Poxet

Poxet is a medicine composed of dapoxetine used for premature ejaculation. Although it is not yet approved by the US FDA (Food and Drugs Administration), it is approved in other parts of the world. It is also granted for use in the European Union by the European Medicine Agency. It is marketed in the US, Japan, and Canada by Furiex pharmaceuticals and in the rest of the countries by Menarini groups. It is available in different dosage forms and variable price ranges. The medicine can be purchased from a medical store or online pharmacy, after being prescribed by the doctor.

In the article, we will try to cover everything you need to know before taking Poxet, including how it works, what is the dose, when to not take the medicine, and what are the side effects.

What is Poxet?

Poxet is a medicine used for the treatment of premature ejaculation in men between the age of 18 and 64 years. Poxet falls under the class of antidepressant medications called Selective serotonin reuptake inhibitory(SSRI). It is believed that the medicine works by increasing the level of serotonin between the nerve cells, which increases the time taken for ejaculation.

Dapoxetine is the only medicine in this class that has been studied to treat premature ejaculation. It is because dapoxetine is a fast-acting SSRI that can show its effects 1-3 hours after intake.

Premature ejaculation is associated with depression, anxiety, and loss of self-esteem. Using Poxet for the condition helps to avoid these problems and significantly improves patients’ quality of life.

What’s the Dose of Poxet?

Poxet is approved for marketing in two dosage forms by the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP). The two dosage forms are 30 mg and 60 mg. It is recommended to start the dose from 30 mg and to increase the dose to 60 mg if you have not responded sufficiently to the 30 mg tablets and also have not suffered from side effects of the medicine or any symptoms suggestive of syncope.

The maximum dose is 1 pill per day. The medicine is to be taken orally with an adequate amount of water.

How Long Does it Take for Poxet to Kick In?

The effects of Poxet will start to kick in about 1 to 3 hours after you take it. In a few cases, it may take longer. Do not increase the dose on your own if it does not work. In such situations, the dose can be increased only after the recommendation of the doctor.

If you have intentionally or accidentally consumed more than the prescribed amount of Poxet Tablet, then you must seek medical help immediately.

How Much Does Poxet Cost?

Poxet costs between $1.5 and $3.5 per pill. The price varies with the dose and manufacturer.

The History of Poxet

Initially, the drug was studied by Eli Lilly pharmaceutical company. It was sold to Johnson & Johnson in 2003 and they filed it for approval to the US FDA but it was rejected. Two-phase II studies were conducted for appropriate dosing for phase III trials. Based on the results of the phase II trial, it was recommended to use 30 mg and 60 mg for further investigations in phase III trials. The results of the phase III trials have found the drug to be effective for the treatment of premature ejaculation but it is not approved by FDA to date.[1]

 But it has been approved by the European Commission and issued a decision in 2012 stating that the benefits of the medicine outweigh its risk and the marketing authorization was granted. 

Who Should Take Poxet?

Dapoxetine is indicated in the treatment of premature ejaculation in men between the age group of 18 to 64 years.[3] You should not take Poxet to delay ejaculation if you have not been diagnosed with Premature Ejaculation (PE). It should only be used under the prescription of the doctor and should be used on-demand basis.

You are suitable to take the medicine if you meet the following criteria:

• Less than 2 minutes of intravaginal ejaculatory latency time (IELT). IELT means the time taken to ejaculate during vaginal penetration.
• Ejaculation soon after penetration, with minimal sexual stimulation.
• Premature ejaculation causes personal distress or affects life.
• Loss of control over ejaculation.
• Premature ejaculation in the majority of the intercourse in the last 6 months.

Is Poxet Safe?

Although Poxet is generally considered safe and well-tolerated for use in patients with premature ejaculation [2], there are few potential side effects to be considered. The most common side effects bothering patients leading to discontinuation are nausea and dizziness, both of which are short-lived and easily treated.

Some common side effects associated with the use of Poxet according to body systems include:

• Nervous system disorder: dizziness, headache, somnolence, disturbance in attention, tremor, paraesthesia, syncope, akathisia, dysgeusia, lethargy, sedation, depressed level of consciousness
• Eye problems: the blurring of vision, visual disturbances
• Ear disorders: tinnitus and vertigo
• Psychiatric disorders: anxiety, agitation, restlessness, insomnia, abnormal dreams, decreased libido, depressed mood, euphoric mood, mood altered, nervousness, apathy, confusional state, disorientation, thinking abnormal, hypervigilance, sleep disorder
• Cardiac disorders: sinus arrest, sinus bradycardia, tachycardia
• Respiratory disorders: sinus congestion, yawning
• Gastrointestinal disorders: diarrhea, vomiting, constipation, abdominal pain, dyspepsia, flatulence, stomach discomfort, abdominal distension, dry mouth
• Vascular disorder: flushing

Drug Interactions of Poxet

Poxet can interact with several other medications, causing different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Before taking Poxet, talk with your doctor and pharmacist. Tell them about all prescriptions, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

Some of the potentially serious drug interactions are:

• Serotonin syndrome: One of the potential fatal interactions with certain medications like monoamine oxidase inhibitor (MAOI), L-tryptophan, triptans, tramadol, linezolid, SSRIs, SNRIs, lithium, and St. John’s Wort can lead to a condition called serotonin syndrome. It is associated with excess serotonin and sometimes can have serious reactions including hyperthermia, rigidity, myoclonus, rapidly fluctuating vitals, and mental status changes.
• Thioridazine: The combined use of the drug can lead to prolonged QT intervals causing ventricular arrhythmia.
• CYP3A4 inhibitors — such as ritonavir, ketoconazole, itraconazole, erythromycin, sodium valproate, omeprazole, cimetidine, and others. This can decrease the metabolism of Poxet and thus leads to an increased risk of side effects.
• CYP3A4 Inducers: Opposite to CYP3A4 inhibitors, some medications increase the activity of this enzyme — leading to faster metabolism of Poxet. This may reduce the effectiveness of the medicine. Common CYP3A4 Inducers are: Rifampicin, Carbamazepine, Phenytoin, Phenobarbitol, Griseofulvin

Who Should Avoid Using Poxet?

Poxet can only be ordered with a written prescription from a doctor.

Here are a few examples of people who should avoid using Poxet altogether:

• People with hypersensitivity to dapoxetine or any of the excipients
• People with certain cardiac conditions like heart failure (NYHA class II-IV), sick sinus syndrome, atrioventricular block, ischemic heart disease, valvular heart disease, and history of syncope.
• People with a history of mania or severe depression
• People taking  monoamine oxidase inhibitors (MAOIs), or within 14 days of discontinuing treatment with an MAOI
• People with moderate or severe hepatic impairment.

How Does Poxet Work?

The sensory input from the integration of genital and cerebral stimuli is processed at the spinal cord level by sympathetic, parasympathetic, and somatic spinal centers. The processed information is then passed to the central ejaculatory neural circuit, which is comprised of spinal and cerebral areas.

There is experimental evidence suggesting that the role of serotonin in the ejaculatory pathway is inhibitory. The selective serotonin reuptake inhibitor like Poxet exerts its action by increasing neuronal reuptake of serotonin and thus potentiating serotonin activity. This increase in serotonin activity causes inhibition of the ejaculatory pathway prolonging the time for ejaculation.

Poxet is particularly effective among SSRIs because of its faster onset of action. It can be taken 1 to 3 hours before engaging in sexual activity as on-demand medicine.

Other Alternative Treatments for Premature Ejaculation

Dapoxetine is available under different brand names, all over the world. There are various other alternatives for Poxet in different forms.

Behavioral Techniques

The behavioral techniques for premature ejaculation might involve simple steps such as masturbating a few hours before the intercourse so that you would be able to delay ejaculation during sexual intercourse.

The doctor might also advise avoiding penetration for a certain period and focusing on some other types of sexual play so that you can avoid the pressure associated with sexual intercourse.

Pelvic Floor Exercise

Pelvic floor weakness can sometimes be associated with loss of control over ejaculation. Loss of control is one of the causes of premature ejaculation. So, pelvic floor strengthening exercises like Kegel exercises can be effective for regaining control over your ejaculation.

Pause-sqeeze technique/ Stop-Start technique

The technique involves asking your sexual partner to squeeze the end of your penis when you are about to ejaculate. After some practice over some time, you no longer require your partner to squeeze and you would learn how to modulate your feeling to delay ejaculation.

If you feel pain or discomfort with this technique, there is another technique called the stop-start technique, in which you can stop sexual stimulation just before the ejaculation, until the level of arousal has decreased, and start again.[4]

Climax Control Condoms

There are condoms called “Climax Control”. These condoms are made to delay ejaculation by either having a numbing agent like lidocaine at its tip or by making them of thicker latex to delay ejaculation.

Pharmaceutical Alternatives

• Topical Analgesics: Topical creams or sprays containing a numbing agent like lidocaine, prilocaine, or benzocaine. These agents are to be applied 10 to 15 minutes before sexual activity to delay ejaculation.
• Antidepressants: Other SSRIs like escitalopram, sertraline, fluoxetine, or paroxetine are used to delay ejaculation.
• Tramadol
• Phosphodiesterase-5 inhibitors: Sildenafil, tadalafil, and vardenafil are combined with SSRIs to work for erectile dysfunction and premature ejaculation. This combination acts in synergy to be more effective than individual drugs.
• Modafinil

Natural Alternatives

• Kaunch beej
• Yauvanamrit vati

Where to Buy Poxet?

Poxet is not approved by US Food and Drug Administration (FDA) and is currently in phase III trial in the United States. However, the medicine is approved for use in erectile dysfunction in other parts of the world including Europe. You can get it in the US as well under the prescription of a doctor for “off-label” use.

Your doctor will assess any underlying medical conditions, the medications that you are taking, and the risk for potential allergic reactions before prescribing the medicine.

Once you have your prescription, you can visit any local pharmacy to order Poxet or you can order it from the online drug store

References Used

1. McMahon, C. G. (2012). Dapoxetine: a new option in the medical management of premature ejaculation. Therapeutic advances in urology, 4(5), 233-251.
2. Pryor, J. L., Althof, S. E., Steidle, C., Rosen, R. C., Hellstrom, W. J., Shabsigh, R., … & Dapoxetine Study Group. (2006). Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomized controlled trials. The lancet, 368(9539), 929-937.
3. Hoy, S. M., & Scott, L. J. (2010). Dapoxetine. Drugs, 70(11), 1433-1443.
4. Abdel-Hamid, I. A., El Naggar, E. A., & El Gilany, A. H. (2001). Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation. International journal of impotence research, 13(1), 41-45.