Dapoxetine and Super Kamagra: what the labels say and what to watch for

Dapoxetine is the active ingredient in Priligy. Its summary of product characteristics (SmPC) lists one use: premature ejaculation in adult men aged 18 to 64.

The Priligy label gives a starting dose of 30 mg as needed, 1 to 3 hours before sexual activity. It can go up to 60 mg, no more than once in 24 hours, and it is not a daily medicine.

Everything here is general label information, not personal advice.

Both are products whose packs list sildenafil 100 mg and dapoxetine 60 mg together. The shop carries three: Super Kamagra tablets, Super Kamagra Oral Jelly and Super P-Force Oral Jelly (5 g single-dose sachets).

Sildenafil is the ingredient in Viagra, and the US label lists erectile dysfunction as its use. Dapoxetine, as above, is labelled for premature ejaculation.

Both labels belong to the single ingredients. Neither is a label for a combination product.

The Priligy SmPC says Priligy should not be used in patients taking PDE5 inhibitors, because of possible orthostatic hypotension (a drop in blood pressure on standing). It adds that safety of the two together has not been established in men with erectile dysfunction.

Sildenafil is a PDE5 inhibitor.

As far as we could check, no official label exists for a sildenafil plus dapoxetine product; the labels that do exist cover each ingredient separately. So this article gives no dose for the combination, and does not say the combination is safe or works better. That question belongs with a doctor before use.

Each ingredient's label has its own list, so a product with both needs both lists checked.

• People taking nitrates (for example under-the-tongue chest pain tablets) or riociguat, per the sildenafil label.
• People with heart failure, heart conduction problems, significant ischaemic heart or valve disease, or a history of fainting, per the Priligy label.
• People taking SSRIs, SNRIs, tricyclic antidepressants, MAOIs or other serotonergic medicines (for example triptan migraine medicines, some serotonergic painkillers or St John's Wort), because the Priligy label bars them.
• People taking potent CYP3A4 inhibitors such as ketoconazole, itraconazole or ritonavir.
• People with moderate or severe liver impairment, or a history of mania or severe depression, per the Priligy label.

This is only part of each list. Read the full leaflet, and tell a doctor or pharmacist about every medicine and condition.

The Priligy label says fainting (syncope) can happen at any time, with or without warning signs such as dizziness, palpitations or a cold sweat. At the first sign, lie down or sit with your head lowered. The label says to avoid driving or hazardous machinery.

It also advises avoiding alcohol, which can add to dizziness and drowsiness and raise the chance of fainting and injury.

Common dapoxetine side effects on the label are nausea, dizziness, headache, diarrhoea, insomnia and fatigue. Nausea was reported in 11.0% of men at 30 mg and 22.2% at 60 mg. Sildenafil side effects such as headache, flushing and a stuffy nose are covered in the sildenafil article.

Both labels set the same ceiling: no more than once a day. A product containing both should not be used more than one unit per day.

Do not add another sildenafil or tadalafil product on the same day, which would push PDE5 medicine beyond what the labels allow.

The Super Kamagra sachet reads "As directed by the Physician" and is for one-time use. Its packaging gives no numeric dose.

• Fainting, or dizziness so severe you cannot stand.
• An erection lasting more than 4 hours, or a painful one.
• Sudden blurred vision or vision loss, or sudden hearing loss.
• Chest pain, an irregular heartbeat or shortness of breath.
• Allergic signs such as rash, swelling or trouble breathing.
• Thoughts of self-harm or sharp mood changes, which the Priligy label warns about.

• Before starting, above all because the Priligy label warns against combining dapoxetine with sildenafil and no label covers the combination.
• If you take chest pain medicine, antidepressants, migraine medicine, antifungals, HIV medicine or blood pressure tablets.
• If you have heart disease, low blood pressure, a history of fainting, liver disease or a mood disorder.
• If side effects bother you, or you are unsure of the dose or form.
• For any symptom under the urgent list: go to hospital straight away, do not wait.