Dapoxetine and tadalafil: How do they work together?

DoktorABC editorial team

Accurate, up-to-date health information written by our editorial team and reviewed by UK-registered prescribers.

What is Dapoxetine?

Dapoxetine is a short-acting selective serotonin reuptake inhibitor (SSRI) and the only medicine licensed in the UK specifically for the treatment of premature ejaculation. It was originally marketed under the brand name Priligy, manufactured by Menarini, though the UK patent expired in October 2025 and generic dapoxetine is now available.

Dapoxetine is licensed for the treatment of premature ejaculation in adult men aged 18 to 64 years who meet specific clinical criteria. These include an intravaginal ejaculatory latency time of less than two minutes, persistent or recurrent ejaculation with minimal stimulation, and marked personal distress as a consequence. 

Unlike daily SSRI antidepressants, which take weeks to build to therapeutic levels, dapoxetine is specifically designed as a short-acting, on-demand medicine. It is taken one to three hours before sexual activity and cleared from the body relatively quickly, with a time to peak plasma concentration of approximately one to two hours.

How dapoxetine works

Human ejaculation is primarily mediated by the sympathetic nervous system. Dapoxetine works by inhibiting the reuptake of serotonin in nerve synapses, increasing serotonin's action at pre- and post-synaptic receptors. This modulation of serotonin signalling in the central nervous system delays the ejaculatory reflex, extending the time to ejaculation.

In a pooled analysis of four randomised controlled trials, dapoxetine taken on demand produced a statistically significant increase in intravaginal ejaculatory latency time compared with placebo. 

Dapoxetine is available in two strengths: 30 mg and 60 mg. The recommended starting dose is 30 mg, with an increase to 60 mg if the response is insufficient and the lower dose is well tolerated.

What is tadalafil? A brief recap

Tadalafil is a PDE5 inhibitor used for erectile dysfunction and benign prostatic hyperplasia. It works by blocking the PDE5 enzyme, which allows cyclic GMP to accumulate in penile tissue, relaxing smooth muscle and increasing blood flow in response to sexual arousal. It is available as an on-demand dose (10 mg or 20 mg) or as a daily low dose (2.5 mg or 5 mg).

Can dapoxetine and tadalafil be taken together?

The regulatory position and clinical evidence point in slightly different directions, and both are worth understanding clearly before discussing this with a prescriber. 

The UK regulatory position

The dapoxetine Summary of Product Characteristics notes that co-administration with PDE5 inhibitors including tadalafil requires consideration of the drug-drug interaction, specifically the additive blood pressure-lowering effect. This is not an absolute contraindication in the way that nitrates are, but a caution that requires individual clinical assessment.

Treatment for patients taking both dapoxetine and PDE5 inhibitors such as tadalafil or sildenafil should take into account the drug-drug interaction between them. The primary concern is the potential for an additive reduction in blood pressure, which can increase the risk of dizziness, light-headedness, and fainting. 

In practice, the combination is used in clinical settings under prescriber supervision, and the BSSM has acknowledged the growing evidence base supporting its use. The key is that it requires proper individual risk assessment rather than self-administration, and it should always be discussed with a prescriber before combining the two medicines.

What the clinical evidence shows

Despite the regulatory caution, clinical research has investigated this combination, and the evidence is meaningful.

A prospective randomised controlled trial published in 2023 compared tadalafil 5 mg alone, dapoxetine 30 mg alone, and the combination of both in men with premature ejaculation. All three groups showed highly statistically significant improvements in intravaginal ejaculatory latency time and satisfaction scores at one, two, and three months. The improvement was more pronounced in the combination group. 

A 2023 study comparing tadalafil 5 mg on demand with dapoxetine showed a 4.5-fold prolongation of ejaculatory latency time at four, eight, and twelve weeks for both drugs individually, and a 6.5-fold prolongation with the combination, well maintained at 12 weeks. Adverse events were mild and discontinuation rates were low.

The British Society for Sexual Medicine (BSSM), in its 2024 position statement on premature ejaculation, acknowledged the growing evidence for PDE5 inhibitors in PE and supported their use either alone or in combination with dapoxetine, particularly given the frequent co-occurrence of ED and PE.

Safety profile of the combination

The primary safety concern with combining dapoxetine and tadalafil is the additive effect on blood pressure.

Both medicines can lower blood pressure. Tadalafil does so through vasodilation; dapoxetine, as an SSRI, can cause a modest reduction in blood pressure as part of its autonomic effects. When taken together, the combined effect can be more pronounced, increasing the risk of symptomatic hypotension, including dizziness, light-headedness, and in some cases fainting, particularly on standing up quickly.

This risk is further compounded if either medicine is taken alongside alcohol, other antihypertensives, or alpha-blockers. For men on blood pressure medication, this combination requires particularly careful clinical assessment.

The combination does not carry the same level of cardiovascular risk as mixing either medicine with nitrates, but it is not without clinical significance.

Dosing when used together

Where a prescriber does assess the combination as clinically appropriate following individual risk assessment, the dosing approach in clinical studies has typically been:

• Tadalafil 5 mg on demand, taken approximately 30 to 60 minutes before sexual activity
• Dapoxetine 30 mg on demand, taken one to three hours before sexual activity

The lower dose of tadalafil (5 mg) is preferred in this context because it produces a lower peak blood level than 10 mg or 20 mg, reducing the magnitude of the additive blood pressure-lowering effect.

Important: Your prescriber will determine the appropriate doses for your individual circumstances. Do not self-adjust either dose when taking them in combination.

Availability in the UK: Licensed vs unlicensed routes

It is worth being clear about what is and is not available through legitimate UK channels.

Dapoxetine alone: Available on prescription in the UK. Some NHS areas provide it following specialist referral; it is also available via private prescription. Since patent expiry in October 2025, generic dapoxetine is available at lower cost.

Tadalafil alone: Available on NHS and private prescription for ED and BPH.

Licensed combination products: There is no MHRA-licensed fixed-dose combination product containing both tadalafil and dapoxetine available in the UK. Products marketed as "Super Tadapox" or similar combination tablets are not licensed by the MHRA and are not available through legitimate UK prescription channels.

If a prescriber determines that co-administration is appropriate for your individual circumstances, both medicines would be prescribed separately at their respective licensed doses.

Who may be a candidate for this combination?

Based on the clinical evidence and the UK regulatory context, the following profile describes the type of patient for whom a prescriber might consider this combination after individual assessment:

• Men with a confirmed diagnosis of both ED and premature ejaculation, where both conditions are causing significant distress
• Men who have tried tadalafil alone for PE with partial response
• Men with no contraindications to either medicine, including no nitrate use, no significant cardiovascular disease, and no hypotension
• Men not taking other medicines that interact with either drug, particularly antihypertensives, alpha-blockers, or other serotonergic medicines
• Men who understand the combination is outside standard licensed use and have given informed consent to a prescriber-supervised approach

Who should not use this combination

The combination is not appropriate for men who:

• Are taking nitrate medicines in any form
• Have significant cardiovascular disease or hypotension
• Are taking other serotonergic medicines, including antidepressants, which can interact with dapoxetine to cause serotonin syndrome
• Have moderate to severe liver or kidney impairment
• Are taking strong CYP3A4 inhibitors, which significantly increase tadalafil blood levels
• Are over 65, as both medicines are used with caution in older men

Alternative approaches to managing both ED and PE

For men who are not candidates for the combination, or who prefer to explore other options first, the following approaches are worth discussing with a prescriber.

Treat ED first: If you have both ED and PE, a reasonable first approach is to treat ED first. Resolving ED often reduces the performance anxiety that contributes to PE, and for some men the PE resolves or significantly improves without specific treatment. 

Tadalafil alone for both conditions: There is increasing evidence that PDE5 inhibitors are superior to placebo for the treatment of PE, independent of their effect on ED. Tadalafil alone may produce meaningful improvement in ejaculatory control in some men, without the interaction risks of the combination. 

Dapoxetine alone: For men whose primary concern is PE and who do not have significant ED, dapoxetine alone is the licensed first-line pharmacological option in the UK.

Behavioural and psychosexual approaches: Psychosexual therapy and behavioural techniques including the stop-start method and the squeeze technique can be effective for PE, particularly where there is a significant psychological component. These can be used alongside or instead of medication.

Topical anaesthetic agents: Topical products applied to the glans penis to reduce sensitivity are an alternative approach for PE that does not interact with tadalafil.

Final thoughts

The co-occurrence of ED and premature ejaculation is common, and the question of whether dapoxetine and tadalafil can be taken together is clinically relevant for many men. The honest answer is that the combination is outside standard UK licensed use, carries a real but manageable interaction risk, and requires careful individual assessment by a prescriber rather than self-administration.

The clinical evidence is encouraging, and the British Society for Sexual Medicine acknowledges the growing research base supporting PDE5 inhibitors in PE management. But the right approach is a thorough medical consultation, not sourcing unlicensed combination products online.

FAQ

The DoktorABC medical advisory board

Dr. Roland Ruiken

Medical advisor, Norway

Dr. Viktor Simunovic

Medical advisor, Croatia

To the medical advisory board