Tablets for Premature Ejaculation, and How They Compare

• Every tablet used for premature ejaculation in the UK is set out here, with its licensing status stated rather than glossed over
• On demand tablets and daily tablets are separated properly, because they are used in completely different ways
• The tablet and spray trial figures are shown side by side, together with an honest explanation of why they cannot be read as a head to head result
• Standard website pricing is stated openly, with no urgency and no claim about being the lowest anywhere

Tablets fall into two groups in the UK: one licensed tablet taken before an occasion, and several tablets prescribed off label and taken daily. Both groups work through serotonin, and that single split explains most of what people find confusing when they compare them.

The two groups are used in opposite patterns. One is taken before an occasion. The others are taken every day whether an occasion arises or not. They differ in how quickly they act, in what the evidence base covers, and in who carries responsibility for the prescribing decision.

Key Things to Know

• One tablet is licensed in the UK specifically for this condition. Every other tablet used for it is prescribed off label
• The licensed tablet is taken on demand. The off label tablets are taken daily, because their onset of action is longer
• All of them are prescription medicines. None can be bought over the counter
• In the trials behind the licensed tablet, ejaculatory latency at 12 weeks rose from 0.9 minutes to 3.1 or 3.6 minutes depending on strength, against 1.9 minutes on placebo
• Nausea, dizziness and headache are recorded as very common, and the rates roughly double between the two strengths
• Treatment suitability depends on an individual clinical assessment

What Is Available in the UK

There is one licensed tablet and several prescribed off label. All are prescription medicines, and none is available over the counter.

The Licensed Tablet

Dapoxetine, sold as Priligy, is licensed for the treatment of premature ejaculation in adult men aged 18 to 64 years. It is a short-acting selective serotonin reuptake inhibitor and is available in 30 mg and 60 mg strengths.

A UK generic version of dapoxetine also has a marketing authorisation. The MHRA's records show UK marketing authorisations for dapoxetine 30 mg and 60 mg film-coated tablets granted on 29 March 2023.

Tablets Prescribed Off Label

NICE identifies several other medicines that may be used off label for premature ejaculation. These include daily treatment with longer-acting SSRIs such as citalopram, fluoxetine, paroxetine and sertraline, daily clomipramine, and on-demand tramadol.

Off-label prescribing means that the medicine is being used outside the terms of its marketing authorisation. It does not, by itself, mean that the medicine is unlawful or that the treatment is inherently unsafe. The prescriber remains responsible for deciding whether the treatment is appropriate for the individual patient and for explaining the relevant risks and alternatives.

On Demand Versus Daily

The difference is not preference, it is pharmacology.

How Occasional Tablets Work

A tablet used before an occasion has to reach an effective concentration quickly and clear quickly. Dapoxetine does exactly that. Time to maximum plasma concentration is about 1 to 2 hours after intake, and plasma levels are less than 5% of peak by 24 hours post dose.

That profile is why it can be used occasionally. Nothing accumulates, so there is no need to keep taking it between occasions.

How Daily Tablets Work

Daily tablets have a longer onset of action, so the effect depends on a concentration built and held over time rather than on a single tablet.

NICE puts the reason plainly: because longer acting SSRIs such as citalopram, fluoxetine or paroxetine have a longer onset of action than the shorter acting dapoxetine, they need to be taken on a daily basis.

Which Pattern Suits Which Situation

How These Tablets Work

They act on serotonin, a chemical messenger involved in the reflex that controls ejaculation. Raising serotonin activity at nerve endings lengthens that reflex rather than dulling sensation.

Serotonin and Ejaculatory Control

SSRIs reduce the reuptake of serotonin by nerve cells, allowing serotonin signalling to remain active for longer. The precise relationship between this pharmacological action and delayed ejaculation is more complicated.

For dapoxetine, the product information and clinical guidance describe the mechanism in terms of serotonin reuptake inhibition and increased serotonergic activity. It is better to describe this as the proposed mechanism rather than suggesting that the complete pathway is established beyond doubt.

Why a Short Acting Tablet Exists At All

Serotonin reuptake inhibitors have been used for this purpose for a long time, but the standard ones were built to hold a steady level for weeks.

A tablet designed to rise and fall within a day allows treatment on the occasions that matter rather than dosing to the calendar. That is the entire reason a short acting version of a very familiar drug class was developed and licensed.

How Quickly They Act

It depends which tablet. The licensed occasional tablet acts on the day it is taken. Daily tablets build over weeks.

Two things worth saying plainly. Peak plasma concentration is a pharmacokinetic measurement, not an instruction about when to take anything. Timing comes from your prescriber and the leaflet in the pack.

And judge any tablet over several occasions rather than one. The trials behind the licensed tablet ran from 9 to 24 weeks precisely because a single occasion tells you very little.

How Effective They Are

The licensed tablet produces a measurable improvement in most men but not all, and the size of the effect is more modest than the marketing around these products suggests.

The Trial Figures

The evidence comes from a pooled analysis of 5 phase III randomised controlled trials involving 6,081 men aged 18 and over, running from 9 to 24 weeks. The primary outcome was ejaculatory latency measured with a stopwatch held by the partner.

Patient reported outcomes were recorded too. Perceived control over ejaculation was rated good or very good by 26.2% of men on treatment against 11.2% on placebo, and satisfaction was 37.9% against 24.4%.

Read those last two figures carefully. They mean roughly three quarters of men on treatment did not rate their control as good or very good. That is not a reason to avoid treatment, but it is a long way from the picture painted by pages promising transformation.

No Tablet Cures the Condition

Searches for a cure are looking for something that does not currently exist as a tablet.

The licensed tablet works on the occasions it is used, but it does not retrain anything and its effect does not persist once the drug has cleared. Daily tablets maintain an effect only while being taken.

The approaches with a plausible claim to lasting change are the ones that build a skill or address the underlying pattern, which is why combining a tablet with behavioural techniques is a common and sensible pairing rather than an either or choice. The full range of PE treatments covers both routes.

Tablets Versus Sprays

They work in completely different ways. Tablets act on serotonin from inside the body. Sprays are numbing agents applied to the skin that reduce sensitivity locally.

The Two Evidence Bases Side By Side

The Practical Differences That Actually Matter

Since the numbers cannot settle it, the choice usually comes down to practical factors.

• Sprays act within minutes. Tablets need longer to reach peak concentration
• Tablets are swallowed and affect the whole body, so contraindications and drug interactions matter a great deal. Sprays act locally
• Sprays reduce sensation, and the product information records that this can affect a partner as well as the user
• Sprays have barrier compatibility considerations. The licensed spray is compatible with latex rubber, polyisoprene, nitrile and silicone but must not be used with polyurethane condoms
• Tablets suit men who would rather not apply anything. Sprays suit men who cannot take the tablet for clinical reasons

Both are prescription decisions. Neither should be chosen from a comparison table alone.

Side Effects

The recorded effects of the licensed tablet come from that same trial programme, grouped by how often they were reported.

Two entries deserve attention. Erectile dysfunction appears as an uncommon effect, which surprises men who assumed a tablet for one problem could not cause the other. And the rare category contains heart rhythm effects, which is why cardiac history is asked about before supply rather than after.

Effects That Change With Strength

Nausea roughly doubles between the two strengths, so the profile is not fixed across the range. Dizziness follows the same direction. Headache is recorded as very common but is not broken down by arm, so no percentage by strength can honestly be given for it.

Discontinuation for any reason was 31.1% on treatment and 28.9% on placebo, a narrower gap than most men expect.

Dizziness and Fainting

Dizziness is very common and syncope is uncommon. Syncope can arrive at any point according to the product information, with or without warning symptoms beforehand.

Because of that, patients are warned to avoid situations where injury could result, including driving or operating hazardous machinery. If you feel dizzy or light headed, particularly soon after standing, sit or lie down until it passes and raise it with your prescriber or pharmacist before taking another tablet.

If dizziness comes with chest pain or an irregular heartbeat, seek medical help rather than waiting for your next consultation.

Alcohol and Grapefruit

The advice recorded by NICE is that patients should be advised not to use dapoxetine in combination with recreational drugs or alcohol.

That is unusually direct for alcohol advice, and there is a reason. The product information records that combining the tablet with alcohol increases somnolence and dizziness. Since dizziness is already very common and fainting is the rare event driving the safety warnings, alcohol can increase dizziness, drowsiness and the risk of injury from fainting, so the patient information advises avoiding alcohol while taking dapoxetine.

Grapefruit juice belongs in the same section. It is a potent CYP3A4 inhibitor and the product information advises avoiding it within 24 hours before taking the tablet.

Never Doubling Up

The product information is explicit that the tablet must not be taken more frequently than once every 24 hours.

Dapoxetine should not be taken more than once in a 24-hour period. If you are unsure whether you have taken a dose, check with a pharmacist or prescriber rather than taking another tablet.

Long Term Use

Dapoxetine can be continued under prescriber supervision when treatment remains appropriate, but the pivotal clinical trials were relatively short, generally lasting 9 to 24 weeks.

That means the evidence base is much stronger for treatment over weeks or several months than for making confident claims about many years of continuous use. Questions such as long-term tolerance should therefore be discussed with the prescriber rather than assumed from the short-term trial data.

For daily off-label medicines, the decision is different because treatment involves continuous exposure. If a medicine stops working or side effects develop, the appropriate response is a clinical review rather than increasing the dose yourself.

When Tablets Are Not the Right Starting Point

Tablets are not the only route, and for some men they are not where to begin.

• When the licensed tablet is contraindicated for you
• When erectile difficulties are also present, they should be assessed because addressing the erectile problem may form part of managing the overall sexual difficulty.
• When the problem is occasional rather than persistent, the clinician may first explore situational factors rather than assuming that ongoing medication is required.
• When relationship difficulties or performance anxiety appear to be contributing substantially, addressing those factors may be an important part of treatment alongside, or instead of, medication.
• When lifestyle factors such as alcohol intake are contributing and have not been addressed.

What Investigation Involves

A consultation for this condition is based on history rather than tests. Blood tests are not routine, and the NICE evidence summary does not set out a panel of investigations for it.

Hormone tests, including follicle stimulating hormone, are mentioned on some pages as part of assessing an ejaculation problem. Those do not appear in the UK regulator record for this condition, so this page does not present them as standard. If a prescriber does want further tests, it will usually be because something in your history points to a specific reason.

What They Cost

Priligy tablets are listed on our site at a standard price of £19.79. That is our regular listed price, not a first order or promotional figure.

Licensed UK packs contain 2, 3, 4 or 6 tablets, reflecting that the tablet is used before an occasion rather than daily. Annual cost therefore depends entirely on how often treatment is used, so a single pack price tells you very little about what a year costs.

Compare only suppliers who carry out a genuine consultation. A lower figure from a site that skips the clinical step is not a cheaper version of the same service.

Medical Disclaimer

This page is general information, not medical advice, and contains no dosing schedule or timing instructions. These are prescription medicines and should only be used under the supervision of an appropriately qualified UK prescriber after an individual assessment.

Always read the patient information leaflet supplied with your medicine, and speak to a prescriber or pharmacist about your own circumstances. Suspected side effects can be reported through the MHRA Yellow Card scheme.