Drug Action
Dapoxetine is a short-acting selective serotonin re-uptake inhibitor.
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Drug reference
Dapoxetine is a short-acting selective serotonin re-uptake inhibitor.
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Premature ejaculation in men who meet all the following criteria: poor control over ejaculation, a history of premature ejaculation over the past 6 months, marked distress or interpersonal difficulty as a consequence of premature ejaculation, and an intravaginal ejaculatory latency time of less than two minutes ▶BY MOUTH ▶Adult: Initially 30 mg, to be taken approximately 1–3 hours before sexual activity, subsequent doses adjusted according to response; review treatment after 4 weeks (or 6 doses) and at least every 6 months thereafter, not recommended for adults 65 years and over; maximum 1 dose per day; maximum 60 mg per day
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DUE TO INTERACTIONS ▶Manufacturer advises max. dose 30 mg with concurrent use of moderate inhibitors of CYP3A4 except in patients verified to be extensive CYP2D6 metabolisers where manufacturer recommends max. dose 60 mg. ▶Manufacturer advises avoid with concurrent use of potent inhibitors of CYP3A4 except in patients verified to be extensive CYP2D6 metabolisers where manufacturer recommends max. dose 30 mg.
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History of bipolar disorder. history of mania. history of severe depression. history of syncope . postural hypotension. significant cardiac disease. uncontrolled epilepsy
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Bleeding disorders. epilepsy (discontinue if convulsions develop). susceptibility to angle-closure glaucoma
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Test for postural hypotension before starting treatment.
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→Appendix 1: SSRIs
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▶Common or very common Anxiety. asthenia. concentration impaired. constipation. diarrhoea. dizziness. drowsiness. dry mouth. gastrointestinal discomfort. gastrointestinal disorders. headache. hypotension. mood altered. nausea. paraesthesia. sexual dysfunction. sinus congestion. sleep disorders. sweat changes. syncope. tinnitus. tremor. vasodilation. vision blurred. vomiting. yawning ▶Uncommon Akathisia. arrhythmias. behaviour abnormal. confusion. depression. eye pain. feeling abnormal. feeling hot. hypertension. level of consciousness decreased. mydriasis. pruritus. taste altered. thinking abnormal. vertigo SIDE-EFFECTS, FURTHER INFORMATION Discontinue if psychiatric disorder develops.
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Manufacturer advises avoid in moderate to severe impairment.
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Use with caution if eGFR 30–80 mL/minute/1.73 m2; avoid if eGFR less than 30 mL/minute/1.73 m2.
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There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 2, 25 ▶Priligy (A. Menarini Farmaceutica Internazionale SRL) Dapoxetine 30 mg Priligy 30mg tablets | 3 tablet P £14.71 DT = £14.71 | 6 tablet P £26.48 DT = £26.48 Dapoxetine 60 mg Priligy 60mg tablets | 3 tablet P £19.12 DT = £19.12 | 6 tablet P £34.42 DT = £34.42 Obstetrics Obstetrics Prostaglandins and oxytocics Prostaglandins and oxytocics are used to induce abortion or induce or augment labour and to minimise blood loss from the placental site. They include oxytocin p. 868, carbetocin p. 870, ergometrine maleate p. 869, and the prostaglandins. All induce uterine contractions with varying degrees of pain according to the strength of contractions induced. Induction of abortion Gemeprost p. 872, a prostaglandin administered vaginally as pessaries, is suitable for the medical induction of late therapeutic abortion; gemeprost is also used to ripen the cervix before surgical abortion, particularly in primigravidas. The prostaglandin misoprostol p. 872 is given by mouth, buccally, sublingually, or vaginally, to induce medical abortion [unlicensed indication]; intravaginal use ripens the cervix before surgical abortion [unlicensed indication]. Extra-amniotic dinoprostone is rarely used nowadays. Pre-treatment with mifepristone p. 871 can facilitate the process of medical abortion. It sensitises the uterus to subsequent administration of a prostaglandin and, therefore, abortion occurs in a shorter time and with a lower dose of prostaglandin. Induction and augmentation of labour Dinoprostone is available as vaginal tablets, pessaries and vaginal gels for the induction of labour. The intravenous solution is rarely used; it is associated with more side- effects. Oxytocin (Syntocinon ®) is administered by slow intravenous infusion, using an infusion pump, to induce or augment labour, usually in conjunction with amniotomy. Uterine activity must be monitored carefully and hyperstimulation avoided. Large doses of oxytocin may result in excessive fluid retention. Misoprostol is given orally [unlicensed route] or vaginally for the induction of labour. NICE Guidance, Induction of labour (updated July 2008), available at www.nice.org.uk/guidance/CG70. Prevention and treatment of haemorrhage Bleeding due to incomplete miscarriage or abortion can be controlled with ergometrine maleate and oxytocin (Syntometrine ®) given intramuscularly, the dose is adjusted according to the patient’s condition and blood loss. This is commonly used before surgical evacuation of the uterus, particularly when surgery is delayed. Oxytocin and ergometrine maleate combined are more effective in early pregnancy than either drug alone. Genito-urinary system Active management of the third stage of labour reduces the risk of postpartum haemorrhage; oxytocin is given by intramuscular injection [unlicensed] on delivery of the anterior shoulder or, at the latest, immediately after the baby is delivered. Alternatively, ergometrine maleate with oxytocin (Syntometrine ®) can be given by intramuscular injection in the absence of hypertension; oxytocin alone causes less nausea, vomiting, and hypertension than when given with ergometrine maleate. In excessive uterine bleeding, any placental products remaining in the uterus should be removed. Oxytocic drugs are used to treat postpartum haemorrhage caused by uterine atony; treatment options are as follows: . oxytocin by slow intravenous injection, followed in severe cases by intravenous infusion of oxytocin at a rate that controls uterine atony or . ergometrine by intramuscular injection or . ergometrine by slow intravenous injection (use with caution—risk of hypertension) or . ergometrine with oxytocin (Syntometrine ®) by intramuscular injection Carboprost p. 870 has an important role in severe postpartum haemorrhage unresponsive to ergometrine maleate and oxytocin. Misoprostol [unlicensed] can be used in postpartum haemorrhage when oxytocin, ergometrine maleate, and carboprost are not available or are inappropriate. Mifepristone For termination of pregnancy, a single dose of mifepristone is followed by administration of a prostaglandin (gemeprost or misoprostol [unlicensed]). Guidelines of the Royal College of Obstetricians and Gynaecologists (November 2011) include [unlicensed] regimens for inducing medical abortion. Ectopic pregnancy Systemic methotrexate p. 963 [unlicensed indication] is used for the management of ectopic pregnancy. Myometrial relaxants Tocolytic drugs postpone premature labour and they are used with the aim of reducing harm to the child. However, there is no satisfactory evidence that the use of these drugs reduces mortality. The greatest benefit is gained by using the delay to administer corticosteroid therapy or to implement other measures which improve perinatal health (including transfer to a unit with neonatal intensive care facility). The oxytocin receptor antagonist, atosiban p. 871, is licensed for the inhibition of uncomplicated premature labour between 24 and 33 weeks of gestation. Atosiban may be preferable to a beta2 agonist because it has fewer side effects. The dihydropyridine calcium-channel blocker nifedipine p. 174 also has fewer side-effects than a beta2 agonist. The beta2 agonists salbutamol p. 267 and terbutaline sulfate p. 269 are licensed for inhibiting uncomplicated premature labour between 22 and 37 weeks of gestation to permit a delay in delivery of up to 48 hours. Use of high-dose short acting beta2 agonists in obstetric indications has been associated with serious, sometimes fatal cardiovascular events in the mother and fetus, particularly when used for a prolonged period of time. Oral therapy is no longer recommended and parenteral therapy should be restricted to a maximum duration of 48 hours, given under the supervision of a specialist, and with close monitoring. Indometacin p. 1206, a cyclo-oxygenase inhibitor, also inhibits labour [unlicensed indication] and it can be useful in situations where a beta2 agonist is not appropriate; however, there are concerns about neonatal complications such as transient impairment of renal function and premature closure of ductus arteriosus. Genito-urinary system 5.1 Induction of labour Other drugs used for Induction of labour Misoprostol, p. 872 OXYTOCIN AND ANALOGUES
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The dose should preferably be reduced gradually over about 4 weeks, or longer if withdrawal symptoms emerge (6 months in patients who have been on long-term maintenance treatment).
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Postural hypotension and syncope Patients should be advised to maintain hydration and to sit or lie down until prodromal symptoms such as nausea, dizziness, and sweating abate.
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Initially 30 mg, to be taken approximately
First-line fragment. Read the complete Indications and Dose section above.
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