Premature Ejaculation

Key takeaways

• Premature ejaculation medicines fall into two groups: oral tablets that delay ejaculation through serotonin pathways, and topical anesthetics that numb sensation directly.
• Dapoxetine is the only medicine designed specifically for on-demand PE use; fluoxetine and duloxetine are antidepressants used off-label for the same effect.
• Sildenafil, tadalafil, vardenafil and avanafil treat erectile function, not ejaculation timing on their own, though combination products pair a PDE5 inhibitor with dapoxetine.
• Dapoxetine can cause dizziness or fainting, especially after the first dose: take it with a full glass of water, stay seated for a while afterward, and avoid alcohol.

How premature ejaculation medicines work

Serotonin reuptake inhibitors raise serotonin activity in the brain and spinal cord, which delays the ejaculatory reflex; dapoxetine is short-acting, so it's taken 1 to 3 hours before sex rather than daily. Topical anesthetics like lidocaine work locally, numbing the nerve endings in the skin that trigger the reflex, without affecting the brain or spinal cord at all.

Choosing between dapoxetine, lidocaine and the other premature ejaculation medicines

• Dapoxetine: the only medicine designed specifically for on-demand PE treatment, taken 1 to 3 hours before sex. Its short half-life clears it from the body within a day, but it can cause dizziness and fainting, particularly after the first dose or when standing up quickly. Take it with a full glass of water, stay seated for a while afterward, and skip alcohol entirely while using it.
• Fluoxetine and Duloxetine: antidepressants used off-label for PE, usually taken daily rather than on-demand. The delay in ejaculation builds up over one to two weeks of continuous use rather than working from the first dose.
• Lidocaine: a topical spray or cream applied to the tip of the penis 10 to 20 minutes before sex to reduce sensitivity. Wipe off any excess before penetration or use a condom, since it also numbs a partner's skin on contact and heavy application can interfere with a latex condom's grip.
• Sildenafil, Tadalafil, Vardenafil and Avanafil: PDE5 inhibitors for erectile function, not ejaculation timing on their own. When PE happens alongside erectile difficulty, some products combine a PDE5 inhibitor with dapoxetine to address both; see erectile dysfunction for how these tablets differ from each other.

Common questions

Can I take dapoxetine every time I have sex?

Yes, it's designed for on-demand dosing. Leave at least 24 hours between doses and never take more than one dose in a day.

Will lidocaine spray numb my partner too?

Yes. If it isn't wiped off or a condom isn't used, it transfers on contact and can reduce sensation on a partner's skin as well.

Can I combine an SSRI with a PDE5 inhibitor?

Only within a combination product designed for that purpose, or under a prescriber's guidance. Combining separate serotonergic and PDE5 medicines on your own raises the risk of interactions that need checking first.

Safety essentials

• Take dapoxetine with a full glass of water, stay seated or lying down for a while after the first dose, and avoid alcohol, since it can cause a sudden drop in blood pressure and fainting.
• Wipe off excess lidocaine or use a condom to avoid transferring numbness to a partner, and note that heavy application can reduce a condom's grip.
• Don't combine dapoxetine with other serotonergic medicines (other SSRIs, SNRIs, tramadol) without medical advice, since this raises the risk of serotonin syndrome.
• Seek urgent care for fainting, an erection lasting more than 4 hours if using a PDE5 inhibitor, or any sudden vision or hearing loss.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.