Brief Answer: Try drug break for few days. Detailed Answer: Hello, You have been on three medicines for ED and PME. they are helpful; but you have difficulty in bearing the Side effects. I hope you are using these with a prescription from a doctor. Ignitor -- is a multi vitamin, so it is not associated with much side effects you are facing, you may go on taking it daily. Tadalafil ( tazzale)-- is most probably related to all stomach complaints and pain in penis. These side effects usually go away within few hours to maximum of two days of taking the drug. But if you are taking the drug daily then it may cause concerns. In such cases, I would either choose to change the drug or give you a free interval. One may think of reducing the dosage, if possible.. Best will be to go for drug break for few days and then start it , may be on alternate days. Dapoxetine-- is a newer formulation for PME managment, it is good that it can be taken just 1/2 hour only before the sexual activity and not daily. So, stick to its use only when needed. Hope the reply is useful Feel free to ask more questions for clarification If you are satisfied, kindly close the query and rate the answer Dr. Manisha Gopal MD Psychaitry

---

Brief Answer: SOS use can give problem, visit urologist Detailed Answer: Hello, Yes, tazzale can cause these symptoms on SOS use also, as these are its commonest side effects. Dapoxetine is duralast ( duralast is its market name) only. You are using it for your PME,( it gives good results if it suits someone). one may go upto 60 mg on SOS basis. However, you may use some thing else for ED if this side effect of tazzale bothers you a lot. There is no point in troubling ones self unnecessarily, if that can be avoided. You may try with higher dose of dapoxetine ( dura last ) and see if that helps. ##Also, it will be wise to investigate why you have ED, you are young to have this. You have not given any history of diabetes or high blood pressure. A visit to a urologist will be useful in looking out for the cause and managing that. This will may cure ED itself or atlest reduce it. Hope the reply is helpful please feel free to ask more questions for clarification Dr. Manisha Gopal MD Psychiatry

---

Brief Answer: Try with other names or can take paroxetine Detailed Answer: Hello, Dapoxetine is also available in name of -sustinex, or kutub. See if you can find with these names. If not, then I usually prescribe paroxetine in such cases, it should be taken daily but the effects are much better compared to dapoxetine. It can be started in 20 mg at night and increased if required. Dosage can go upto 40-50 mg a day. Effect comes in a week or so. Hope this helps you Dr. Manisha Gopal MD psychiatry

---