Priligy®

Priligy is a medication approved in Germany specifically for the treatment of premature ejaculation (ejaculatio praecox). The active ingredient dapoxetine belongs to the group of selective serotonin reuptake inhibitors (SSRIs), but was developed specifically for this indication.

Unlike other SSRIs, which are taken daily as antidepressants, dapoxetine acts very quickly and is taken only as needed. The effect begins with the very first dose – no weeks-long build-up phase is necessary.

In clinical studies, Priligy was able to prolong the time to ejaculation 2- to 3-fold. Many men also report improved control and greater satisfaction with their sex life.

The medication is distributed by Menarini and has been available in Germany since 2009.

The background: Premature ejaculation is often related to an imbalance of the messenger substance serotonin in the brain. Serotonin plays an important role in controlling ejaculation – higher serotonin levels can inhibit the ejaculatory reflex.

How dapoxetine works: Dapoxetine inhibits the reuptake of serotonin into nerve cells. As a result, more serotonin remains available in the synaptic cleft and signal transmission is altered. This leads to better control over the timing of ejaculation.

What makes dapoxetine special: Unlike other SSRIs used for depression, dapoxetine acts very quickly and is also broken down quickly. Its blood levels rise within 1-2 hours, and after a few hours it has largely left the body. Therefore:

• Taken only as needed, not daily
• Effective from the very first dose
• No accumulation in the body

Study results: In studies, the average time to ejaculation increased from about 1 minute to 3-4 minutes. In a 24-week study, 53.4% (30 mg) and 65.6% (60 mg) of men rated their condition at the end as at least slightly better, compared with 28.8% on placebo.

Priligy is suitable for men with:

Primary (lifelong) premature ejaculation:

• The problem has existed since the first sexual experiences
• Often genetic or neurobiological in origin
• Typical time to ejaculation: under 1-2 minutes

Acquired premature ejaculation:

• The problem only developed later in life
• Often associated with stress, relationship problems, or erectile dysfunction
• Onset after a period of normal ejaculatory control

Important requirements:

• Age 18-64 years
• Diagnosis of premature ejaculation
• Significant distress
• No serious heart disease
• Not taking certain medications (see contraindications)

Priligy can be combined with:

• PDE-5 inhibitors (sildenafil, tadalafil) in cases of concurrent erectile dysfunction
• However, the doctor should monitor this combination

Available doses:

• 30 mg – Recommended starting dose
• 60 mg – If the effect is insufficient and the medication is well tolerated

Dosage recommendations:

• Start: 30 mg, 1-3 hours before sexual intercourse
• If the effect is insufficient: Increase to 60 mg possible
• If side effects are severe: Stay at 30 mg or reconsider treatment

Important:

• No more than one dose per 24 hours
• Take only when sexual intercourse is planned
• Not suitable for continuous daily use

Initial assessment: After 4 weeks or 6 doses, the success of treatment should be reviewed. If the effect is not sufficient, treatment should not be continued.

How to take:

• 1-3 hours before planned sexual intercourse
• Swallow the tablet whole, without chewing, with a glass of water
• Can be taken with or without food
• No more than once daily

Optimal timing: The effect is strongest about 1-3 hours after taking it. Plan accordingly, but do not put yourself under pressure – Priligy also works if you take it somewhat earlier or later.

What you can expect:

• Longer time to ejaculation
• Better control over timing
• Possibly greater sexual satisfaction
• The effect begins with the very first dose

Alcohol: Combining it with alcohol is not recommended. Alcohol increases the risk of side effects such as dizziness, light-headedness, and fainting.

After taking it: Watch for dizziness or light-headedness, especially when standing up. Stand up slowly and sit or lie down if you feel unwell.

Absolute contraindications:

Heart conditions:

• Heart failure (NYHA II-IV)
• Severe cardiac arrhythmias
• Coronary heart disease
• Heart valve disease

Mental health conditions:

• Current depression or a history of severe depression
• Bipolar disorder
• Mania (including a history of mania)

Drug interactions:

• MAO inhibitors (including up to 14 days after stopping them)
• Other SSRIs or SNRIs
• Tricyclic antidepressants
• Triptans (migraine medications)
• Tramadol
• St. John's wort
• Strong CYP3A4 inhibitors (ketoconazole, ritonavir, etc.)

Other contraindications:

• Moderate and severe liver impairment
• History of a tendency to faint
• Uncontrolled epilepsy
• Age under 18 or over 64 years

Use with caution in:

• Low blood pressure
• Orthostatic hypotension
• Use of blood pressure-lowering medications

Very common side effects (10% or more):

• Dizziness
• Headache
• Nausea

Common side effects (1-10%):

• Diarrhea
• Tiredness, sleepiness
• Sleep disturbances
• Nervousness

Uncommon (0.1-1%):

• Blurred vision
• Dry mouth
• Sweating
• Erection problems (paradoxical)
• Drop in blood pressure when standing up (orthostatic hypotension)

Rare but important side effects:

• Fainting (syncope): Especially when standing up or in combination with alcohol. Occurs mainly in the first hours after taking it. Sit or lie down immediately if you feel dizzy.
• Serotonin syndrome: When combined with other serotonergic medications. Symptoms: restlessness, tremor, sweating, fever – see a doctor immediately.

Note: Many side effects (nausea, dizziness) are dose-dependent and occur less frequently at 30 mg than at 60 mg.

Absolutely contraindicated:

• MAO inhibitors: Severe, potentially life-threatening interactions
• Other SSRIs/SNRIs: Increased risk of serotonin syndrome
• Triptans: Increased risk of serotonin syndrome
• Tramadol: Increased risk of serotonin syndrome
• Strong CYP3A4 inhibitors: Ketoconazole, itraconazole, ritonavir

Important interactions:

• Moderate CYP3A4 inhibitors (erythromycin, fluconazole): Maximum dose 30 mg
• CYP2D6 inhibitors: Caution, dapoxetine levels may be increased
• PDE-5 inhibitors: Combination possible, but with close monitoring
• Blood pressure medications: Increased lowering of blood pressure possible
• Alcohol: Increases the risk of fainting and side effects

St. John's wort: Do not take at the same time – increased risk of serotonin syndrome.