Dapoxetine and Fortacin: the two licensed treatments for premature ejaculation

This page is medicine information, not an advert. It describes two prescription only medicines licensed in the UK for premature ejaculation so that people who have been offered them, or who want to understand the options before speaking to a clinician, can read something accurate. Whether either is suitable is a decision for a prescriber after an assessment.

Dapoxetine

Dapoxetine is a selective serotonin reuptake inhibitor, but an unusual one. Most SSRIs are taken daily for weeks and reach a steady level in the body. Dapoxetine is absorbed quickly and cleared quickly, which is why it is licensed as an on-demand treatment rather than a daily one ^{[1, 3]}.

How it is taken. One tablet, with a full glass of water, one to three hours before sexual activity, and no more than one dose in any 24 hours ^[1]. It can be taken with or without food. Treatment is usually started at the lower strength and only increased on review.

What it does. Serotonin signalling is involved in the ejaculatory reflex. Increasing it briefly delays that reflex. In the licensing trials the effect was measured as intravaginal ejaculatory latency time, which increased by a few minutes on average compared with placebo — a change many men notice, though the averages conceal a wide spread of individual responses.

Common side effects listed in the product information include nausea, dizziness, headache, diarrhoea and insomnia ^[1]. Two warnings matter more than the rest:

• Fainting. Dapoxetine can cause syncope, sometimes preceded by light-headedness or sweating. The product information advises adequate fluid intake and avoiding situations where a faint could cause injury, and warns against getting up quickly after sitting or lying down ^[1].
• Alcohol. Combining dapoxetine with alcohol increases the risk of fainting and injury, and the product information advises against it ^[1].

Interactions. Dapoxetine must not be taken with monoamine oxidase inhibitors, thioridazine, other SSRIs or SNRIs, or within the washout periods the product information specifies around them ^[1]. Potent CYP3A4 inhibitors — including ketoconazole, itraconazole, ritonavir and clarithromycin — are contraindicated. Combining it with recreational drugs is unsafe. It is not licensed for men with significant heart disease, moderate to severe liver impairment, or a history of mania or severe depression ^[1].

Men also taking an erectile dysfunction medicine should raise this specifically. Dapoxetine and PDE5 inhibitors both lower blood pressure to some degree, and the product information advises caution with the combination ^[1].

Fortacin

Fortacin is a metered-dose spray containing lidocaine and prilocaine, two local anaesthetics ^[2]. It works on the surface rather than through the bloodstream: reducing sensation in the glans raises the threshold at which the ejaculatory reflex fires.

How it is used. Three actuations sprayed onto the head of the penis, five minutes before sex ^[2]. The foreskin, where present, is retracted first. The product information gives a maximum of three doses in 24 hours, each at least four hours apart.

Practical points. Wiping the head of the penis after five minutes reduces transfer to a partner and is advised when a condom is not used ^[2]. Some men find sensation is reduced more than they want; using it for a shorter contact time before wiping is something to discuss with the prescriber rather than improvise. Fortacin is compatible with latex and polyurethane condoms according to the product information, but not all barrier products have been tested.

Side effects are mostly local — reduced sensation, burning or numbness in the genital area, and in some cases the same in a partner ^[2]. Systemic absorption is low but not zero, and it is not suitable for people with a known allergy to local anaesthetics of the amide type.

Choosing between them

Neither is better in the abstract. A tablet taken an hour or more in advance suits some couples; a spray used five minutes before suits others. Dapoxetine has more systemic interactions and cautions; Fortacin has more effect on sensation. A man with both erectile difficulty and early ejaculation is often advised to address the erectile problem first, because anxiety about losing an erection can itself drive rapid ejaculation.

Behavioural approaches — the stop-start and squeeze techniques, pelvic floor work, and couple-based therapy — have their own evidence base, and the strongest results in trials have come from combining a behavioural approach with a medicine rather than relying on either alone. Our guide to premature ejaculation covers those in more detail.

Buying safely

Both medicines are prescription only in the UK ^[5]. Sites offering either without any assessment, or offering “dapoxetine” alongside unlicensed combinations, are not operating legally in the UK, and the contents of what arrives cannot be relied on. A UK-registered pharmacy will always ask questions about your health and current medicines before supplying.

This article is for general information and isn’t a substitute for advice from your own clinician. If you feel unwell, contact your GP or NHS 111. In an emergency, call 999.