Dawaa Reference

chronic

Premature Ejaculation

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

EAU Guidelines on Sexual and Reproductive Health 2024 · UK eMC Fortacin Spray / EMLA 5% Cream SmPC (or DailyMed EMLA Cream Package Insert)

Verified against3 documents
  • EAU Guidelines on Sexual and Reproductive Health 2024
  • UK eMC Fortacin Spray / EMLA 5% Cream SmPC (or DailyMed EMLA Cream Package Insert)
  • Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (9)

  • A sense of loss of ejaculatory control tied to stress, anxiety, or nervousness rather than any physical dysfunction [anxiety]
  • Associated emotional strain including anxiety, depression, and diminished self-esteem is common [anxiety · low mood]
  • It means ejaculation happening, again and again, sooner than the man or his partner would wish
  • Around 30% of men have it, and some reviews put it as high as 75%
  • It is the commonest male sexual disorder there is
  • Roughly 3 in 10 men aged 18 to 59 have trouble with it, and shame keeps most of them from ever raising it in the consultation
  • The occasional episode does not matter; what does harm is the chronic pattern, which brings anxiety, depression and discord at home [anxiety · low mood]
  • Once it has run a year or more it starts to damage the couple, and depression tends to follow [low mood]
  • To count as the diagnosis it has to have run at least 6 months and be causing him real distress

Tests (10)

  • Testosterone and prolactin may be checked when premature ejaculation coexists with erectile dysfunction or low libido suggestive of hypogonadism
  • Testosterone replacement does not fix the ejaculatory problem even though low testosterone is more common in these men
  • A thyroid-stimulating hormone level is reasonable when excess thyroid hormone is suspected, since treating it can improve symptoms
  • No laboratory or imaging study is routinely needed to make the diagnosis
  • Specialized studies such as penile vibration threshold testing, nerve conduction studies, and hormone panels remain investigational, not routine
  • A psychosexual evaluation by a mental health professional experienced with male sexual dysfunction is part of the standard workup
  • By the sexual medicine criteria: within about a minute of penetration since the very first sexual experience is the lifelong form, and a drop to about 3 minutes or less that troubles him is the acquired form
  • The second limb of that definition is that he cannot delay it on nearly every occasion
  • The third is what it costs him: distress, bother, frustration, and avoiding intimacy altogether
  • DSM-5 asks for about a minute after penetration, before he wishes it, on 75% to 100% of occasions

If not this — what else fits (2)

  • Markedly delayed orgasm in the female partner can make ordinary ejaculation timing look like premature ejaculation
  • Adverse effects of psychotropic medications should be weighed as a contributing factor

SourceStatPearls "Premature Ejaculation" - disease-level clinical article

Presentation findings are traced to the source above.

1

DAPOXETINE

1st line

Strength30 mg

Formoral.solid

Adult dose and duration

30 mg orally taken 1 to 3 hours before intended sexual activity (max 60 mg once daily if 30 mg tolerated but insufficient) - On-demand PRN

Paediatric dose

Not indicated in pediatric populations under 18 years

Choice

Dapoxetine is the first choice here; paroxetine, fluoxetine, sertraline, citalopram and escitalopram are further options.

Dose source

EAU Guidelines on Sexual and Reproductive Health 2024

Why

Dapoxetine is a short-acting SSRI designed specifically for on-demand use before intercourse; its rapid onset and clearance delay ejaculation without the accumulation seen with standard SSRIs taken daily.

Cautions
  • Contraindicated in severe heart failure, significant ischemic heart disease, heart block, or severe hepatic impairment.
  • Do not combine with MAOIs, CYP3A4 inhibitors, or other SSRIs/SNRIs.
  • May cause dizziness, nausea, headache, syncope, or orthostatic hypotension; advise patient to stay hydrated.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAPOXEMED 30 MG 3 F.C. TABS.MEDIZEN PHARMACEUTICAL INDUSTRIES17.50 EGP (5.83/unit)
MATUJAC 30 MG 3 F.C. TABS.HOCHSTER PHARMACEUTICAL INDUSTRIES > NOVELL PHARMA21.00 EGP (7.00/unit)
WESTOXETIN 30 MG 3 F.C. TABS.WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA21.00 EGP (7.00/unit)
EJADAXTIN 30 MG 3 F.C. TABS.WADI ELNEEL BENTA23.00 EGP (7.67/unit)
PREDAPOX 30 MG 6 F.C. TABS.ADWIA86.00 EGP (14.33/unit)
DELEPE 30 MG 3 F.C. TABS.PENTA PHARMA-EGYPT > PENTA PHARMA45.00 EGP (15.00/unit)
DERILGY 30 MG 3 F.C. TABS.MASH PREMIERE > BIOMED PHARMACEUTICALS65.00 EGP (21.67/unit)
PRILIGY 30 MG 3 F.C. TABS.MENARINI > EGYPTIAN PHARMACEUTICAL TRADING COMPANY382.00 EGP (127.33/unit)
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Dapoxetine has a poor side-effect profile and extremely high discontinuation rates in European data.
3

PAROXETINE

1st line

Formoral.solid

Adult dose and duration

10 to 40 mg/day

Paediatric dose

Paroxetine should not be used in the treatment of children and adolescents under the age of 18 years. That sentence is the Paroxetine 20 mg film-coated tablets SmPC section 4.2, verbatim.

Dose source

Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt)

Why

Off-label daily SSRI used as initial drug of choice to delay ejaculatory onset in premature ejaculation.

Cautions
  • May cause sexual dysfunction (decreased libido, anorgasmia, erectile dysfunction).
  • Avoid abrupt withdrawal to prevent serotonin discontinuation syndrome.
Egyptian brands
Egyptian brandManufacturerIndicative price
XANDOL 20MG 20 TAB.EUROPEAN EGYPTIAN PHARM. IND.42.00 EGP (2.10/unit)
PAXETIN 20 MG 10 F.C.TABS.PHAROPHARMA22.80 EGP (2.28/unit)
DEPANX 20MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS24.00 EGP (2.40/unit)
PAROXETINE 20 MG 30 F.C.TABS.EVA PHARMA93.00 EGP (3.10/unit)
PAROXETINE CR 12.5 MG 30 F.C.TABS.EVA PHARMA99.00 EGP (3.30/unit)
PAROXEDEP CR 37.5 MG 30 F.C.TABS.APEX PHARMA117.00 EGP (3.90/unit)
SEROXAT CR 25MG 30 F.C.TABS.GLAXO SMITHKLINE321.00 EGP (10.70/unit)
PAROXEDUR XL 25 MG 30 EXT. REL. F.C. TABS.P&C LABS > BIOMED94.50 EGP
4

FLUOXETINE

1st line

Formoral.solid

Adult dose and duration

20 to 40 mg/day

Paediatric dose

FLUOXETINE should only be used in children and adolescents aged 8 to 18 years for the treatment of moderate to severe major depressive episodes and it should not be used in other indications.

Dose source

Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt)

Why

Off-label daily SSRI used to delay ejaculatory onset in premature ejaculation.

Cautions
  • May cause sexual dysfunction (decreased libido, anorgasmia, erectile dysfunction).
  • Long half-life; monitor for drug interactions.
Egyptian brands
Egyptian brandManufacturerIndicative price
ALZAC 10MG 20 CAPS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI)18.00 EGP (0.90/unit)
FLUOZAC 10MG 20 CAPS.JEDCO INT. CO. FOR PHARMACEUTICALS18.00 EGP (0.90/unit)
PHILOZAC 10MG 10 CAPS.AMOUN9.00 EGP (0.90/unit)
FLUTIN 20 MG 14 CAPS.EIPICO26.00 EGP (1.86/unit)
OCTOZAC 20MG 10 CAPS.OCTOBER PHARMA21.60 EGP (2.16/unit)
PROZAC 20MG 14 CAPS.ELI LILLY118.00 EGP (8.43/unit)
DURAZAC WEEKLY 90MG 4 DELAYED REL. CAPS.BIOPHARM EGYPT > ANDALOUS PHARMA48.00 EGP
FIESTO 90MG 4 DELAYED RELEASE CAPS.INTERNATIONAL DRUG AGENCY (IDI) > SINA PHARM48.00 EGP
5

SERTRALINE

1st line

Formoral.solid

Adult dose and duration

50 to 200 mg/day

Paediatric dose

Sertraline should not be used in the treatment of children and adolescents under the age of 18 years, except for patients with obsessive compulsive disorder aged 6-17 years old. That sentence is the LUSTRAL 50 mg film coated tablets SmPC section 4.2, verbatim.

Dose source

Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt)

Why

Off-label daily SSRI used to delay ejaculatory onset in premature ejaculation.

Cautions
  • May cause sexual dysfunction (decreased libido, anorgasmia, erectile dysfunction).
  • Take with food to reduce gastrointestinal side effects.
Egyptian brands
Egyptian brandManufacturerIndicative price
OPIRALINE 50 MG 20 F.C. TABS.EL-OBOUR29.00 EGP (1.45/unit)
AGRELOCIT 50 MG 20 TAB.MEMPHIS > ATM PHARMACEUTICAL INDUSTRIES34.80 EGP (1.74/unit)
DEPR-STAT 50MG 10 CAPS.MEMPHIS21.60 EGP (2.16/unit)
OPIRALINE 100MG 10 F.C.TAB.EL-OBOUR32.00 EGP (3.20/unit)
SIRTO 50MG 10 F.C. TABS.HI-PHARM34.00 EGP (3.40/unit)
MOODAPEX 100 MG 30 F.C.TAB.MULTI-APEX123.00 EGP (4.10/unit)
LUSTRAL 50 MG 20 F.C.TABS.VIATRIS136.00 EGP (6.80/unit)
SERLIFT 100MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > REXCEL74.00 EGP (7.40/unit)
6

CITALOPRAM

1st line

Formoral.solid

Adult dose and duration

20 to 40 mg/day

Paediatric dose

No paediatric dose is stated in the sources held for this drug.

Dose source

Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt)

Why

Off-label daily SSRI used to delay ejaculatory onset in premature ejaculation.

Cautions
  • May cause sexual dysfunction and QTc prolongation at higher doses.
Egyptian brands
Egyptian brandManufacturerIndicative price
CITALIFE 10 MG 20 F.C.TAB.UNIPHARMA CO. > UNIPHARMA31.20 EGP (1.56/unit)
PURACIT 20MG 14 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS36.00 EGP (2.57/unit)
CEROPRAM 20MG 14 TAB.EGPI42.00 EGP (3.00/unit)
TALOPRAM 40MG 30 F.C. TAB.ADWIA108.00 EGP (3.60/unit)
RAMDEEP 40 MG 10 F.C. TAB.WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA43.00 EGP (4.30/unit)
CITALO 40 MG 30 F.C.TAB.DELTA PHARMA180.00 EGP (6.00/unit)
CIPRAM 20 MG 28 TABS.H.LUNDBECK A/S DENMARK > MULTIPHARMA232.00 EGP (8.29/unit)
LECITAL 40MG 30 F.C.TAB.JOSWE MEDICAL-JORDAN > SPACE MEDICAL255.00 EGP (8.50/unit)
RAMDEEP 2MG/ML SYRUP 120ML? strength differs? different route - not oral solidWESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA21.75 EGP
CITALO 2MG/ML ORAL SOLUTION 120 ML? strength differs? different route - not oral solidDELTA PHARMA38.00 EGP
7

ESCITALOPRAM

1st line

Formoral.solid

Adult dose and duration

10-20 mg/day

Paediatric dose

Escitalopram should not be used in the treatment of children and adolescents under the age of 18 years (see section 4.4). That sentence is the Escitalopram 10 mg film-coated tablets SmPC section 4.2, verbatim.

Dose source

Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt)

Why

Off-label daily SSRI used to delay ejaculatory onset in premature ejaculation.

Cautions
  • May cause sexual dysfunction (decreased libido, anorgasmia, erectile dysfunction).
Egyptian brands
Egyptian brandManufacturerIndicative price
HERMPRO 5 MG 20 F.C.TABS.SABAA > SOVALUE PHARMA24.00 EGP (1.20/unit)
ESCTIKANA 10 MG 14 F.C.TABS.HOCHSTER PHARMACEUTICAL INDUSTRIES17.00 EGP (1.21/unit)
CITALOMEP 10 MG 14 F.C.TABS.MEPACO26.00 EGP (1.86/unit)
MOODAMASH 10 MG 14 F.C. TABS.MASH PREMIERE63.00 EGP (4.50/unit)
ESCITA 10 MG 14 F.C.TABS.GENESIS PHARMACEUTICALS77.00 EGP (5.50/unit)
JOVIAPRAM 20 MG 30 F.C. TABS.SUN PHARMA EGYPT LIMITED201.00 EGP (6.70/unit)
CIPRALEX 10 MG 28 F.C.TABS.LUNDBECK > MULTIPHARMA392.00 EGP (14.00/unit)
TALOSCITO 20 MG 30 SCORED F.C. TABS.P & C LABS157.50 EGP
XYGAROT 5MG/5ML SYRUP 100ML? strength differs? different route - not oral solidMULTI-APEX21.00 EGP
ESCITALOBORG 5 MG/5ML SYRUP 125 ML? strength differs? different route - not oral solidBORG50.00 EGP
8

LIDOCAINE + PRILOCAINE

2nd line

Formtopical

Adult dose and duration

For Fortacin spray: 3 actuations (sprays) applied to glans penis 5 minutes before intercourse. For EMLA 5% cream: apply 1-2 g (thin layer) to glans penis 15-30 minutes before intercourse, wiped off prior to penetration. - On-demand PRN

Paediatric dose

Not applicable - condition restricted to adult males

Dose source

Fortacin 150 mg/ml + 50 mg/ml cutaneous spray solution SmPC (eMC product 100391). Section 4.1: "Fortacin is indicated for the treatment of primary premature ejaculation in adult men." Section 4.2: "3 actuations applied to cover the glans penis"; "After 5 minutes any excess spray should be wiped off prior to intercourse"; "A maximum of 3 doses can be used within 24 hours with at least 4 hours between doses." The EMLA figure shown alongside comes from a different product and rests on no named document - see the caution.

Why

Lidocaine-prilocaine is a topical local anesthetic combination applied to the glans to reduce sensitivity and delay ejaculation; it offers a non-oral alternative to dapoxetine, though residue must be wiped off or a condom used to avoid numbing the partner.

Cautions
  • Fortacin's own ceiling: "A maximum of 3 doses can be used within 24 hours with at least 4 hours between doses." Prilocaine can cause methaemoglobinaemia, so the limit matters.
  • THE EMLA ROUTE IS OFF-LABEL AND ITS FIGURE RESTS ON NO NAMED DOCUMENT. EMLA Cream 5% SmPC section 4.1 (eMC 7994) carries no premature-ejaculation indication. Its only genital-skin figures sit under "Skin of male genital organs - Prior to injection of local anaesthetics": "1 g/10 cm2 for 15 minutes" or "1-2 g/10 cm2 for 60 minutes". The same SmPC states that application to genital skin "should only be performed by or under the supervision of a healthcare professional". Fortacin is the licensed alternative here.
  • Must wipe off residue before intercourse or use a condom to prevent numbness in partner.
  • Avoid applying to broken or inflamed penile skin.
  • Contraindicated in history of allergy to local anaesthetics of the amide type.
Egyptian brands
Egyptian brandManufacturerIndicative price
MELACAINE 5% CREAM 15 GM> MELANO PHARMA36.50 EGP
EMLA 5% CREAM 5 GM 5 TUBESASTRA ZENECA > PHOENIX GROUP120.00 EGP
PRIDOCAINE TOPICAL CREAM 15 GMGLOBAL NAPI PHARMACEUTICALS32.00 EGP
ANASEZIAGO CREAM 30 GMAL ESRAA PHARMACEUTICAL OPTIMA > ELIXIR PHARMA55.00 EGP
AVRISURG TOPICAL CREAM 30 GMMEDIZEN PHARMACEUTICAL INDUSTRIES55.00 EGP
PRIDOCAINE TOPICAL CREAM 30 GMGLOBAL NAPI PHARMACEUTICALS55.00 EGP
MANOVIPERCAINE PLUS TOPICAL SPRAY 15 MLEVA PHARMA56.00 EGP
9

BEHAVIORAL THERAPY AND SEX COUNSELING

add-on - not a substitute
Adult dose and duration

Practice behavioral techniques (stop-start technique, squeeze technique, pelvic floor muscle training) regularly during sexual activity - Ongoing (minimum 4-8 weeks)

Paediatric dose

Not applicable

Dose source

EAU Guidelines on Sexual and Reproductive Health 2024

Why

Stop-start and squeeze techniques, together with pelvic floor training, teach the patient to recognize and control arousal levels; they are used alongside pharmacologic or topical treatment and work best combined with partner communication and anxiety reduction.

Cautions
  • The best results are achieved when this is combined with partner communication and anxiety reduction.
  • Rule out co-existing erectile dysfunction or thyroid disorders prior to initiating therapy.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.