Super Tadapox

Super Tadapox is a fixed-dose tablet that pairs two medicines aimed at different aspects of male sexual function. Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor: it relaxes the smooth muscle of the penile blood vessels so that, with sexual stimulation, an erection is easier to achieve and keep. Dapoxetine is a short-acting selective serotonin reuptake inhibitor developed for premature ejaculation; it is designed to lengthen the time to ejaculation and is taken only before sex rather than every day. The idea behind the combination is to address both erectile dysfunction and premature ejaculation with one tablet.

Each film-coated tablet contains 40 mg of tadalafil and 60 mg of dapoxetine (as dapoxetine hydrochloride). Packs of 30, 60, 90, 120 or 180 tablets are listed. Super Tadapox is an imported generic product. This brand is not licensed in the UK, and there is no UK marketing authorisation for any product containing tadalafil and dapoxetine together.

Both substances are prescription-only medicines (POM) when supplied on their own. Tadalafil is licensed in 2.5 mg, 5 mg, 10 mg and 20 mg tablets, as the originator brand and as many generic versions. Dapoxetine is available in the UK as Priligy 30 mg and 60 mg tablets. For erectile dysfunction, the tadalafil SmPC suggests 10 mg taken at least 30 minutes before sex, raised to 20 mg if needed, no more than once a day; with severe kidney impairment the ceiling is 10 mg. For dapoxetine the information covers men aged 18 to 64, starting at 30 mg one to three hours beforehand, with 60 mg as the upper limit and no more than one dose in 24 hours. A 40 mg tadalafil tablet is therefore twice the highest on-demand amount described for erectile dysfunction, and it skips the recommended 30 mg dapoxetine starting step. Any decision to use these ingredients, separately or combined, rests with the prescriber.

Tadalafil must never be used with nitrates (including glyceryl trinitrate sprays and isosorbide tablets) or with riociguat, as blood pressure can fall dangerously. It is also unsuitable after a heart attack in the last 90 days or a stroke in the last six months, with unstable angina, moderate heart failure in the previous six months, uncontrolled heart rhythm problems, low blood pressure below 90/50 mmHg, uncontrolled high blood pressure, or loss of sight in one eye from NAION. Dapoxetine is contraindicated in significant heart disease, in anyone who has fainted in the past, in mania or severe depression and in moderate or severe liver impairment. It must not be combined with MAOIs, other antidepressants, lithium, tramadol, triptans, St John's wort or strong CYP3A4 inhibitors such as ketoconazole or ritonavir. The dapoxetine leaflet also warns that use with PDE5 inhibitors may lower tolerance to standing up, and the safety of taking the two together has not been established.

Unwanted effects can come from either ingredient. Tadalafil commonly causes headache, indigestion, back pain, aching muscles, flushing and a blocked nose, and these become more frequent as the dose increases. Dapoxetine often causes nausea, dizziness, headache, diarrhoea, poor sleep and tiredness, and it can occasionally make people faint, usually within a few hours of a dose; warning signs such as light-headedness mean lying down or sitting with the head low. Alcohol makes dizziness and fainting more likely. An erection lasting four hours or more, sudden changes in eyesight or a sudden loss of hearing need urgent attention at A&E.

Because Super Tadapox contains more tadalafil per tablet than any UK-licensed tadalafil tablet, it is worth checking with a GP whether either ingredient is appropriate at all. Erectile difficulties can be an early sign of heart disease or diabetes, and premature ejaculation sometimes responds to behavioural techniques alone. Bring a full list of current medicines to that appointment, including anything for blood pressure, the heart, mood or infections.