In some studies, sildenafil and other phosphodiesterase type 5 (PDE5) inhibitors in combination with SSRIs has yield better results in treating premature ejaculation than SSRIs alone. The mechanism of this effect is unknown. Regardless of the mechanism, PDE5 inhibitors are safe and effective treatment adjuncts for premature ejaculation if not otherwise contraindicated.
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Treatment of male sexual dysfunction. No names, no logos, no delivery fee. All content on this page has been medically reviewed by: Hassan Thwaini, Clinical Pharmacist and Copywriter, Master of Pharmacy (MPharm) on 30 March, 2026. 4.6* from over 33,000 people like you. You’ll be assessed by our UK-based clinicians via a simple online consultation.
Lidocaine 2.5% and prilocaine 2.5% (EMLA)
Your medication will be delivered swiftly in unmarked packaging. Repeat prescriptions keep you topped up, and you can switch any time if you wish to try alternative treatments. We’re with you throughout your journey. You can access your medical team whenever you need to, via phone and email. How we make it possible for you to have longer-lasting sex. The only PDE5 inhibitors studied to any degree in this setting are sildenafil and tadalafil; vardenafil may also work, but more data are needed.
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Sildenafil is FDA-approved for the treatment of erectile dysfunction but not specifically for the treatment of premature ejaculation.
What is ejaculation?
The TCA most studied for treatment of premature ejaculation is clomipramine, which may be more effective than many SSRIs for this purpose. These actions are believed to be responsible for its antidepressant activity. Inhibition of serotonin probably gives rise to the SSRI-like activity that produces side effects (eg, inhibition of ejaculation). Topical anesthetics may reduce penile sensitivity and excitability and delay ejaculation. Topical anesthetic cream is probably the lowest-risk medication that can be used for premature ejaculation; it has no adverse systemic effects, in the absence of prior hypersensitivity to the medication on the part of the patient or his partner. If both conditions are present, sildenafil may help them both. Sildenafil in combination with an SSRI-type drug alleviates premature ejaculation better than an SSRI-type drug alone, as measured by prolongation of intravaginal ejaculatory latency time (IELT).
A Guide to Prescription Delay Pills
Desensitizing creams containing local anesthetics can also be useful in some cases; though not FDA-approved, they are believed to be of at least some efficacy and carry minimal risk. Premature ejaculation that relates to erectile dysfunction may resolve if the erectile difficulty is treated successfully. Drugs for the treatment of erectile dysfunction include sildenafil, vardenafil, tadalafil, alprostadil, and, possibly, an SSRI (if depression is causing the erectile dysfunction). The mechanism of action of SSRIs is linked to their inhibition of neuronal uptake of serotonin (5-HT) in the central nervous system (CNS). Various animal studies suggest that SSRIs have weak effects on norepinephrine and dopamine neuronal reuptake.
SSRIs for Premature Ejaculation
They do not antagonize adrenergic (eg, alpha1 -adrenergic, alpha2 -adrenergic, or beta-adrenergic), cholinergic, GABAergic, dopaminergic, histaminergic, serotonergic (5-HT1A, 5-HT1B, or 5-HT2), or benzodiazepine receptors; therefore, they have fewer adverse anticholinergic effects than tricyclic antidepressants (TCAs) do. Adverse effects of long-term SSRI use are a significant concern and should be considered by both the physician and the patient. These adverse effects include psychiatric and neurologic sequelae, dermatologic reactions, anticholinergic effects, fluctuation in body weight, cognitive impairment, drug interactions, and sexual side effects other than delayed ejaculation (eg, erectile dysfunction or loss of libido. Paroxetine is a potent SSRI used to treat premature ejaculation. Improvement may not be fildena ct evident until at least 3 weeks after the initiation of treatment. More drug-related adverse events may occur because 2 medications are being used rather than just 1. Tadalafil is FDA-approved for the treatment of erectile dysfunction but not specifically for the treatment of premature ejaculation.
| Pill Type | Effectiveness Rate (%) | Onset of Action | Duration of Effect | User Satisfaction (%) | Notes |
|---|---|---|---|---|---|
| Lidocaine-based sprays | 70-85 | 5-15 mins | 30-60 mins | 75 | Quick, numbing effect |
| Dapoxetine tablets | 60-80 | 1-3 hours | 1-3 hours | 70 | Prescription required |
| Natural supplements | 40-60 | Varies | Varies | 50 | Limited scientific evidence |
| Tramadol off-label | 75 | 30 mins | 2-4 hours | 80 | Additional risks involved |
Studies suggest that it may improve both conditions concurrently.
| Mechanism | Description | Example Drugs/Ingredients | Effect Duration | Notes |
|---|---|---|---|---|
| Local Anesthetic Effect | Numbs the penis to temporarily reduce sensitivity | Lidocaine, Prilocaine | 30-60 minutes | Used in creams/spays |
| Serotonin Reuptake Inhibition | Alters neurotransmitter levels to delay ejaculation | Dapoxetine, SSRIs | 1-3 hours | Prescription medications |
| Central Nervous System Modulation | Influences brain pathways controlling ejaculation | Tramadol, certain antidepressants | 2-4 hours | Off-label use |
Tadalafil in combination with an SSRI-type drug alleviates premature ejaculation better than an SSRI-type drug alone, as measured by prolongation of IELT. Inhibition of PDE5 increases cyclic guanosine monophosphate (cGMP) activity, which increases the vasodilatory effects of nitric oxide.
- Many pills aim to increase serotonin levels to delay ejaculation.
- Lifestyle factors like alcohol and smoking can worsen PE.
- Overuse of delay pills can cause dependence or reduced effectiveness.
- The placebo effect may improve perceived control with some pills.
- Consult a doctor for personalized treatment options.
Sexual stimulation is necessary to activate response.
- Some PE pills are designed to be used as needed before sex.
- Side effects vary based on pill composition and individual health.
- It's important to differentiate between temporary and chronic PE.
- Combining pills with mindfulness training can improve sexual control.
- Educating oneself about PE helps in making informed choices.
Increased sensitivity for erections may last 36 hours with intermittent dosing. For more frequent sexual activity (eg, twice weekly), a daily low-dose regimen may be recommended; men can attempt sexual activity at any time between daily doses.
| Brand Name | Active Ingredient | Duration of Effect | Typical Dose | Side Effects | Price Range ($) |
|---|---|---|---|---|---|
| Fortacin | Lidocaine | 30-60 minutes | 2 sprays per use | Numbness, irritation | 15-25 |
| Emla Cream | Lidocaine & Prilocaine | 30-45 minutes | Apply 10-15 mins before | Loss of sensation | 10-20 |
| Dapoxetine (Priligy) | Dapoxetine | 1-3 hours | 30 mg as needed | Dizziness, nausea | 1.5-2.5 per pill |
| Super Ejaculation | Tramadol (off-label) | 2-4 hours | 50 mg | Drowsiness, constipation | 12-18 |
| Amlodipine | Amlodipine (off-label) | Varies | 5-10 mg daily | Swelling, fatigue | 5-12 |
Tadalafil is available as 2.5-mg, 5-mg, 10-mg, and 20-mg tablets.
Frequently Asked Questions about PE Medication
As a rule, there is no contraindication for combined therapy with topical anesthetics, antidepressants, and behavioral therapy. Lidocaine and prilocaine are amide-type local anesthetic agents. Both agents stabilize neuronal membranes by inhibiting the flow of certain ions required for the initiation and conduction of nerve impulses, thus producing local anesthesia. Lidocaine and prilocaine are applied to intact skin under an occlusive dressing, providing dermal analgesia. The effectiveness of this approach when it is applied to the penis is unproved; an occlusive dressing might also be difficult unless the penis is covered with a condom or cellophane. Pindolol is a nonselective beta-adrenergic antagonist that has been shown to have 5-HT1A autoreceptor antagonist properties in the dorsal raphe nuclei.
A Holistic Path to Sexual Confidence
If there is no beneficial effect on premature ejaculation after 6 weeks or if adverse effects become troublesome, it should be discontinued in favor of an alternative treatment. Sertraline is a potent SSRI used to treat premature ejaculation. Citalopram is a potent SSRI used to treat premature ejaculation. Fluoxetine is a potent SSRI used to treat premature ejaculation. Drugs with SSRI-like side effects (eg, delaying sexual climax), such as certain TCAs, can be used to treat premature ejaculation. It is hypothesized that this 5-HT1A autoreceptor antagonism increases the synaptic content of 5-HT and subsequently potentiates the action of an SSRI medication. More studies are required before pindolol can be considered an ideal option for first- or second-line treatment of premature ejaculation. Pindolol is a nonselective beta-adrenergic antagonist used in combination with paroxetine for premature ejaculation refractory to paroxetine alone. Tramadol is an analgesic with centrally acting opioid activity (weak μ-opioid effect) in addition to inhibition of reuptake of 5-HT and norepinephrine.
Take Control and Restore Your Confidence
Innovative methods of delaying ejaculation enable longer-lasting sex without compromising on pleasure. Some treatments delay premature ejaculation by boosting serotonin levels in the body, and others work by gently reducing sensitivity in the penis. Treatments for premature ejaculation can take as little as 10 seconds to start working, and usually last long enough for satisfying sex. Premature ejaculation is a common sexual dysfunction where an individual ejaculates earlier than they’d like during sexual activity. It can cause distress and frustration and can occur for a variety of reasons.
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Psychological contributors may include anxiety, stress, or relationship issues, while physical factors can range from hormonal imbalances to certain neurological conditions. There are simple ways to treat premature ejaculation and medical intervention can provide individuals with tailored strategies that help solve the issue. Treatment for premature ejaculation often involves a combination of techniques. Behavioural strategies like the stop-start or squeeze techniques can be helpful. Medications such as selective serotonin reuptake inhibitors (SSRIs) or topical anaesthetics may be prescribed. It is hypothesized that the increased synaptic content of serotonin and norepinephrine at the level of the spinal cord and peripheral sensory nerves provides the mechanism for effective treatment of premature ejaculation.
- Dapoxetine is a fast-acting medication approved for PE.
- Combining medications with therapy enhances results.
- Some pills contain PDE5 inhibitors, like sildenafil, for better control.
- Side effects of pills may include dizziness or nausea.
- Always check for drug interactions before taking PE pills.
Tramadol is a centrally acting opioid analgesic that exerts its effect by combining opioid receptor activation with inhibition of norepinephrine and serotonin reuptake. Treatment of premature ejaculation is an off-label use of tramadol.
Tramadol (Ultram)
Counselling or therapy can also be beneficial when psychological factors are involved. Specialists in medicine, nutrition, performance, and diagnostics. BSc (Hons) MBBS MRCGP AFHEA MA (Hons) AFMCP I occasionally experienced premature ejaculation during sex. Not every time, but enough that it became something that was weighing on my mind whenever I got intimate with a girl. My life is so much better now that it seems silly to have wasted so much time not being satisfied.
What Causes Premature Ejaculation?
The service is accessible and easily takes away the embarrassment factor. Answer a few simple questions to get the treatment you need. No drug is specifically approved by the US Food and Drug Administration (FDA) for the treatment of premature (early) ejaculation. However, various agents have been safely and effectively used for this purpose. Selective serotonin reuptake inhibitors (SSRIs) and antidepressants with SSRI-like effects have been the most successful. Yes, a pill can sometimes help you last longer: SSRIs and certain topical anesthetics can delay ejaculation for many men, though they manage symptoms rather than cure the issue. There are several factors to consider, and combining medication with behavioral techniques often works best; side effects, causes, and when to talk to a doctor matter for choosing your next step, with important details and guidance below.
- Prescription pills must be taken under medical supervision.
- Natural remedies often include ingredients like ginseng or yohimbine.
- Over-the-counter delay sprays can also help.
- Consistent use of certain medications may reduce PE frequency.
- Psychological counseling can be effective for performance anxiety.
Discover what’s causing premature ejaculationSee if your symptoms need care todayFind out if premature ejaculation has serious causesLearn OTC options for sexual performance concernsFind a doctor for premature ejaculation treatmentDiscover medically valid home remedies for PEUnderstand if it could be a treatable condition Finishing sooner than you or your partner would like is more common than most men think.
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