What is dapoxetine?

The dapoxetine It is a medication developed specifically for the treatment of premature ejaculation (PE) in men. It belongs to the class of selective serotonin reuptake inhibitors (SSRIs), commonly used as antidepressants, but it differs from other SSRIs in that quick start to the action and the short half-life, features that make it ideal for use as needed

Initially studied as an antidepressant, dapoxetine was subsequently repositioned for the treatment of PE thanks to its unique pharmacokinetic profile, which allows for rapid action and quick elimination from the body. This distinguishes it from traditional SSRIs, which are unsuitable for PE due to their long duration of action and delayed effect.

Uses of dapoxetine

Premature ejaculation is one of the most common male sexual dysfunctions, affecting approximately 20–30% of men worldwide. It is characterized by a reduced ability to control ejaculation, which occurs sooner than desired, often within one minute of vaginal penetration. This condition can have a significant negative impact on psychological well-being, romantic relationships, and quality of life.

The dapoxetine represents the the first oral treatment specifically approved for EP, demonstrating a clinically significant increase in the intravaginal ejaculatory latency time (IELT) and improved ejaculatory control.

Clinical studies have shown that, compared to placebo, dapoxetine 30 mg and 60 mg increases IELT by up to 2.7–3.4 times and 3.4–4.3 times, respectively, in subjects with baseline IELT of less than one minute (McMahon et al., 2010).

Dapoxetine and premature ejaculation in athletes who use steroids

Theuse of anabolic steroids It is relatively common among athletes and can cause hormonal imbalances that lead to various sexual dysfunctions, including premature ejaculation. Steroid-induced androgenic changes can interfere with the neuroendocrine mechanisms that regulate ejaculation.

It has been shown that the dapoxetine It is also effective in PE associated with steroid use, thanks to its ability to modulate central serotonergic pathways and increase levels of serotonin, a key neurotransmitter involved in delaying the ejaculatory reflex. Several studies indicate a significant improvement in ejaculatory control and sexual quality of life in athletes with steroid-induced PE (Corona et al., 2011).

Combination of dapoxetine with tadalafil or sildenafil

The dapoxetine It can be used in combination with medications for erectile dysfunction such as tadalafil or sildenafil. This combination helps improve both the duration of sexual intercourse and the quality of erections, offering a more comprehensive therapeutic approach to men’s sexual health and enhancing overall satisfaction with sexual relations.

Mechanism of action of dapoxetine

The mechanism of action of the dapoxetine It works by inhibiting the serotonin transporter, resulting in an increase in serotonin concentration in the synaptic cleft. This enhancement of serotonergic activity in the central nervous system modulates the neural circuits involved in ejaculation, delaying the ejaculatory reflex.

Serotonin plays a fundamental role in regulating mood, emotions, and sexual functions; its increase contributes directly to better control of ejaculation (Kirkeby et al., 2010).

After oral administration, dapoxetine is rapidly absorbed, reaching peak plasma concentrations within 1–2 hours. His short half-life (about 1.5 hours) It allows for rapid elimination, reducing the risk of accumulation and the side effects typically associated with long-term use of SSRIs (Buvat et al., 2009).

Therapeutic indications for dapoxetine

Treatment of premature ejaculation

The dapoxetine It is recommended for men between the ages of Ages 18 to 64 affected by premature ejaculation. Randomized, placebo-controlled clinical trials have shown that dapoxetine:

significantly increases the IELT
improves perceived control over ejaculation
reduces the psychological distress associated with PE
increases individual and couple sexual satisfaction

The medication is taken 1–3 hours before sexual intercourse, based on an “on-demand” approach that allows for spontaneity and flexibility in one’s sex life.

Other potential uses

Although dapoxetine is an SSRI, It is not indicated as an antidepressant for the long-term treatment of depression due to its short half-life. However, in off-label settings, it may offer temporary relief from acute anxiety symptoms. Such uses, however, are not sufficiently documented and require further clinical studies (Rowland, 2011).

Dapoxetine dosage

Recommended dosages

Starting dose: 30 mg
Increasing the dose: up to 60 mg if necessary and well tolerated
Maximum frequency: once every 24 hours

Individualization of dosage is essential to optimize efficacy and minimize side effects. Periodic clinical monitoring is recommended (Sangkum et al., 2013).

Side effects of dapoxetine

The most common side effects include:

nausea
dizziness
headache
diarrhea
insomnia

In some cases, the following may occur syncope (fainting), especially within the first three hours after taking the medication and more frequently with the 60-mg dose. For this reason, it is recommended to avoid driving and activities that require full attention after taking the medication (Buvat et al., 2009).

Precautions and contraindications

The dapoxetine It is contraindicated in patients with:

serious cardiovascular diseases
cardiac conduction disorders
concomitant use of MAOIs
history of mania or severe depression

Alcohol consumption may increase the risk of adverse effects, particularly syncope. Combination with potent CYP3A4 inhibitors, which may increase plasma concentrations of dapoxetine, is also not recommended (McMahon, 2012).

Storage of dapoxetine

Dapoxetine should be stored at room temperature (15–30°C), in its original packaging, protected from light and moisture. It must be kept out of the reach of children and pets to ensure the safety and effectiveness of the medication (FDA, 2020).