Can you take Viagra and Priligy together? Not according to the Australian label for Priligy. Its product information says Priligy (dapoxetine) "should not be used in men with erectile dysfunction (ED) who are using PDE5 inhibitors" — the class that includes sildenafil, the medicine in Viagra — because together they may make you faint or dizzy when you stand up. It adds that the safety and efficacy of the pair "have not been established" (Priligy product and consumer medicine information).
What does the Priligy label say about Viagra?
It rules the pair out. Priligy "should not be used in patients using PDE5 inhibitors due to possible reduced orthostatic tolerance", and taking the two together "may result in orthostatic hypotension" — a fall in blood pressure when you stand up (Priligy product information). Sildenafil (Viagra) and tadalafil (Cialis) are both PDE5 inhibitors (healthdirect — ED medicines), so the rule covers Cialis too. The consumer leaflet names medicines for "erectile dysfunction (impotence)" among those to tell your doctor about, for the same reason (Priligy consumer medicine information).
What is Priligy approved for in Australia?
It is approved for premature ejaculation in men aged 18 to 64 who meet a strict definition. Priligy has been on the Australian Register of Therapeutic Goods since 2 September 2010, and it is the only dapoxetine product on it (ARTG search: dapoxetine). The label limits it to men who have all of the following (Priligy product information):
- ejaculation less than two minutes after penetration;
- ejaculation that is persistent or recurrent, with minimal stimulation, "before, on, or shortly after penetration and before the patient wishes";
- "marked personal distress or interpersonal difficulty" as a result;
- poor control over ejaculation.
Dapoxetine is a short-acting SSRI (Australian Prescriber), prescription-only in Australia (TGA) and taken only when needed: one 30 mg tablet 1 to 3 hours before sex, at most once in 24 hours, "not intended for continuous daily use" (Priligy product information). We do not sell dapoxetine. Daily use: can dapoxetine be taken with sildenafil every day?
Why is fainting the worry?
Because Priligy can cause it on its own. The leaflet warns "PRILIGY can make you faint"; nausea, dizziness or light-headedness may come first, and you should "immediately lie down or sit down with your head between your knees" until they pass (Priligy consumer medicine information). In the trials, fainting was more common on Priligy than on placebo, mostly in the first 3 hours after a dose, and the label asks the doctor to check your pulse and blood-pressure readings lying down and standing before the first tablet (Priligy product information). Viagra can cause dizziness and, less often, fainting (healthdirect — ED medicines), and alcohol may make fainting on Priligy more likely, so its label advises avoiding alcohol (Priligy product information).
Do Viagra and Priligy change each other's levels?
Only slightly. In a single-dose study, sildenafil 100 mg raised exposure to dapoxetine by 22%, a change "not expected to be clinically significant", and tadalafil had no effect (Priligy product information). The problem is what the two do together when you stand up, and the label offers no gap between the tablets as a way round it. Dapoxetine has a terminal half-life of about 19 hours (Australian Prescriber); Cialis can work for up to 36 hours (Cialis CMI).
What did a trial in men already taking a PDE5 inhibitor find?
A benefit, but the Australian label still says no. In a 12-week trial led from Sydney, 495 men with both problems, on a stable dose of a PDE5 inhibitor, took dapoxetine (30 or 60 mg) or placebo before sex. Average time to ejaculation reached 5.2 minutes on dapoxetine and 3.4 on placebo; side effects affected 29.6% against 20.0%, including nausea (9.2%) and dizziness on standing (2.4%) (McMahon et al., J Sex Med 2013). The Australian product information, revised in 2020, still says the combination's safety and efficacy "have not been established". Tablets containing both medicines are a separate question: can sildenafil and dapoxetine be taken together in one tablet?
Can Priligy itself cause erection problems?
Sometimes. In the main trials, 2.3% of men on Priligy 30 mg reported erectile dysfunction against 1.6% on placebo, and men with significant erectile dysfunction were left out (Priligy product information). The leaflet asks you to mention erectile dysfunction, as "it is not known whether PRILIGY can worsen these conditions" (Priligy consumer medicine information).
What if you have both problems?
The erection is usually treated first. The two often come together, as men with erectile dysfunction may try to ejaculate before the erection is lost; on their own, PDE5 inhibitors do not lengthen the time to ejaculation (RACGP). The options are compared in treating premature ejaculation and erectile dysfunction together; whether Viagra alone helps is in can Viagra treat premature ejaculation?
The short answer
Priligy is not taken with Viagra, Cialis or another PDE5 inhibitor: the Australian label rules the pair out because of fainting and dizziness on standing. If both problems matter, a GP can treat the erection first. Nitrates for chest pain are never taken with Viagra (why nitrates and Viagra never mix); every other combination is in our guide to taking Viagra or Cialis with other medicines.
