Role in Improving Sexual Satisfaction and Relationship Quality

100 patients with PE were randomly allocated into two groups. In group 1, patients were given paroxetine 10 mg daily and in group 2, patients received paroxetine 10 mg plus tadalafil 10 mg daily.

Additional information

P values were considered statistically significant at P < 0.05. To determine the sample size using the G*Power Version 3.1.9.4, we used the IELT to detect a 60-second (1-minute) variation among groups A, B, and C (based on the previous studies). A standard deviation of 150 seconds (2.5 minutes) was used for the sample size calculation. The Cohen’s d effect size was approximately estimated to be 0.4. Therefore, with an alpha of 0.05 using the ANOVA test, the enrollment of a total of 84 patients in each group will provide 90% power.

Clinical monitoring

The sample size was increased to compensate for any attrition bias. We evaluated the eligibility of 385 patients for this research. After exclusions, 92 patients were included in group A and received tadalafil (5 mg) for 12-weeks period, 91 patients were included in Group B and received dapoxetine (30 mg) for 12-weeks period, and 89 patients were included in Group C and received tadalafil (5 mg) and dapoxetine (30 mg) together for 12-weeks period (). All patients reported the medication intake in their files with no dropouts but the needed time for drug intake (two hours before sexual intercourse) was not regularly respected by the patients. No statistically substantial variations were found before treatment among the three groups as regard age, BMI, smoking, fasting blood sugar, FSH, LH, testosterone, E2, and prolactin levels (). At the 3rd month follow-up, the mean IELT in groups 1 and 2 were 4.5 ± 1.5 and 5 ± 2.4 minutes, respectively (P = 0.285) and at the 6th month follow-up, the mean IELT were 4.8 ± 1 and 5.3 ± 2 minutes, respectively (P = 0.278).

The authors concluded that tadalafil can increase the mean IELT and can be used for treatment of PE in combination with paroxetine.

• Sildenafil is also used in treating certain cases of high blood pressure in lungs.
• Dapoxetine’s primary goal is to delay ejaculation, increasing sexual confidence.
• Both drugs are typically prescribed after clinical assessment of sexual health issues.
• Proper storage of sildenafil and dapoxetine involves keeping away from moisture and heat.
• Sildenafil can cause visual disturbances as a rare side effect.
• Dapoxetine may sometimes lead to mood changes or irritability.
• Both medications are contraindicated with recreational drugs for safety.
• Sildenafil requires careful dose titration for optimal effectiveness.
• Dapoxetine’s use is generally limited to short-term management of PE.
• Patients should report any side effects such as chest pain or severe dizziness.
• Sildenafil’s absorption can be affected by high-fat meals, delaying effects.
• Dapoxetine should be ingested with water, on an empty stomach if possible.

Flushing episodes, as a side effect, were more obvious in group 2 (P = 0.000) [Citation18].

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Highly statistically substantial variations were found among group A and group C and among group B and group C regarding satisfaction scores and Δ satisfaction in favor of group C (P < 0.001; ). No statistically substantial variations were found among groups regarding the side effects except for headache and flushing which were more prominent in group C (P = 0.036 and P < 0.001, respectively; ). Premature ejaculation leads to negative consequences on the partner’s life. Although the importance of this area of male sexual health, it is usually neglected [Citation16]. Our results showed that on-demand administration of tadalafil 5 mg or dapoxetine 30 mg was beneficial for dapoxetine sildenafil online treating PE, but improvement was better with a combination of both drugs. performed a meta-analysis involving 17 trials with 5,739 participants.

• Sildenafil enhances erectile function by relaxing smooth muscle tissue.
• Dapoxetine’s action involves prolonging ejaculatory latency.
• Both medications are available in tablet form with varying dosages.
• Sildenafil’s effects last about 4-6 hours, depending on individual factors.
• Dapoxetine’s onset is usually within 1-3 hours, with effects lasting up to 4 hours.
• Never double dose of sildenafil or dapoxetine if one dose is missed.
• Sildenafil should be avoided in patients with cardiovascular conditions without doctor advice.
• Dapoxetine is not approved for women or children.
• Patients should inform doctors about any other medications to prevent interactions.
• Alcohol can diminish sildenafil’s effectiveness and increase side effects.
• Dapoxetine may require dose adjustment based on response and tolerability.
• Using both drugs together may enhance sexual performance but increases risk of adverse effects.

Seven single medications (paroxetine, fluoxetine, dapoxetine, sertraline, sildenafil, tadalafil and placebo) and five combination therapies were included (tadalafil with sildenafil, tadalafil with fluoxetine, paroxetine with sildenafil, dapoxetine with mirodenafil, and sildenafil with fluoxetine).

How long does dapoxetine make me last?

Patients were followed up every month for three months. The local Ethics Committee approved tadalafil dapoxetine the study. The ethical approval code is: SVU-MED-URO 016-1-21-4-183. The study was performed according to the ethical declaration of Helsinki. Every participant signed a written statement of permission.

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The Statistical Program for Social Science (SPSS) Version 24.0 was used for the statistical analysis. The mean and standard deviation (M ± SD) were used to represent quantitative data. The frequencies and percentages [n(%)] were used to convey qualitative data. Nonparametric data were compared using a Chi-squared (x2) test. When contrasting more than two means, a one-way analysis of variance (ANOVA) was utilized if the data was normally distributed and Kruskal Wallis (KW) test was utilized if the data was not normally distributed. They concluded that the combination of phosphodiesterase-5 inhibitors and SSRIs were more effective than monotherapy [Citation19].

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Patients were randomly assigned into 4 groups: dapoxetine was given to the first group, paroxetine to the second, and tadalafil with dapoxetine to the third, and the fourth received paroxetine combined with tadalafil for one month. The mean pretreatment and posttreatment IELT among groups were 57.8 ± 34.2 vs 204.4 ± 82 in group 1, 59.4 ± 32 vs 208.8 ± 65.1 in group 2, 56.1 ± 31 vs 269.9 ± 100.4 in group 3, and 54.6 ± 30.9 vs 259.3 ± 83.4 in group 4. They concluded that combination therapy (tadalafil with dapoxetine or paroxetine) was associated with better improvement in the IELT than mono-therapy. No significant differences were detected between the groups regarding the side effects except for headache and flushing which were significantly higher in the groups who received a combination therapy [Citation17]. In the management of PE, Moudi et al. Elbakary and colleagues evaluated the effectiveness of sildenafil combined with dapoxetine for treating PE.

Limitations of the study

If an individual met the International Society for Sexual Medicine’s requirements which describes PE as ejaculation that always happens within a minute, following vaginal penetration during the initial sexual encounter (lifetime PE), or a substantial decline in IELT, often within less than 3 minutes (acquired PE), with detrimental personal effects, including anxiety, annoyance, and/or avoiding of sexual intimacy, PE was assumed to be present. All patients were evaluated by filling a detailed documented medical history including the International Index of Erectile Function (IIEF) 5- items questionnaires to exclude those with erectile-dysfunction [Citation14]. All patients were instructed to report in a written diary the correct medication intake in their files. Inclusion criteria were heterosexually active men aged more than 20 years with PE (patients with type 1 or lifelong PE were not discriminated from those with acquired type) with IIEF > 22 and at least a three-months period in a stable sexual relationship preceding the research. Exclusion criteria were individuals with diabetes mellitus, chronic prostatitis, erectile dysfunction (IIEF <22), neurological disorders, penile implants or deformities, homosexual men and those who were taking medications for neurological or psychiatric disorders and non-compliant patients.

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Each patient received a comprehensive pretreatment evaluation that include medical history, clinical assessment, fasting blood glucose level, and hormonal profile (blood glucose and testosterone were measured in the early morning while the patient was fasting). Each patient was assessed with measurements of IELT using a stopwatch (held by the partner) at baseline and after treatment. A full explanation about the measurement of the ILET (beginning with intromission and ending with ejaculation) was done. The Kim and Paick scale, which ranges from 0 to 5, while 0 denoting severe dissatisfaction and 5 denoting extreme pleasure, was used to evaluate sexual satisfaction in all participants prior to and following therapy [Citation15]. Patients were also advised to note any side effects following medication delivery in their follow-up sheets both during medication intake and at the end of treatment. Eighty patients with PE without erectile dysfunction were allocated into 2 groups.

• Sildenafil does not protect against sexually transmitted infections.
• Dapoxetine does not reduce the frequency of ejaculation but delays it.
• Patients on nitrate therapy should avoid sildenafil due to severe hypotension risk.
• Dapoxetine is often used in combination with behavioral therapy for PE.
• Sildenafil may interact with medications for HIV and other conditions.
• Dapoxetine’s safety profile is well-established for short-term use.
• Both medications should be stored safely away from children.
• Sildenafil can sometimes cause priapism, which requires emergency treatment.
• Dapoxetine should be discontinued if adverse effects are intolerable.
• Combining sildenafil with alcohol can worsen hypotensive side effects.
• Dapoxetine may also cause dry mouth and blurred vision in some users.
• Regular medical check-ups are recommended during long-term use of these drugs.

The 1st group (40 patients) were given on- demand dapoxetine 30 mg for three months, the 2nd group (40 patients) received an on-demand combination of dapoxetine 30 mg and sildenafil 50 mg for three months. The means of pretreatment and posttreatment IELT among groups were 51.72 ± 12.53 vs 322 ± 24.62 in group 1 and 56.6 ± 10.93 vs 352.5 ± 29.33 in group 2 (P < 0.001).

Side effects

The mean of IELT in all the studied patients was 39.3 ± 10.5 seconds, median was 37 (31.25–46) seconds with minimum IELT of 25 seconds and maximum IELT of 65 seconds. When comparing IELT before treatment and at the end of treatment (12 weeks posttreatment), there were highly statistically substantial variations in group A (39.4 ± 10 sec. When comparing group C with either group A and group B, no significant variation was found (P = 0.580) for the mean pretreatment IELT measurements (group A: 39.4 ± 10 sec; group B: 40.8 ± 11.2 sec; and group C: 37.9 ± 10.9 sec; ). When comparing group C with either group A and group B, highly statistically substantial variations were found in the mean IELT at 4, 8, and 12 months posttreatment in favor of group C (P = < 0.001), also highly statistically substantial variations were found in the mean Δ IELT in favor of group C (P < 0.001; ). Post hoc tests at 4, 8, and 12 weeks vardenafil with dapoxetine tablets posttreatment revealed no statistically substantial variations in the mean IELT (P = 0.346, P = 0.508, P = 0.442 respectively) or Δ IELT (P = 0.340) among group A and group B.

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Highly statistically substantial variations were found among group A and group C and among group B and group C regarding IELT and Δ IELT in favor of group C (P < 0.001; ). When comparing satisfaction scores before treatment and at the end of treatment (12 weeks posttreatment), there were highly statistically substantial variations in group A (1 ± 0.6 vs 3 ± 0.6; p < 0.001), group B (1 ± 0.7 vs 3.2 ± 0.6; p < 0.001), and group C (1.1 ± 0.8 vs 4.1 ± 0.8; p < 0.001) (). When comparing group C with either group A and group B, no significant variation was found (P = 0.821) in the mean pretreatment satisfaction scores (group A: 1 ± 0.6; group B: 1 ± 0.7; and group C: 1.1 ± 0.8; ). When comparing group C with either group A and group B, highly statistically substantial variations were found in the mean satisfaction scores at 4, 8, and 12 months posttreatment in favor of group C (P = < 0.001), also a highly statistically substantial variations were found in the mean Δ satisfaction scores in favor of group C (P < 0.001; ). Post hoc tests at 4, 8, and 12 weeks post-treatment revealed no statistically substantial variations in the mean satisfaction scores (P = 0.71, P = 1, P = 0.353 respectively) or Δ satisfaction scores (P = 0.011) among group A and group B.