The two combinations that do have trials: sildenafil with dapoxetine, tadalafil with dapoxetine

Some combinations in this catalogue have been randomised and some have not, and the line runs in a specific place. This page covers the two that do: the sildenafil-and-dapoxetine products — Sextreme Power XL, P-Force and Extra Super P-Force — and the tadalafil-and-dapoxetine products, Sextreme Power XL and Super Carefill.

The sildenafil combination: a five-arm trial

The 2018 trial from Sohag University is the only randomised trial of sildenafil with dapoxetine in this file, and it is a proper one. In a single-blind, placebo-controlled study, 150 patients with premature ejaculation without erectile dysfunction were randomised into five groups of 30 each. The arms were on-demand placebo; paroxetine 30 mg; dapoxetine 30 mg; sildenafil citrate 50 mg; and dapoxetine 30 mg with sildenafil citrate 50 mg, each for 6 weeks.

Patients recorded intravaginal ejaculatory latency time and were assessed with the Premature Ejaculation Diagnostic Tool and a patient satisfaction score, before and after treatment. All groups improved significantly (p = 0.001), and the combination arm “had the best values of IELT, satisfaction scores and PEDT in comparison with other treatment groups” (p < 0.001).

Note what is absent: the abstract does not print a latency in seconds for any arm, so the size of the advantage cannot be read from it. What it establishes is the design — a placebo arm and three active comparators — which is more than most combination products in this catalogue can point to.

The tadalafil combination: two trials

The 2024 prospective comparison randomised men to tadalafil 5 mg, dapoxetine 30 mg, or the combination of both, and reported the combination scoring best on ejaculatory latency against its own components. The 2021 randomised trial in the Urological Journal compared dapoxetine/tadalafil against paroxetine/tadalafil as combination therapies — a comparison of two combination regimens rather than of a combination against placebo.

That is a meaningful difference in what a trial can support. A combination-versus-placebo design supports a claim about the combination; a combination-versus-combination design supports a ranking between two options. Neither converts into a statement about milligram strengths, because the abstracts do not print them.

The only number in the file: the interaction study

Where the combination trials report rankings, the 2006 pharmacokinetic study reports a measurement. In an open-label, randomised crossover study in 24 men, dapoxetine 60 mg was compared with dapoxetine 60 mg plus tadalafil 20 mg and dapoxetine 60 mg plus sildenafil 100 mg, with plasma concentrations determined by liquid chromatography-tandem mass spectrometry.

The results, precisely: tadalafil did not affect dapoxetine pharmacokinetics, while sildenafil increased the dapoxetine AUC by 22 % — an effect the authors deemed not clinically important. Dapoxetine did not appear to affect the pharmacokinetics of tadalafil or sildenafil. Most adverse events were mild.

Twenty-four men, a single combination each, and one quantified interaction. That is the level of detail the rest of this literature does not reach.

What the meta-analysis does with all of it

The 2018 network meta-analysis of 44 randomised trials ranked dapoxetine 30 mg as the agent most likely to be best overall, and its combination arms list dapoxetine 30 mg with mirodenafil, paroxetine with sildenafil, topical lidocaine with tadalafil, paroxetine with tadalafil and combined fluoxetine with tadalafil. The sildenafil-dapoxetine trial above is from 2018, published in the same window.

Where the pair is absent from a ranking, it is absent because no trial fed it into the network — not because the network judged it inferior.

What the data do not show

• No abstract in this file prints a latency in seconds. The combination’s advantage is reported as a ranking and a p-value, not as an effect size a reader can check.
• Only the sildenafil trial has a placebo arm and three comparators. The tadalafil trials compare regimens.
• The interaction study is 24 men, open-label, with one 22 % AUC change on sildenafil and none on tadalafil.
• No trial of the vardenafil combination appears here, which is why it has its own page on this site.
• Nothing on this page is advice. These are research materials sold as research materials; the milligram figures are the regimens those trials ran, and nothing here recommends any product to any person.