Dapoxetine

How it works

By inhibiting presynaptic serotonin reuptake it enhances serotonergic neurotransmission in the pathways controlling the ejaculatory reflex, thereby delaying ejaculation.

Prescribing in practice

• It can cause orthostatic hypotension and syncope, so it is contraindicated in significant cardiac disease and patients should be counselled to recognise prodromal symptoms.
• It is taken only on demand a few hours before anticipated sexual activity rather than continuously.
• Avoid co-administration with monoamine oxidase inhibitors and other serotonergic drugs because of the risk of serotonin syndrome.

Monitoring

No routine laboratory monitoring is required, but assess cardiovascular status and orthostatic tolerance before and during treatment.

Counselling the patient

• Take a single dose only when sexual activity is anticipated, not every day.
• If you feel faint, lie down with your legs raised and avoid situations where fainting could cause injury.
• Do not combine with recreational drugs or alcohol, which can worsen dizziness.

Evidence & guidelines

Randomised controlled trials demonstrate that dapoxetine increases intravaginal ejaculatory latency time compared with placebo in premature ejaculation.