Cenforce D

Cenforce D is meant for men troubled at the same time by difficulty getting an erection and by climaxing too early. Its first ingredient, sildenafil, is a PDE5 inhibitor: it relaxes the blood vessels of the penis so that an erection can develop when a man is sexually aroused. The second, dapoxetine, is a short-acting selective serotonin reuptake inhibitor used on demand to lengthen the time before ejaculation. Sildenafil needs sexual stimulation to work, and neither ingredient raises libido.

The tablets offered here are an imported generic in a single strength, 100mg sildenafil with 60mg dapoxetine, sold in quantities of 30, 60, 90, 120 or 180. Nothing that joins these two substances in one tablet holds a UK marketing authorisation, and Cenforce D itself is absent from the UK medicines register. At this strength, sildenafil on its own is licensed here as a prescription-only medicine; it is the active substance of Viagra, and generic sildenafil tablets are widely prescribed. Dapoxetine is likewise supplied in the UK only on prescription.

The UK SmPC for sildenafil recommends 50mg about an hour before sex, with a range of 25mg to 100mg; 100mg is the highest dose, and it should not be taken more than once in a day. Men with liver problems, severe kidney impairment or who take certain other medicines start at 25mg. Product information for dapoxetine sets the starting dose at 30mg, taken one to three hours beforehand, with 60mg kept for men who found 30mg not effective enough and tolerated it well; it is limited to one dose in any 24 hours and to men aged 18 to 64. A tablet of Cenforce D therefore delivers the top dose of both ingredients at once, a point any prescriber would weigh carefully.

Sildenafil must not be used by men for whom sexual activity is unwise because of heart disease, such as unstable angina or severe heart failure, nor after a recent stroke or heart attack, with blood pressure below 90/50, with severe liver impairment, with an inherited retinal disease such as retinitis pigmentosa, or after loss of sight in one eye from NAION, a type of damage to the optic nerve caused by poor blood supply. Dapoxetine can cause dizziness and fainting, particularly on standing, and drinking alcohol makes this more likely. Men with significant heart conditions or a history of fainting, mania or severe depression are not candidates for it.

Nitrates for angina, nicorandil, amyl nitrite ("poppers") and riociguat must never be combined with Cenforce D, as blood pressure can drop sharply. Ritonavir is not advised with sildenafil, and other CYP3A4 inhibitors such as ketoconazole, erythromycin or cimetidine push its levels up. Alpha-blockers like doxazosin can lead to a fall in blood pressure on standing. Because of the dapoxetine, other antidepressants, MAO inhibitors, lithium and St John's wort are also a concern. Grapefruit juice modestly increases sildenafil levels.

Headache is the most frequent complaint with sildenafil, followed by flushing, dizziness, a stuffy nose, indigestion, nausea and changes in vision such as blurring or a tinge of colour. Dapoxetine commonly causes dizziness, headache and nausea. An erection that lasts more than four hours, sudden loss of vision or hearing, or chest pain during sex needs urgent treatment at A&E. Only a prescriber who knows your heart health and other medicines can say if Cenforce D is an option for you.