoxetine did not change either erectile drug's levels.

The leaflet adds that erectile tablets can lower blood pressure, possibly on standing, the same mechanism behind dapoxetine fainting. The leaflet asks men to tell their prescriber about it.

Most listed combinations carry 60 mg of dapoxetine, and the EU labelling says men should not start on 60 mg. Top Avana is the only listing with 30 mg, alongside avanafil 50 mg. I found no regulator product information for a fixed-dose dapoxetine and erectile-medicine tablet; the information I read covers dapoxetine on its own.

Never take the sildenafil or tadalafil half with nitrates for chest pain, or with nitrate poppers: blood pressure can fall dangerously. The erectile half has its own guide in erectile dysfunction pills in Hong Kong.

What else helps?

If you would rather not take a tablet, there is a fair amount you can do without one, and some of it works alongside dapoxetine.

Practical measures first. Masturbating an hour or two before sex takes the edge off. A thicker condom dulls sensation. Having your partner on top lets them pull away when you are close. The squeeze technique means stopping just before ejaculation, squeezing the head for 10 to 20 seconds, waiting about 30 seconds, then carrying on. Stop-go is the simpler version: pause until the urgency fades, then resume. Psychosexual counselling tackles the anxiety and relationship side. Condoms are effective in their own right, particularly combined with a local anaesthetic.

For lifelong premature ejaculation, the European first-line drugs are dapoxetine or a lidocaine and prilocaine spray. Off-label daily SSRIs or clomipramine come second, and off-label tramadol, with caution, third.

Fortacin, a lidocaine 150 mg/ml with prilocaine 50 mg/ml spray, takes three actuations covering the glans, with excess wiped off after five minutes and before intercourse, at most three doses in 24 hours and four hours apart. Two double-blind trials in 539 men took the geometric mean time from 0.58 to 3.17 minutes over three months, against 0.56 to 0.94 minutes on placebo. Genital numbness affected 4.5% of men and erectile dysfunction 4.4%; 3.9% of partners had vulvovaginal burning. Polyurethane condoms are out; latex, polyisoprene, nitrile and silicone are fine. Transfer can numb a partner.

Our listed spray is lidocaine only, Hiforce in a 20 g can, a different product, so Fortacin's trial results do not carry over to it. More generally, numbers from different trials are not a head-to-head comparison.

Which premature ejaculation medicines does PockDose list?

The product information covers dapoxetine 30 mg and 60 mg and says to start on 30 mg, which makes the plain tablets (dapoxetine) the natural starting point: 30 mg first, and 60 mg only if 30 mg did not work well enough and brought no moderate or severe side effects or fainting symptoms. The lidocaine spray is the non-tablet option.

Ordering from PockDose needs no prescription. Everything above sits in the premature ejaculation category, and the sildenafil and tadalafil halves are covered in the erectile dysfunction category.