Can you take PE & ED medication together?

Some nights it's a race to the finish. Other nights you're fighting to stay hard. Plenty of men deal with both, because premature ejaculation (PE) and erectile dysfunction (ED) often turn up together.

So can you take PE and ED medication together? Some combinations, yes. Numbing sprays and creams, and SSRIs like paroxetine, can be used alongside ED tablets such as sildenafil and tadalafil. Dapoxetine (Priligy) is the exception. It shouldn't be taken with ED tablets.¹

Here's what you can combine and what you can't.

How are PE and ED connected?

They're the two most common sexual problems in men, and they often share the same root causes. Stress, performance anxiety, and relationship problems can all play a part in both.

They also tend to show up together. In one survey, around three in four men with PE also reported signs of ED, compared with one in five men without PE.²

Picture the scene. You're so focused on staying hard that you rush to finish before your erection fades. Or you try to cool things down to last longer, and lose your erection altogether. Either way, enjoyment takes a back seat.

That's why clinical guidelines recommend treating ED in men who also have PE.³

Which PE and ED medications can you take together?

Here's a quick guide to the most common combinations:

• Numbing spray or cream with sildenafil or tadalafil: yes.

• Paroxetine with sildenafil or tadalafil: yes, if a clinician prescribes it.

• Dapoxetine (Priligy) with sildenafil or tadalafil: no.

Can you use a delay spray with sildenafil or tadalafil?

Yes. Delay sprays, creams, and wipes contain local anaesthetics such as lidocaine, prilocaine, or benzocaine. They numb the head of the penis slightly, which can help you last longer.

Because they're applied to the skin, very little reaches your bloodstream.⁴ That's why they aren't known to interact with ED tablets like sildenafil or tadalafil. Wipe off any excess before sex so your partner doesn't go numb too, and check the leaflet before using one with condoms. Some can damage polyurethane condoms.⁴

Can you take paroxetine with sildenafil or tadalafil?

Yes. Paroxetine is an antidepressant (an SSRI) that's sometimes prescribed off-label for premature ejaculation. SSRIs don't change how sildenafil works in the body,⁵ so a clinician may prescribe the two together if they're right for you.

The combination may also work better than either medicine on its own. In a six-month study of 80 men with PE, those taking paroxetine plus sildenafil lasted longer (about 5.3 minutes, compared with 4.2) and were more satisfied with sex than men taking paroxetine alone.⁶ A review of six studies involving 971 men found the same pattern. Combining an SSRI with an ED tablet improved time to ejaculation more than either drug alone, whether or not the men had ED.⁷

The trade-off is more side effects, mostly mild headaches and flushing.^6,7 You may also see paroxetine and tadalafil combination tablets sold online. These aren't licensed in the UK, so stick to medicines prescribed by a regulated provider.

Can you take dapoxetine (Priligy) with Viagra or tadalafil?

No. Dapoxetine, sold under the brand name Priligy, is the only tablet licensed to treat PE in the UK. But its licence says it shouldn't be taken by men using ED tablets such as sildenafil (Viagra) or tadalafil (Cialis).¹

Taken together, they can cause orthostatic hypotension, a sudden drop in blood pressure when you stand up. That can leave you dizzy or faint, and dapoxetine already carries a small risk of fainting on its own.¹

The same goes for pills that combine dapoxetine and sildenafil in one tablet. They're sold online and in some countries, but they aren't licensed in the UK.

What shouldn't you mix with PE and ED medication?

Alcohol

Alcohol is often seen as a fix for PE, but it can have the opposite effect. Drinking a lot makes it harder to get and keep an erection, and can make it hard to orgasm at all. If you take dapoxetine, avoid alcohol altogether. It makes dizziness, drowsiness, and fainting more likely.¹

Poppers and nitrates

Never take sildenafil or tadalafil with poppers (amyl nitrite) or nitrate medicines for chest pain. Together, they can cause a dangerous drop in blood pressure.⁵

Our clinicians check your health and any other medicines you take before recommending a treatment, so you know your combination is safe.

Other ways to manage PE and ED

Learn to relax

Relaxing helps on both fronts. You're more likely to stay hard and less likely to finish early. Try some relaxation techniques for longer-lasting erections, and talk to your partner about what's going on. It takes the pressure off you both.

Keep practising

Take the pressure out of it. For PE, try the stop-start technique and other natural remedies. For ED, practise letting your erection fade and come back during foreplay. Once you know it'll return, there's less to worry about.

Do pelvic floor exercises

Yes, men can do these too. Squeeze the muscles you'd use to stop yourself peeing, a few times a day, in quick and long bursts. Done regularly, they can help you control both your erections and when you ejaculate.

The numan take

PE and ED often go hand in hand, and you can treat both at once. Numbing sprays and creams can be used alongside sildenafil or tadalafil, and so can paroxetine if a clinician prescribes it. Dapoxetine can't. Speak to a clinician before combining any treatments, and always read the patient information leaflet before taking any medication.

References

^{1 A. Menarini Farmaceutica Internazionale SRL. (2021). Priligy 30 mg film-coated tablets: Summary of product characteristics. Electronic Medicines Compendium. https://www.medicines.org.uk/emc/product/1269}

^{2 Tsai, W.-K., Chiang, P.-K., Lu, C.-C., & Jiann, B.-P. (2019). The comorbidity between premature ejaculation and erectile dysfunction: A cross-sectional internet survey. Sexual Medicine, 7(4), 451–458. https://doi.org/10.1016/j.esxm.2019.06.014}

^{3 Shindel, A. W., Althof, S. E., Carrier, S., et al. (2022). Disorders of ejaculation: An AUA/SMSNA guideline. The Journal of Urology, 207(3), 504–512. https://doi.org/10.1097/JU.0000000000002392}

^{4 European Medicines Agency. (n.d.). Fortacin (lidocaine/prilocaine): Summary of product characteristics. EPAR product information. https://www.ema.europa.eu/en/documents/product-information/fortacin-epar-product-information_en.pdf}

^{5 European Medicines Agency. (n.d.). Viagra (sildenafil): Summary of product characteristics. EPAR product information. https://www.ema.europa.eu/en/documents/product-information/viagra-epar-product-information_en.pdf}

^{6 Salonia, A., Maga, T., Colombo, R., Scattoni, V., Briganti, A., Cestari, A., Guazzoni, G., Rigatti, P., & Montorsi, F. (2002). A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation. The Journal of Urology, 168(6), 2486–2489. https://doi.org/10.1016/S0022-5347(05)64174-2}

^{7 Bai, Y., Pu, C., Han, P., Li, J., Yuan, H., Tang, Y., Wang, X., & Wei, Q. (2015). Selective serotonin reuptake inhibitors plus phosphodiesterase-5 inhibitors for premature ejaculation: A systematic review and meta-analysis. Urology, 86(4), 758–765. https://doi.org/10.1016/j.urology.2015.06.045}