Cenforce D

Cenforce D is intended for a man who struggles to get or keep an erection and who also reaches climax sooner than he wants. Its sildenafil blocks the enzyme PDE5, which allows blood to flow into the penis after sexual stimulation has started; it does nothing in the absence of stimulation and leaves desire as it was. Its dapoxetine is a short-acting relative of the SSRI antidepressants, used to hold back ejaculation. Cenforce D comes from abroad as an import.

There is only a single combination of 100 mg sildenafil and 60 mg dapoxetine per tablet, so no lower or higher dose can be chosen. Pack counts are 30, 60, 90, 120 and 180. Packaging that was made with another market in mind needs checking: find both ingredient names, the 100/60 mg marking and a legible expiry date on the carton and strip. Store the blisters in a cool, dry place away from children.

British authorisation exists for sildenafil as a treatment for erectile dysfunction in adult men, with 100 mg as the largest recommended dose and 100 mg products on prescription only. The electronic medicines compendium has no tablet combining sildenafil and dapoxetine, so Cenforce D is an unlicensed product. A practical consequence is that its dose cannot be tailored. The SmPC says a sildenafil starting dose of 25 mg should be considered with hepatic impairment, severe renal impairment or CYP3A4 inhibitors, and that severe hepatic impairment is a contraindication, yet this fixed tablet has no way to provide 25 mg.

Sildenafil is flatly incompatible with riociguat, with amyl nitrite and other nitric oxide donors, and with nitrates including GTN spray and isosorbide mononitrate. A man should also steer clear if his heart is too frail for sexual exertion, if he has lately had a stroke or heart attack, if his blood pressure is low, if his liver is severely impaired, or if he has ever lost sight suddenly in one eye through NAION. Dapoxetine adds restrictions of its own. Other antidepressants, lithium and St John’s wort must not be combined with it, leaving 14 days or more after stopping those and 7 days or more after stopping dapoxetine before they start. Episodes of fainting, mania, severe depression and significant heart disease, such as heart failure or rhythm disturbance, rule it out, and a history of psychosis must be mentioned.

The sildenafil is timed for about an hour before sex and the SmPC allows no more than one dose in 24 hours. The product information for dapoxetine itself recommends against combining it with sildenafil, since blood pressure may fall when standing up. Swallow it whole with a drink of water. Skip alcohol, add no second sildenafil or dapoxetine product, and tell the prescriber about any current treatment for erection or ejaculation problems before Cenforce D is started. If you feel faint, sit or lie down with your head low, and do not drive.

From the sildenafil, expect a possible headache, facial flushing, indigestion, a stuffy nose, dizziness or a change in colour vision. The dapoxetine contributes nausea, dizziness and, for some men, a faint; dehydration or alcohol make that likelier. An erection lasting more than four hours, chest pain, and sudden loss of hearing or vision are reasons to get emergency help. The MHRA Yellow Card website accepts reports of suspected side effects from patients and professionals. Prescribers will often weigh Cenforce D against licensed products, each of which treats just one of the two problems.