Dapoxetine vs. Alternatives: Which Premature Ejaculation Treatment Works Best?

Quick Takeaways

• Dapoxetine is the only on‑demand SSRI approved for premature ejaculation (PE).
• Other oral SSRIs (paroxetine, sertraline, clomipramine) require daily dosing and have a slower onset.
• Topical anesthetics give fast relief but can cause loss of sensation for both partners.
• Behavioural techniques are drug‑free but need consistency and practice.
• Cost, side‑effect profile, and personal preference decide the best fit.

When you type "dapoxetine comparison" into a search engine you’re looking for a clear answer: how does dapoxetine stack up against the other options on the market? Below you’ll find a ground‑up breakdown of the most common PE treatments, their real‑world performance, and the factors you should weigh before choosing a path.

What is Dapoxetine?

Dapoxetine is a short‑acting selective serotonin reuptake inhibitor (SSRI) that was specifically developed for on‑demand use in premature ejaculation. It increases serotonin levels in the synaptic cleft, which helps delay the ejaculatory reflex. The drug was first approved in Europe in 2009 and is now available in more than 30 countries.

How Dapoxetine Works

Unlike classic SSRIs that stay in the system for days, dapoxetine peaks within 1‑2hours and is cleared in about 12hours. This pharmacokinetic profile lets men take a single tablet 1-3hours before sexual activity, mimicking the convenience of a “pop‑and‑go” solution.

Common Alternatives to Dapoxetine

Below are the six alternatives you’ll most likely encounter when researching PE treatments. Each is introduced with a brief definition and key attributes.

• Paroxetine - a long‑acting SSRI often prescribed off‑label for PE. Typical dose: 20mg daily.
• Sertraline - another daily SSRI used off‑label. Typical dose: 50mg daily.
• Clomipramine - a tricyclic antidepressant with strong serotonergic activity. Typical dose: 25mg daily.
• Lidocaine‑Prilocaine Spray - a topical anesthetic applied directly to the penis 15minutes before intercourse. Provides localized numbness.
• Behavioural Therapy - non‑pharmacological approaches such as the “stop‑start” and “squeeze” techniques. Requires practice and partner involvement.
• Sildenafil - a phosphodiesterase‑5 inhibitor used for erectile dysfunction that can indirectly improve ejaculatory control when combined with other methods.
• Ginkgo Biloba Extract - a herbal supplement claimed to increase penile blood flow and modestly delay ejaculation. Evidence is mixed.

Side‑by‑Side Comparison

Pros and Cons at a Glance

1. Dapoxetine
   • Pros: On‑demand, fast onset, clinically proven for PE.
   • Cons: Short‑term side‑effects, prescription‑only, not suitable for men with certain heart conditions.
2. Paroxetine, Sertraline, Clomipramine (Daily SSRIs)
   • Pros: Low cost, widely available, some men achieve lasting benefit after weeks.
   • Cons: Require daily adherence, slower onset, higher risk of sexual side‑effects.
3. Lidocaine‑Prilocaine Spray
   • Pros: Immediate effect, no systemic exposure.
   • Cons: May numb partner, can feel unnatural, needs precise timing.
4. Behavioural Therapy
   • Pros: No medication, improves overall sexual communication.
   • Cons: Demands practice, success varies by commitment.
5. Sildenafil (as adjunct)
6. Ginkgo Biloba

How to Choose the Right Option for You

Think of the decision as a simple checklist. Answer each question honestly, then match your profile to the most suitable row in the table above.

• Do you need a fast‑acting solution for occasional use? → Dapoxetine or topical spray.
• Are you comfortable taking a daily pill and waiting a few weeks for benefit? → Paroxetine, Sertraline, or Clomipramine.
• Do you want to avoid any medication? → Behavioural techniques or a herbal supplement (with realistic expectations).
• Do you have cardiovascular disease or are you on nitrates? → Avoid dapoxetine and sildenafil, consider behavioural or non‑systemic options.
• Is cost a major factor? → Daily SSRIs are cheapest per month, but consider the total cost of multiple prescriptions.

Practical Steps to Start Treatment

1. Consult a qualified GP or urologist. Mention any current meds, especially antidepressants or heart drugs.
2. Ask specifically for dapoxetine if you want the on‑demand route. The doctor will usually start with 30mg and adjust to 60mg if tolerated.
3. If you prefer a daily SSRI, discuss the risk‑benefit profile; the doctor may start at a low dose to minimise side‑effects.
4. For topical spray, purchase a reputable brand, test a small area for skin reaction, and apply 15minutes before intercourse.
5. Start a behavioural program with your partner - use a timer or apps that guide the “stop‑start” cadence.
6. Track your progress. Keep a simple log: date, treatment used, ejaculatory latency time, side‑effects, and overall satisfaction.

When to Seek Further Help

If you’ve tried two different approaches for at least six weeks without noticeable improvement, it’s time to revisit the clinician. Persistent anxiety, relationship strain, or any severe side‑effects (e.g., chest pain with dapoxetine) warrant immediate medical attention.