Dapoxetine instructions for use, how to take?

Dapoxetine is a unique medicinal product that was specifically designed and approved for the treatment of Premature Ejaculation (PE) in adult men aged 18 to 64 years. It is the first agent of its kind to hold this specific indication.

Pharmacologically, it belongs to the class of Selective Serotonin Reuptake Inhibitors (SSRIs). However, unlike traditional SSRIs used to treat depression and anxiety disorders, Dapoxetine possesses unique pharmacokinetic properties: it is short-acting. This means it is very rapidly absorbed by the body (reaching peak concentration in approximately 1-2 hours) and just as rapidly eliminated. This characteristic makes it unsuitable for treating depression (which requires a constant concentration) but ideal for "on-demand" use, i.e., immediately before sexual activity.

The primary goal of the medication is to help a man prolong the duration of intercourse before ejaculation occurs, thereby significantly improving personal control over the ejaculatory process and reducing the psychological distress and stress associated with the condition.

Indications for Use of Dapoxetine

Dapoxetine is indicated exclusively for the treatment of men suffering from persistent or recurrent premature ejaculation. It is important to understand that this diagnosis is not based on a single poor experience. The medical criteria for PE typically include a triad of symptoms:

1. Short Ejaculatory Latency Time: Ejaculation that almost always occurs before, during, or within one to two minutes of initiating vaginal penetration.

2. Lack of Control: A persistent or recurrent inability to delay or control the onset of ejaculation.

3. Negative Psychological Consequences: Marked personal distress, frustration, anxiety, and, as a result, avoidance of sexual intimacy.

The medication helps not just to mechanically "delay" ejaculation, but to restore a man's sense of control, which is key to improving sexual quality of life and relationships.

How Does Dapoxetine Work? An In-depth Mechanism

The mechanism of action of Dapoxetine is complex and tied to the neurobiology of the ejaculatory reflex. This reflex is controlled by a specialized center in the spinal cord, which in turn receives signals from the brain.

A key neurotransmitter in this process is serotonin (5-HT). Serotonin, among its many functions, acts as an inhibitory (slowing) signal in the ejaculatory reflex. When serotonin levels in the synapse (the space between nerve cells) are high, the threshold for triggering ejaculation is raised.

Dapoxetine, as an SSRI, works by blocking the serotonin transporter protein (SERT). This protein is responsible for "reuptake," i.e., returning serotonin from the synapse back into the nerve cell for reuse. By blocking this pump, Dapoxetine artificially increases the amount of active serotonin in the synaptic cleft.

This elevated level of serotonin enhances its inhibitory effect on the neural pathways that control ejaculation. As a result, it takes more time and more intense stimulation for the man to reach the "point of no return," which is what leads to the prolongation of intercourse.

How to Take Dapoxetine Correctly

• Dosage: Treatment should always be initiated with the minimum recommended dose: 30 mg. This dose is taken approximately 1 to 3 hours before planned sexual activity. This time window (1-3 hours) is the period of the drug's peak effectiveness.

• Dose Adjustment: If the 30 mg dose is well-tolerated but does not provide a sufficient effect, a physician may consider increasing the dose to 60 mg. This is the maximum recommended daily dose. Escalating to 60 mg is only permissible if there are no adverse effects, particularly orthostatic hypotension (dizziness upon standing).

• Frequency of Use: Dapoxetine is an "on-demand" medication, not a daily course of treatment. It should only be taken when sexual activity is anticipated. It is strictly not recommended to take more than one dose (30 mg or 60 mg) within a 24-hour period.

• Method of Administration: The tablet should be swallowed whole with a full glass of water. This is important as it helps reduce the risk of nausea and also the risk of syncope (fainting) due to dehydration. The drug can be taken with or without food. Food intake, even a high-fat meal, does not significantly affect the speed or extent of Dapoxetine's absorption.

What are the Contraindications for Dapoxetine?

1. Use of MAO Inhibitors (MAOIs): This is an absolute and life-threatening contraindication. The concurrent use of Dapoxetine (an SSRI) and an MAOI (another class of antidepressant) can cause Serotonin Syndrome — a potentially fatal reaction characterized by confusion, high fever, muscle rigidity, tremors, and autonomic instability. Strict "washout" periods must be observed: Dapoxetine must not be taken within 14 days of stopping an MAOI, and an MAOI must not be started within 7 days of stopping Dapoxetine.

2. Other Serotonergic Drugs: This same prohibition applies to other SSRIs (e.g., fluoxetine, sertraline), SNRIs (venlafaxine), tricyclic antidepressants, lithium, tramadol, and St. John's Wort.

3. Significant Cardiovascular Disease: Patients with severe heart failure (NYHA class II-IV), conduction abnormalities (e.g., AV block), ischemic heart disease, or significant valvular disease should not take Dapoxetine. This is due to the risk of syncope (fainting), which can be dangerous for a compromised heart.

4. Hepatic (Liver) Impairment: Use is contraindicated in patients with moderate to severe liver impairment, as the drug is metabolized by the liver.

5. Allergy: A known hypersensitivity to dapoxetine hydrochloride or any of the excipients in the product.

Dapoxetine: What are the Side Effects?

Most Common Side Effects (Usually dose-dependent):

• Nausea: The most frequent complaint. Usually mild to moderate.

• Dizziness: The second most common side effect.

• Headache.

• Dry Mouth.

• Fatigue or somnolence (sleepiness).

• Insomnia or anxiety.

Serious but Less Common Side Effects:

• Syncope (Fainting): This is the most significant risk associated with Dapoxetine. It can cause orthostatic hypotension — a sharp drop in blood pressure when moving from a sitting or lying position to a standing one. This leads to sudden dizziness and loss of consciousness.

• Action if Syncope Risk is Felt: If a patient feels "prodromal" symptoms (nausea, dizziness, lightheadedness, "vision blacking out," sweating), they must immediately lie down flat with their head low, or sit down and put their head between their knees. They must remain in this position until the symptoms pass completely to avoid injury from a fall.

Dapoxetine Interactions with Other Medications

• MAOIs and Antidepressants: As noted, strictly forbidden due to the risk of Serotonin Syndrome.

• CYP3A4 Inhibitors: Dapoxetine is broken down by the CYP3A4 enzyme in the liver. Potent inhibitors of this enzyme (e.g., ketoconazole, itraconazole (antifungals), ritonavir (HIV medication), certain antibiotics) can dramatically slow its elimination, leading to an overdose. Their concurrent use is contraindicated.

• Erectile Dysfunction Drugs (PDE-5 Inhibitors): Combining Dapoxetine with sildenafil, tadalafil, etc., should be done with caution. Both classes of drugs can lower blood pressure. Their combination, especially in patients with cardiac issues, increases the risk of orthostatic hypotension and dizziness.

Special Recommendations

• Alcohol: Consuming alcohol concurrently with Dapoxetine is strongly discouraged. Alcohol itself is a CNS depressant. It significantly worsens side effects such as dizziness, sleepiness, and slowed reflexes, and most importantly, it substantially increases the risk of syncope (fainting).

• Driving and Operating Machinery: Because the drug can cause dizziness, drowsiness, and even fainting, extreme caution should be exercised when driving a car or operating complex machinery. This is especially true in the first few hours after taking a dose and until the patient knows how the drug affects them personally.

Storage

Dapoxetine should be stored in its original packaging to protect it from moisture and direct sunlight. The optimal condition is a dry place, out of the reach of children, at room temperature (usually not exceeding 25-30°C or 77-86°F).

Conclusion

Dapoxetine is an innovative and effective medication specifically created to solve the medical problem of premature ejaculation. Its correct dosing and "on-demand" use allow millions of men to regain control over their ejaculation and improve the quality of their intimate lives. However, it is a serious prescription drug with strict contraindications and significant risks (especially Serotonin Syndrome and fainting). It is absolutely essential to consult with a physician before use to evaluate your health status, rule out contraindications, and avoid dangerous side effects.