Optimal Dosing Strategies for Sildenafil in PE Management

You stop all sexual stimulation until the feeling passes and then resume intercourse. When you approach orgasm, you pause, and you (or your partner) use the thumb and two fingers to gently apply pressure just below the head of the penis for about 20 seconds. Then release the squeeze, and resume sexual activity. Both techniques sildenafil 20 mg tablets can be repeated as often as needed. Another option is to apply a topical numbing agent to the head of the penis. The most convenient types are sprays that contain lidocaine or a similar anesthetic product.

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Azam U. Late-stage clinical development in lower urogenital targets: Sexual dysfunction. Taber MT, Wright RN, Molski TF, Clarke WJ, Brassil PJ, Denhart DJ, Mattson RJ, Lodge NJ. Neurochemical, pharmacokinetic, and behavioral effects of the novel selective serotonin reuptake inhibitor BMS-505130. Pharmacol Biochem Behav 2005;80:521–8.

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Aloosh M, Hassani M, Nikoobakht M. Seminal plasma magnesium and premature ejaculation: A case-control study. Q. I am in a new sexual relationship and surprised that at age 63 I have premature ejaculation. My partner is understanding, but it bothers me. You will need to test this out to see if your partner finds it causes irritation.

• Premature ejaculation is classified as lifelong or acquired.
• Lifelong PE begins from the first sexual experience.
• Acquired PE develops after a period of normal function.
• Sensory sensitivity might influence PE severity.
• Partner communication can improve PE management.
• Pelvic floor exercises may help control ejaculation.
• Squeeze techniques can delay climax.
• Pharmacological options include SSRIs, dapoxetine.
• Biofeedback therapy is an emerging PE treatment.
• Erectile dysfunction and PE can coexist.
• Proper diagnosis ensures effective treatment.

(Using condoms also might help by reducing sensation.) Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), can counter premature ejaculation because delayed orgasm is a common side effect. Some studies suggest that paroxetine (Paxil) may be the most helpful, but any of the other SSRIs also should work, such as fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). However, they need to be taken daily, since they don't work on an as-needed basis. Men who have both ED and premature ejaculation should first address their ED. That usually entails taking medication like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), or avanafil (Stendra). After this, they can add an SSRI.

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Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Sildenafil (Revatio, Viagra) is a generic prescription medication used to treat erectile dysfunction and pulmonary arterial hypertension in adults. Sildenafil, which is also called sildenafil citrate, comes as an oral tablet. The drug also comes as an oral liquid suspension and IV infusion. However, this article does not cover these forms.

MeSH terms

Premature ejaculation is common in older men, especially when beginning a new relationship. Even men with erectile dysfunction (ED), who have difficulty getting and holding an erection, can experience premature ejaculation. It's great that your partner is so understanding, and it benefits you both to be open about the issue and discuss your options together. The official definition of premature ejaculation is uncontrolled and unwanted ejaculation within a minute or less of penetration. Personally, I think this definition is too limiting. It only covers the side effects of sildenafil oral tablets. If you’d like to learn more about these forms, talk with your doctor. As with other drugs, sildenafil can cause side effects (adverse effects).

Parameter	Value	Explanation
Absorption	Fast, begins within 30 min	Peak plasma concentration achieved in 1 hour
Bioavailability	~40%	Due to first-pass metabolism
Metabolism	Liver (CYP3A4 enzyme)	Adjust dose if on CYP3A4 inhibitors
Excretion	Feces (~60%), urine (~30%)	Slow process, affects timing of doses

It’s typically taken as a long-term treatment.

Author information

Available at NEW01624.html (accessed March 24, 2008). Rosen RC, Casey R, Levine SB, Mudumbi R, Tesfaye F, Hasmonay R. Treatment of premature ejaculation (PE) with dapoxetine (DPX) is not associated with suicidality. Healy D, Whitaker C. Antidepressants and suicide: Risk-benefit conundrums.

the Sildenafil Study Group: Oral sildenafil in the treatment of erectile dysfunction

Girgis SM, El-Haggar S, El-Hermouzy S. A double-blind trial of clomipramine in premature ejaculation. Clomipramine as a treatment for rapid ejaculation: A double-blind crossover trial of fifteen couples. Effective daily treatment with clomipramine in men with premature ejaculation when 25 mg (as required) is ineffective. Maier U, Koinig G. Read on to learn about potential common, mild, and serious side effects. For a general overview of sildenafil, including details about its uses, refer to this article. Your doctor can also tell you more about sildenafil. Sildenafil can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days to weeks.

About the Author

Assessment of as needed use of pharmacotherapy and the pausesqueeze technique in premature ejaculation. Efficacy of sildenafil citrate in treatment of erectile dysfunction: Impact of associated premature ejaculation and low desire. Goldmeier D, Lamba H. Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation by Abdel-Hamid et al. Intracavernous medication for treatment of premature ejaculation.

Allergic reaction

Chen J, Mabjeesh NJ, Matzkin H, Greenstein A. Efficacy of sildenafil as adjuvant therapy to selective serotonin reuptake inhibitor in alleviating premature ejaculation. A new combination treatment for premature ejaculation: A sex therapist’s perspective. Symonds T, Perelman MA, Althof S, Giuliano F, Martin M, May K, Abraham L, Crossland A, Morris M. Development and validation of a premature ejaculation diagnostic tool. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with sildenafil pink pill your doctor or pharmacist. These are just a few of the more common side effects reported by people who took sildenafil in clinical trials:* * To learn more about the clinical trials of sildenafil, refer to the drug’s prescribing information for erectile dysfunction and pulmonary arterial hypertension.

Effect	Description	Onset Time	Duration	Notes
Vasodilation	Dilates blood vessels to improve blood flow	30-60 min	4-6 hours	Main mechanism for erectile support
Neural modulation	May influence neural pathways involved in ejaculation	N/A	N/A	Not fully understood
Side effects	Headache, flushing, dizziness	Within hours	Varies	Common with higher doses

† For more information about this side effect, see “Sildenafil: Side effect specifics” below. Optum Perks is owned by RVO Health. By clicking on this link, we may receive a commission. Mild side effects can occur with sildenafil use. This list doesn’t include all possible mild side effects of the drug. For more information, you can refer to sildenafil’s prescribing information for erectile dysfunction (ED) and pulmonary arterial hypertension (PAH). Mild side effects that have been reported with sildenafil include: These side effects may be temporary, lasting a few days to weeks.

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Of course, men need to be realistic about their expectations for staying power. But if a man is consistently ejaculating before he wants to, and it causes him distress, then he should speak with his doctor. However, there are two techniques you and your partner can try right away that may help. They are the "stop-start" and "stop-squeeze" methods. With stop-start, you begin sexual intercourse and keep going until you are close to the point of orgasm. Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you develop a side effect while taking sildenafil and want to tell the FDA about it, visit MedWatch. * For more information about this side effect, see “Sildenafil: Side effect specifics” below. † An allergic reaction is possible after taking sildenafil.

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Andrological findings in young patients under long-term antidepressive therapy with clomipramine. Mousavizadeh K, Ghafourifar P, Sadeghi-Nejad H. Calcium channel blocking activity of thioridazine, clomipramine and fluoxetine in isolated rat vas deferens: A relative potency measurement study. Tramadol HCL has promise in on-demand use to treat premature ejaculation. J Sex Med 2008;5:188–93.

Pelvic floor exercises

Safety and efficacy of tramadol in the treatment of premature ejaculation: A double-blind, placebo-controlled, fixed-dose, randomized study. Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, Wang T. Sexual problems among women and men aged 40–80 y: Prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Ejaculatory abnormalities in mice lacking the gene for endothelial nitric oxide synthase (eNOS-/-). Abdel-Hamid IA ENE, El Gilani A-H. However, this side effect was rarely reported in clinical trials of sildenafil for ED and PAH. To learn more, see the “Sildenafil: Side effect specifics” section below. The list below may not include all possible serious side effects of the drug. If you develop serious side effects while taking sildenafil, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number. Serious side effects that have been reported and their symptoms include: Symptoms can include:tinnitus (ringing in your ear)dizzinessdecrease in hearing Symptoms can include:trouble sildenafil citrate 150 mg red pill seeing in either eyeblurry visionseeing eye floaters * To learn more about this side effect, see the “Sildenafil: Side effect specifics” section below. Sildenafil is not approved by the Food and Drug Administration (FDA) for use in children. In clinical trials, children who were given sildenafil long term to treat pulmonary arterial hypertension had an increased risk of fatality.

• Sildenafil may enhance arousal and delay climax.
• The drug is not a cure for premature ejaculation.
• Overuse of sildenafil can lead to adverse effects.
• Combining sildenafil with alcohol can decrease effectiveness.
• Sexual timing and foreplay are natural PE remedies.
• Using sildenafil does not address orgasm control issues.
• Some men report increased confidence with sildenafil.
• The drug can cause priapism if misused.
• Psychological counseling can be beneficial for PE.
• Erectile health impacts PE treatment outcomes.
• Consistent use under medical supervision is recommended.

However, your child’s doctor may recommend taking sildenafil off-label in some cases. (With off-label use, a doctor prescribes an FDA-approved drug for a purpose other than what it’s approved for.) Talk with your child’s doctor to determine if sildenafil is right for your child. They can help compare the risks and benefits of the drug. Sildenafil oral tablets come in different strengths: 20 milligrams (mg), 25 mg, 50 mg, and 100 mg. The dosage you’re prescribed will depend on what condition you’re taking sildenafil for. It also depends on how the dosage is working for you. You can experience mild or severe side effects from sildenafil with any dosage. However, you may have an increased risk of side effects with higher dosages. If you start to experience side effects that become bothersome or severe while taking sildenafil, talk with your doctor.