Premature Ejaculation Pills: 5 Options and the Evidence

Premature ejaculation pills fall into five main groups: dapoxetine taken on demand, daily SSRI antidepressants, clomipramine, tramadol and PDE5 inhibitors such as sildenafil. Only dapoxetine is licensed for premature ejaculation, and only in some countries. The others are used off-label, and European guidelines rank them as second-line, third-line or situational options. This guide explains what each pill does, how strong the evidence is and why “natural” stamina supplements can be risky. It is one part of our premature ejaculation treatment overview.

Sources: EAU — Guidelines on Sexual and Reproductive Health: Disorders of Ejaculation; Cleveland Clinic — Premature Ejaculation

How premature ejaculation pills work

Most premature ejaculation pills act on serotonin, a chemical messenger that works as a brake on the ejaculation reflex. After a nerve releases serotonin, a transporter pump pulls it back into the nerve ending. Selective serotonin reuptake inhibitors (SSRIs) block that pump, so more serotonin stays active between nerve cells and ejaculation is delayed. Dapoxetine, paroxetine, sertraline, fluoxetine and citalopram all work this way. Clomipramine, an older tricyclic antidepressant, has a strong serotonin effect too.

Tramadol works differently from the other premature ejaculation pills. It is a centrally acting painkiller that both activates opioid receptors and blocks the reuptake of serotonin and noradrenaline. PDE5 inhibitors such as sildenafil and tadalafil are erection medicines; their benefit in premature ejaculation (PE) is less direct and is discussed below.

Sources: EAU — Disorders of Ejaculation; Cleveland Clinic — Premature Ejaculation

Researchers judge premature ejaculation pills mainly by the intravaginal ejaculatory latency time (IELT), the stopwatch-measured time from penetration to ejaculation, together with questionnaires on control, distress and satisfaction. Results are usually reported as a “fold increase” in IELT. A 3-fold increase turns 40 seconds into about 2 minutes, which is meaningful for many couples but is not a cure. If you are still unsure whether your symptoms count as PE, our guide to premature ejaculation explains the definitions and the difference between lifelong and acquired PE.

Dapoxetine: the on-demand pill made for PE

Dapoxetine (brand name Priligy) is a short-acting SSRI and the only one of these premature ejaculation pills developed specifically for PE. It is taken only when needed, as a 30 mg or 60 mg tablet before planned sex. The EAU notes it is approved in many countries, including in Europe, but not in the USA. The NHS says it is licensed in the UK and is not recommended for some men with heart, kidney or liver problems.

In pooled phase III trials, dapoxetine increased IELT about 2.5-fold at 30 mg and 3.0-fold at 60 mg, and 3.4-fold and 4.3-fold in men whose baseline IELT was under 30 seconds. The most common side effects are dose-related nausea, diarrhea, headache and dizziness. Fainting (vasovagal syncope) occurred in about 0.1% of trial participants, so blood pressure and pulse should be checked lying and standing before the first prescription. Many men stop over time: discontinuation reaches about 90% at two years, often because of cost and because it only works on the day it is taken.

Sources: EAU — Disorders of Ejaculation; NHS — Ejaculation problems

Dosing rules, contraindications and the full trial data are covered in our dedicated article on dapoxetine, so they are not repeated here.

Daily SSRIs: off-label but well studied

Before dapoxetine existed, doctors noticed that common antidepressants delayed ejaculation as a side effect. Daily SSRIs are still widely used as premature ejaculation pills, especially where dapoxetine is unavailable. They are off-label: the medicines are approved for depression and anxiety, not for PE. Cleveland Clinic notes that this use is not approved by the US Food and Drug Administration (FDA), and the AUA/SMSNA guideline states that none of the PE drug options has FDA approval.

Sources: Cleveland Clinic — Premature Ejaculation; AUA — Disorders of Ejaculation: AUA/SMSNA Guideline

Which SSRIs and what doses

The International Society for Sexual Medicine (ISSM) guideline lists the usual daily doses as paroxetine 10–40 mg, sertraline 50–200 mg, fluoxetine 20–40 mg and citalopram 20–40 mg. The EAU says all SSRIs have similar efficacy as premature ejaculation pills, but paroxetine produces the strongest delay. Across meta-analyses, daily SSRIs increased average IELT roughly 2.6- to 13.2-fold; one analysis cited by the ISSM found about an 8.8-fold increase with paroxetine.

Sources: PMC — ISSM Guidelines for the Diagnosis and Treatment of Premature Ejaculation; EAU — Disorders of Ejaculation

How long they take to work

Unlike dapoxetine, daily SSRI premature ejaculation pills build up gradually. Ejaculation delay may begin within a few days, but it is usually clearer after one to two weeks, and the full effect can take two to three weeks. Some men find the effect fades after six to 12 months (tachyphylaxis). Taking an ordinary SSRI only before sex, 3 to 6 hours in advance, is possible but gives a weaker delay than daily use.

Sources: NHS — Ejaculation problems; PMC — ISSM PE guidelines

Side effects and who should avoid them

Common side effects of SSRI premature ejaculation pills include tiredness, drowsiness, yawning, nausea, dry mouth, diarrhea and sweating. They are usually mild and tend to settle after two to three weeks. Lower sex drive, difficulty reaching orgasm, absent ejaculation and erection problems have also been reported. A few men develop agitation or hypomania, and the ISSM advises avoiding SSRIs in men with a history of bipolar disorder.

• Mood and age: the EAU advises caution in young men aged 18 or under and in men with depression, especially with suicidal thoughts.
• Stopping: avoid abrupt cessation or rapid dose reduction to prevent withdrawal symptoms.
• Fertility: men trying to conceive should avoid these premature ejaculation pills because of possible harmful effects on sperm.

Sources: EAU — Disorders of Ejaculation; PMC — ISSM PE guidelines

Clomipramine: daily or on demand

Clomipramine (Anafranil) is a tricyclic antidepressant with a strong serotonin effect. Like daily SSRIs, it is one of the off-label, second-line premature ejaculation pills in the EAU guideline, and it can be taken daily or on demand. The ISSM guideline lists 12.5–50 mg as the usual dose range.

In a randomized trial cited by the EAU, 15 mg taken 2 to 6 hours before sex increased IELT 4.66-fold compared with 2.80-fold on placebo. Nausea (15.7%) and dizziness (4.9%) were the most common side effects. The AUA/SMSNA guideline places on-demand clomipramine among its first-line drug options alongside daily SSRIs and dapoxetine where available.

Sources: EAU — Disorders of Ejaculation; PMC — ISSM PE guidelines; AUA — Disorders of Ejaculation

Tramadol: a third-line option with caveats

Tramadol is a painkiller, not a sexual health drug, but its serotonin and noradrenaline effects delay ejaculation. Trials used on-demand doses such as 25, 50 and 100 mg capsules or 62 and 89 mg dissolving tablets. Results vary: the EAU reports up to a 2.5-fold increase in median IELT, while one smaller study cited by the ISSM reported larger gains.

The EAU recommends tramadol only as an off-label, on-demand, third-line premature ejaculation pill, to be used with caution, because long-term safety data are limited. The FDA issued a warning in 2009 about its potential for addiction and breathing difficulty. MedlinePlus notes that tramadol may be habit-forming and can cause serious breathing problems, with higher risk when mixed with alcohol, street drugs or certain medicines. The ISSM advises against combining tramadol with an SSRI because of the risk of serotonin syndrome, and suggests it be considered only when other therapies have failed. The AUA/SMSNA guideline gives tramadol a conditional recommendation for men who have not responded to first-line drugs.

Sources: EAU — Disorders of Ejaculation; MedlinePlus — Tramadol; PMC — ISSM PE guidelines

PDE5 inhibitors: when ED pills help with PE

Many men with premature ejaculation also have erectile dysfunction (ED). That is why the first EAU recommendation is to treat ED, other sexual problems or genitourinary infections such as prostatitis before targeting PE. Cleveland Clinic notes that sildenafil, tadalafil, vardenafil and avanafil may help PE, particularly when ED is present. The differences between these drugs are explained in our Viagra vs Cialis comparison.

The evidence for ED drugs as premature ejaculation pills is more mixed in men with normal erections. In trials, sildenafil alone did not significantly lengthen IELT, but it improved confidence, perceived control and satisfaction, reduced anxiety and shortened the recovery time before a second erection. Several studies found that a PDE5 inhibitor plus an SSRI works better than an SSRI alone. The EAU now recommends PDE5 inhibitors alone or in combination for PE without ED, while the older ISSM guideline judged the evidence too limited to recommend them in that group. In practice, they are most often added to another treatment rather than used on their own.

Sources: EAU — Disorders of Ejaculation; Cleveland Clinic — Premature Ejaculation; PMC — ISSM PE guidelines

Premature ejaculation pills compared: evidence and licensing

The table below summarizes where each group of premature ejaculation pills sits in the EAU guideline, whether it is licensed for PE and the main safety concern. Strength ratings refer to how firmly the EAU panel recommends the option.

Sources: EAU — Disorders of Ejaculation; AUA — Disorders of Ejaculation

How doctors choose between them

The choice between premature ejaculation pills depends on the type of PE, how often you have sex, other health conditions and your preferences. A man who has sex occasionally may prefer an on-demand pill, while a man in a regular relationship may find a daily tablet simpler. For lifelong PE, the EAU puts dapoxetine on the same first-line level as a lidocaine/prilocaine spray, a non-pill option. For acquired PE, combining medicine with psychological or behavioral therapy is recommended, and the AUA/SMSNA guideline notes that combined approaches may work better than either alone. Practical techniques you can try alongside any pill are covered in our article on how to last longer in bed.

Other drugs are still experimental as premature ejaculation pills. The AUA/SMSNA guideline allows alpha-blockers as an expert-opinion option after first-line failure, and the EAU mentions modafinil, pregabalin and oxytocin receptor blockers without recommending them for routine use.

Sources: EAU — Disorders of Ejaculation; AUA — Disorders of Ejaculation

Supplements and “stamina pills”: evidence and hidden drugs

Herbal capsules, “delay” pills, honey sachets and coffee mixes marketed for stamina are easy to buy online. Their evidence as premature ejaculation pills is thin. A systematic review of complementary medicine for PE found only 10 randomized trials (acupuncture, Chinese and Ayurvedic herbal medicine and a topical herbal cream). Some showed small improvements in IELT, but the risk of bias was unclear in every study, side effects were poorly reported and almost nothing is known about drug interactions. Three studies comparing Chinese herbal medicine with SSRIs favored the SSRIs.

Source: PMC — Complementary and Alternative Medicine for Management of Premature Ejaculation: A Systematic Review (Sex Med, 2017)

The tainted product problem

The bigger danger is what these so-called premature ejaculation pills may secretly contain. The FDA keeps a running list of sexual enhancement products found to contain dangerous hidden ingredients. It warns that they are sold online and in stores, are often marketed as dietary supplements or all-natural products, carry many positive reviews and spread on social media. A product missing from the list is not proof that it is safe.

Laboratory testing backs this up. A 2022 study of male sexual herbal and honey remedies looked for sildenafil, tadalafil, vardenafil, avanafil and dapoxetine, along with the “natural” ingredients the labels claimed. One or more synthetic drugs were found in the products analyzed, while the advertised natural aphrodisiacs were absent. A man taking such premature ejaculation pills cannot know the dose he is getting or check it against his own medicines, such as heart medicines or a prescribed antidepressant.

Sources: FDA — Sexual Enhancement and Energy Product Notifications; PubMed — Illegal synthetic drugs in male sexual herbal and honey remedies (J AOAC Int, 2022)

When to see a doctor

See a urologist or sexual health doctor if PE happens most of the time and causes you or your partner distress, if it started suddenly after years of normal control, or if it comes with erection problems. A doctor can look for causes such as ED or prostatitis and choose the premature ejaculation pills that suit your health. Get medical advice promptly, or urgent care where noted, if:

• You faint, feel very lightheaded or have palpitations after taking dapoxetine or other premature ejaculation pills.
• You notice low mood, agitation, unusual restlessness or thoughts of self-harm on an SSRI or clomipramine (seek urgent help).
• You have slow or difficult breathing, extreme drowsiness or confusion after tramadol (call emergency services).
• You feel unwell, dizzy or have chest pain after an unlabeled “herbal” or “stamina” sex pill.
• Your erections have also weakened, since erectile dysfunction should be treated before PE itself.

Sources: NHS — Ejaculation problems; MedlinePlus — Tramadol; EAU — Disorders of Ejaculation

If you would like a tailored plan rather than trial and error, you can book a confidential consultation with our urologist-andrologist on WhatsApp. Medication, sprays and other options are all reviewed on our premature ejaculation treatment page.

FAQs about premature ejaculation pills

What is the best pill for premature ejaculation?

Among premature ejaculation pills, there is no single best pill for every man. For lifelong PE, European guidelines recommend dapoxetine as a first-line oral choice. Daily paroxetine gives the strongest delay among SSRIs but takes one to two weeks to work and is off-label. If erection problems are present, treating them with a PDE5 inhibitor often comes first. A doctor weighs your health, sex frequency and fertility plans.

Source: EAU — Disorders of Ejaculation

Are premature ejaculation pills available over the counter?

Generally no. Dapoxetine, SSRIs, clomipramine and tramadol are prescription premature ejaculation pills, and dapoxetine is not approved in the United States at all. Products sold freely online as “delay” or “stamina” pills are not regulated medicines, and the FDA has repeatedly found hidden drug ingredients in sexual enhancement products. A prescription lets a doctor check your heart, mood and other medicines first.

Sources: FDA — Sexual Enhancement Product Notifications; EAU — Disorders of Ejaculation

Is it safe to use antidepressants for premature ejaculation if I am not depressed?

Yes, SSRIs are commonly prescribed off-label as premature ejaculation pills in men without depression, and side effects are usually mild and fade within two to three weeks. They are not suitable for everyone: men with bipolar disorder, younger men with mood problems and men trying to conceive need special caution. Do not stop suddenly; your doctor will taper the dose.

Sources: PMC — ISSM PE guidelines; NHS — Ejaculation problems

How quickly do premature ejaculation pills work?

It depends on which of the premature ejaculation pills you take. Dapoxetine works on the day you take it, about 1 to 2 hours before sex. On-demand clomipramine is taken 2 to 6 hours before sex in trials. Daily SSRIs may start working within a few days, but the effect is usually clear only after one to two weeks of regular use.

Sources: EAU — Disorders of Ejaculation; NHS — Ejaculation problems

Can I take dapoxetine with Viagra or Cialis?

Under medical supervision, yes. Early studies found no pharmacokinetic interaction between dapoxetine and sildenafil or tadalafil, and a trial in men without ED found the combination improved timing and satisfaction more than either drug alone. Because dapoxetine can cause dizziness and, rarely, fainting, the combination should only be started by a doctor who has checked your heart health.

Source: EAU — Disorders of Ejaculation

Does tramadol cure premature ejaculation?

No. Tramadol delays ejaculation only while it is in your system, and it does not change the underlying problem. Guidelines treat it as a third-line, off-label option because it is an opioid-type painkiller that may be habit-forming and can cause dangerous breathing problems. It should never be combined with an SSRI or used without a prescription and regular review.

Sources: EAU — Disorders of Ejaculation; MedlinePlus — Tramadol

Do herbal pills for premature ejaculation work?

The evidence for herbal premature ejaculation pills is weak. A systematic review found a handful of small trials of herbal medicines and acupuncture with unclear quality and sparse safety data, and SSRIs outperformed Chinese herbal medicine in head-to-head studies. Laboratory analyses of “natural” sexual remedies have found hidden prescription drugs such as sildenafil and dapoxetine, so an apparent effect may come from an undeclared medicine.

Sources: PMC — CAM for PE: systematic review; PubMed — Illegal drugs in male sexual remedies

Do I have to take premature ejaculation pills forever?

Not necessarily. Premature ejaculation pills control symptoms while you take them rather than curing PE, and many men stop dapoxetine within two years. Combining medication with behavioral techniques or sex therapy can build lasting control, which is why guidelines recommend combined treatment, especially for acquired PE. Your doctor can review whether to continue, switch or taper at regular check-ups.

Sources: EAU — Disorders of Ejaculation; AUA — Disorders of Ejaculation