- Tablets are compared on the six attributes people actually search for, with a straight answer on each rather than a single vague winner.
- Two of those attributes have no published answer at all, and this page says which and why instead of inventing figures.
- The cost per use method is explained so annual outlay can be worked out from how often treatment is needed.
- Every clinical figure is sourced to a named regulator rather than asserted.
Premature Ejaculation Tablets and How They Compare
There is no single top tablet for premature ejaculation, because only one tablet is licensed for this condition in the UK and the rest are borrowed from other uses. What can be compared, attribute by attribute, is which tablet is strongest, which acts fastest, which lasts longest, which carries the fewest side effects, how value works out and whether ratings tell you anything.
This page answers each attribute separately, gives the published figure where one exists, and states plainly where the record contains nothing.
Two of the six have no published answer. Longest lasting is one of them, and it is asked constantly. Rather than fill the gap with a guess, this page explains exactly what the regulator does publish and what it does not, which is more useful than a fabricated number.
Key things to know
- One tablet is licensed in the UK for premature ejaculation. Every other tablet used to delay ejaculation is prescribed off label.
- Strongest and most suitable are different questions. The higher strength produced a larger average gain and roughly double the nausea.
- No duration of effect window is published for the licensed tablet, so longest lasting cannot be answered from the record.
- All of these are prescription only. None can be bought without a consultation.
- Value depends on cost per use and how often treatment is needed, not on the pack size.
- Treatment suitability depends on an individual clinical assessment.
Which tablets are available in the UK
Two groups exist. One licensed option taken before an occasion, and several used off label and taken daily.
| Tablet | Licensed for this condition | How it is used | Class |
|---|---|---|---|
| Dapoxetine | Yes, adult men aged 18 to 64 | Before an occasion | Short acting SSRI |
| Citalopram, fluoxetine, paroxetine, sertraline | No, off label | Daily | Longer acting SSRIs |
| Clomipramine | No, off label | Daily | Tricyclic |
| Tramadol | No, off label | Before an occasion | Opioid analgesic |
NICE records the second group as options in use, all off label. None of them is authorised for this condition. Topical anaesthetics also exist but are not tablets, so they sit outside this comparison.
Every one of these is prescription only. There are no premature ejaculation tablets available over the counter in the UK.
Why an overall winner does not exist
Compare on attributes rather than on an overall ranking, because no trial has compared these tablets against each other. Any page naming an overall winner has constructed that ranking rather than measured it.
The dapoxetine evidence comes from a pooled analysis of 5 phase III randomised controlled trials involving 6,081 men, measured against placebo. The off label tablets have no comparable published figures for this condition at all. No systematic review in the UK regulator record compares them against each other.
So the honest comparison is attribute by attribute, using what is actually published for each.
| Attribute | Can it be answered? | Short answer |
|---|---|---|
| Strongest | Yes | The higher licensed strength produced the larger average gain |
| Fastest acting | Yes | The licensed tablet peaks in about 1 to 2 hours |
| Longest lasting | No | No duration of effect window is published |
| Fewest side effects | Partly | The lower strength has roughly half the nausea rate |
| Value | Yes, by method | Cost per use multiplied by how often treatment is needed |
| Highest rated | No | Ratings are a poor guide here, for a specific reason |
Strongest
The licensed tablet comes in two strengths, and the higher one produced the larger average improvement in the trials. Stronger is not automatically more suitable, and the trade off is measurable.
| Group | Timing at baseline | Timing at 12 weeks | Gain |
|---|---|---|---|
| Placebo | 0.9 minutes | 1.9 minutes | 1.0 minute |
| Lower strength | 0.9 minutes | 3.1 minutes | 2.2 minutes |
| Higher strength | 0.9 minutes | 3.6 minutes | 2.7 minutes |
The higher strength added roughly half a minute over the lower one on average. That is the entire gain from doubling the strength.
What the extra strength costs
| Side effect | Placebo | Lower strength | Higher strength |
|---|---|---|---|
| Nausea | 2.2% | 11.0% | 22.2% |
| Dizziness | 2.2% | 5.8% | 10.9% |
| Fainting | 0.05% | 0.06% | 0.23% |
Nausea roughly doubles. Dizziness roughly doubles. Fainting rises nearly fourfold from a very low base.
Read those two tables together and the honest summary is this: doubling the strength buys about half a minute and doubles the two effects men most often stop for. Whether that trade is worth making is a clinical judgement, and NICE is explicit that treatment is not initiated at the higher strength, and that a man who reacts badly to standing on the lower strength should not be moved up.
Strongest is a real attribute with a real cost attached. It is not a synonym for most suitable.
Fastest acting
The licensed tablet is the fastest of the tablets, reaching maximum plasma concentration in about 1 to 2 hours after intake. It is an on demand treatment, so it acts on the day it is taken.
The off label tablets are not fast at all. NICE sets out why: because longer acting SSRIs have a longer onset of action than the shorter acting dapoxetine, daily dosing is required. They only take effect once a level has built up over weeks.
That 1 to 2 hour figure is a pharmacokinetic measurement rather than a timing instruction, and this page gives no timing instructions. When to take anything comes from your prescriber and the leaflet in your pack.
One thing worth naming. The fastest tablet is not necessarily the one that suits you. Speed matters if you need cover on a specific occasion. It matters far less if treatment is needed most days, where a daily tablet may fit better.
Longest lasting
This cannot be answered from the published record, and that is the honest answer rather than a dodge.
What you can conclude
Two things, both useful.
The licensed tablet clearly does not carry across days. Plasma levels under 5% of peak by 24 hours make that plain, and it is why the tablet is used before an occasion rather than daily.
The daily off label tablets last in a different sense entirely. Their effect depends on a level held continuously, so the effect is present while they are being taken and goes when they stop. That is duration through continuous dosing rather than through a long acting single dose.
If duration is your priority, that difference is the real answer rather than a number of hours.
Fewest side effects
Partly answerable. Among the two licensed strengths, the lower one carries roughly half the nausea and dizziness, as the table above shows. That is a genuine comparison because both figures come from the same trials.
Across the wider group it is not answerable. The off label tablets have no published side effect rates for this condition, only rates from their use as antidepressants or as an analgesic, which is a different population taking a different amount for a different reason. Borrowing those figures and presenting them as premature ejaculation data is a common error.
What can be said is that the side effect profiles differ in kind rather than degree. The licensed tablet brings nausea and dizziness. Daily SSRIs bring the effects of continuous antidepressant exposure. Neither set transfers to the other.
Highest rated
Ratings are a poor guide in this condition, and there is a specific reason rather than a general scepticism about reviews.
Men taking a dummy tablet in the trials gained a full minute, which NICE treats as roughly the minimum clinically important change. So a man could take something inert, experience a real improvement, and write a sincere positive review of a product that did nothing.
That is not a criticism of anyone leaving reviews. It means a rating cannot distinguish a working product from a placebo response in a condition where the placebo response is this large. The published outcomes from 6,081 men are a better guide than any star average.
Value
Value is cost per use multiplied by how often treatment is actually needed. It is not the pack size, and for an on demand tablet the difference between those two things is large.
How to work it out
Divide what a pack costs by the number of tablets in it, then multiply by your realistic monthly frequency. Licensed UK packs contain 2, 3, 4 or 6 tablets, so the per tablet figure depends on which pack you are supplied.
Because the licensed tablet is used before an occasion, a man who needs it twice a month and a man who needs it three times a week will spend very different amounts on the same product. A daily off label tablet inverts that: outlay is predictable because dosing is continuous, but it accrues on days when no cover is needed.
What makes a comparison meaningless
A lower figure from a site that carries out no consultation is not a cheaper version of the same service. The gap is roughly the cost of the clinical step that was removed, and that step is what makes the supply lawful.
First time users
Expect a modest improvement rather than a transformation, and expect side effects to be most noticeable on the first occasion.
NICE records that a check of blood pressure and pulse, lying and standing, is expected before treatment is initiated, and that patients should be counselled on symptoms such as light headedness soon after standing. Read the leaflet in your pack before the first occasion rather than after.
The mistake worth avoiding
Do not make an occasion that matters to you the first time you ever take it.
Nausea affects between one in nine and one in five men depending on strength, and dizziness up to one in nine. Discovering either for the first time on an important occasion is poor timing, and the anxiety that follows can undo the benefit you were after.
Tablets without a prescription
No such thing exists in the UK. Every tablet used to delay ejaculation here is prescription only, and no lawful route skips a clinical assessment.
The licensed tablet is classified as available only by prescription. The off label options are antidepressants and an analgesic, all prescription only in their own right.
So any site offering these tablets without a prescription is not operating lawfully, and there is no assurance about what arrives. Products sold openly without a consultation are generally supplements rather than the tablets described here, and they are not held to the standards a licensed medicine must meet.
Given that a dummy tablet produced a one minute gain in the trials, treat any unproven product's claims with the scepticism that figure deserves.
Do these tablets work?
The licensed tablet produces a statistically significant and clinically meaningful improvement for many men. It is not a cure, and it does not work for everyone.
Nothing in this comparison cures premature ejaculation. The licensed tablet acts on the occasions it is used and the underlying pattern returns once it clears. Daily tablets hold an effect only while being taken.
Approaches that build control are the ones with a claim to lasting change, which is why combining a tablet with behavioural work is a common pairing rather than a choice between the two. Pelvic floor exercises and the stop start and squeeze techniques teach control that does not depend on a medicine, and counselling addresses performance anxiety, which no tablet acts on.
When tablets are not right
Tablets are ruled out for a substantial number of men.
Who they are not suitable for
The licensed tablet is contraindicated in significant cardiac conditions such as heart failure, significant ischaemic heart disease or a history of fainting, in a history of mania or severe depression, and in moderate and severe liver impairment. Severe kidney impairment places it in the not recommended category.
It is contraindicated alongside other serotonin reuptake inhibitors, tricyclics, monoamine oxidase inhibitors, lithium, linezolid, tramadol, St John's Wort, triptans, certain antifungals, telithromycin and PDE5 inhibitors.
If you take something for erectile dysfunction that is directly relevant, since NICE records that dapoxetine should not be used with PDE5 inhibitors and gives sildenafil as its example. The ED treatments available are assessed separately for exactly that reason. Men treated for high blood pressure should raise it too, because the tablet can lower blood pressure on standing.
When it may not be premature ejaculation at all
Occasional episodes do not meet the definition. Alcohol, recreational drugs and tiredness all shorten timing temporarily in men with no underlying condition, and recreational drugs in particular mimic the pattern without causing it.
Retrograde ejaculation is a different condition entirely, where semen travels backwards into the bladder, so the noticeable feature is little or no fluid rather than short timing. No tablet here treats it.
Assessment is history led. Blood tests and further investigations are not routine, and the NICE evidence summary sets out no panel of them.
Getting a tablet prescribed
Every option here requires a consultation reviewed by a prescriber before supply. A remote consultation is lawful; what makes it lawful is the assessment rather than the website.
The assessment establishes your age, cardiac history, mental health history, liver and kidney function, everything else you take including anything bought without a prescription, and how you react to standing up.
Worth knowing before you start: the contraindication list above rules the licensed tablet out for a meaningful number of men before any comparison of attributes becomes relevant. Reading through the full range of PE treatments beforehand means arriving at a consultation knowing which of these six attributes actually matters in your case.
Medical disclaimer
This page is general information, not medical advice, and gives no dosing or timing instructions. These tablets are prescription only and should be used only under the supervision of an appropriately qualified prescriber after an individual assessment. Always read the patient information leaflet supplied with your medicine.
