Dapoxetine

Brand Names: Priligy

Drug Class: Selective serotonin reuptake inhibitor (SSRI)

Overview

Dapoxetine is a selective serotonin reuptake inhibitor (SSRI) specifically developed for the treatment of premature ejaculation (PE) in men aged 18-64 years. It is the first and only oral medication approved for this indication in many countries, including Jordan. Unlike other SSRIs used off-label for PE, dapoxetine is characterized by rapid absorption and elimination, making it suitable for on-demand use rather than daily administration.

Mechanism of Action

Dapoxetine is a short-acting selective serotonin reuptake inhibitor (SSRI). It works by inhibiting the serotonin transporter, increasing serotonin levels in the synaptic cleft. This enhances serotonergic neurotransmission, which is believed to delay ejaculation by affecting the central nervous system's control over the ejaculatory reflex.

Indications

  • Treatment of premature ejaculation (PE) in men aged 18-64 years

Dosage

Recommended starting dose is 30 mg taken orally 1-3 hours before anticipated sexual activity. Dose may be increased to 60 mg if 30 mg is well-tolerated but insufficiently effective. Maximum dosing frequency is once every 24 hours. Should be taken with a full glass of water, with or without food.

Contraindications

  • Hypersensitivity to dapoxetine or any component of the formulation
  • Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy
  • Concomitant use with thioridazine or within 14 days of discontinuing thioridazine
  • Concomitant use with serotonin precursors (such as tryptophan)
  • Men with significant cardiac conditions (e.g., heart failure, conduction abnormalities, significant ischemic heart disease)
  • Severe hepatic impairment

Side Effects

  • Nausea
  • Dizziness
  • Headache
  • Diarrhea
  • Insomnia
  • Fatigue
  • Dry mouth
  • Somnolence
  • Anxiety
  • Abdominal pain
  • Flushing
  • Increased blood pressure
  • Erectile dysfunction
  • Decreased libido
  • Syncope (rare)

Interactions

  • Strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir, clarithromycin): Increase dapoxetine exposure; maximum dose should be 30 mg.
  • Moderate CYP3A4 inhibitors (e.g., erythromycin, fluconazole, diltiazem): Use with caution.
  • CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, bupropion): May increase dapoxetine levels.
  • Serotonergic drugs (e.g., SSRIs, SNRIs, triptans, tramadol): Increased risk of serotonin syndrome.
  • MAOIs: Contraindicated due to risk of serotonin syndrome.
  • Thioridazine: Contraindicated due to risk of QT prolongation.
  • Alcohol: Contraindicated due to increased adverse effects.
  • Antiplatelet agents and anticoagulants (e.g., warfarin, NSAIDs): Increased bleeding risk.