Malegra Dxt Plus (Sildenafil & Duloxet)

Malegra Dxt Plus is Sunrise Remedies's sildenafil & duloxet tablet, 100/60 mg, in a strip of 10 tablets. Sildenafil with duloxetine is a fixed-dose combination of a PDE5 inhibitor and an SNRI antidepressant, sold in a few markets for erectile dysfunction with premature ejaculation.

The combination is used for men who have both erectile dysfunction and premature ejaculation. It is a product of limited availability, and each part also exists as a separate medicine.

Sildenafil blocks the PDE5 enzyme so blood flows into the penis more easily with sexual stimulation. Duloxetine is a serotonin and noradrenaline reuptake inhibitor (SNRI). The raised serotonin delays the ejaculation reflex.

It is taken as the pack and the prescription direct. Duloxetine builds up over days, so ask your doctor how often it should be used. Follow the pack leaflet.

• Headache, flushing and a blocked nose.
• Indigestion, nausea and diarrhoea.
• Dizziness, light-headedness and fainting.
• Changes in colour vision or blurred sight.
• Tiredness, sweating, dry mouth and anxiety.
• A prolonged erection of more than four hours is rare and needs emergency care.

Never take it with nitrate medicines (glyceryl trinitrate, isosorbide) or riociguat, because the combined drop in blood pressure can be dangerous. It is not for men whose heart is too weak for sexual activity, after a recent stroke or heart attack, or with severe low blood pressure. Tell your doctor about alpha-blockers, other blood pressure tablets, severe liver or kidney disease, sickle cell disease, retinitis pigmentosa and any penile shape problem. Strong CYP3A4 inhibitors (ritonavir, ketoconazole, clarithromycin) and grapefruit raise the level, so the dose is lowered. These medicines work only with sexual stimulation and do not raise desire. Not for women or children unless prescribed for another condition. Duloxetine must not be combined with MAO inhibitors, tramadol, linezolid or other serotonergic drugs, because of the risk of serotonin syndrome. It can cause suicidal thoughts in young adults and should be stopped and reported if mood worsens. Stopping it suddenly can cause withdrawal symptoms. It is also not for people with uncontrolled narrow-angle glaucoma or severe liver or kidney disease.