Medical Assessment - Priligy

About You

Are you male aged between 18 - 64?

This treatment is only suitable for men aged 18 - 64.
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Does premature ejaculation cause you personal distress or inter-personal difficulty with your partner?

We are unable to supply you with Priligy if you and/or your partner do not find your premature ejaculation distressing. Consult with your GP for other options.
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Do you drink alcohol?

You are eligible for treatment, however, you should avoid drinking alcohol when taking Priligy since together they can cause drowsiness
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Do you suffer any pain whilst ejaculating, or do you have any difficulty or pain passing urine?

We are unable to supply you with Priligy. Please consult your GP.
We are unable to supply you with Priligy. Please consult your GP.
Symptoms

Do you ejaculate before you want to?

We are unable to supply you with Priligy. Please consult your GP.
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Does it take you less than 2 minutes to ejaculate after penetration?

We are unable to supply you with Priligy. Please consult your GP.
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Have you been suffering from premature ejaculation for more than 6 months?

We are unable to supply you with Priligy. Please consult your GP.
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Do you find it difficult to achieve or maintain an erection before ejaculation?

We are unable to supply you with Priligy. Please consult your GP.
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Health

Do you have low blood pressure (below 90/50)?

  • If you do not know your blood pressure you can have this measured at your local pharmacy/GP surgery.
We are unable to supply you with treatment if you have low blood pressure. Please consult your GP for more information.
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Do you have a tendency to faint or get light-headed when you stand up from a lying position?

We are unable to supply you with Priligy. Please consult your GP about this symptom for more information.
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Are you allergic (hypersensitive) to Priligy or dapoxetine?

We are unable to supply you with Priligy. Please consult your GP.
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Have you ever suffered from any of the problems listed below?

  • mental health conditions such as depression, mania , bipolar disorder or schizophrenia
  • Heart conditions (e.g. angina, chest pain, heart failure, irregular heart beats, heart attack or narrowing of any heart valve)
  • a history of bleeding or blood clotting problems
  • a history of glaucoma or have been told you are at increased risk of glaucoma due to family history raised intraocular pressure
  • kidney problems
  • prostate problems
  • epilepsy
  • recurrent fainting
  • moderate or severe liver problems galactose intolerance, the Lapp lactase deficiency or glucose−galactose malabsorption
  • any serious medical condition which may require immediate hospitalisation
We are unable to supply you with treatment. Please consult your GP.
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Medication

Are you taking any of the following medications?

  • Any treatment for erectile dysfunction (e.g. Viagra,Sildenafil,Cialis, Levitra)
  • Serotonin reuptake inhibitors (citalopram, sertraline, fluoxetine, escitalopram,fluvoxamine)
  • Venlafaxine
  • Tricyclic antidepressants (TCAs) e.g. amitriptylline, imipramine, clomipramine, nortriptyline, lofepramine, doxepin and dosulepin.
  • Monoamine Oxidase Inhibitors (MAOIs) e.g. rasagiline, selegiline, moclobemide, phenelzine
  • St John's Wort (a herbal medicine)
  • Other medicines for depression
  • Medicines for mental health conditions other than depression - including Thioridazine (schizophrenia), Lithium (bipolar disorder)
  • Recreational drugs such as ecstasy, LSD, narcotics or benzodiazepines
  • Tryptophan (for sleep)
  • Tramadol (for pain)
  • 5HT1 antagonists e.g. sumatriptan, rizatriptan and zolmitriptan (for migraines)
  • Antibiotics: erythromycin, clarithromycin, telithromycin, linezolid
  • Antifungals e.g. ketoconazole, itraconazole and fluconazole
  • Medicines for HIV, including amprenavir, atazanavir, fosamprenavir, nelfinavir, ritonavir and saquinavir.
  • Medicines to thin your blood, such as warfarin
  • Non steroidal anti inflammatory medicines such as ibuprofen or aspirin
  • Medicines used to treat high blood pressure and chest pain (angina) that can make you feel dizzy e.g. nitrates, verapamil, diltiazem, doxazosin, atenolol, metoprolol and bisoprolol (if you feel dizzy taking any blood pressure medication you should consult a doctor and not take Priligy)
  • Medicines for enlarged prostate such as tamsulosin and finasteride
  • Aprepitant used to treat nausea.
We are unable to supply you with treatment. Please consult your GP.
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Agreement

Do you understand that if you experience any side effects of treatment such as changes in mood or any seizures, you must discontinue treatment immediately and seek urgent medical attention from a doctor?

Whilst these are uncommon side effects, they are very serious and you must discontinue use immediately. You must agree to this before continuing.
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Do you understand that if you feel light headed soon after standing, you should immediately lie down so your head is lower than the rest of your body or sit down with your head between your knees until the symptoms pass? You should also ensure you do not rise too quickly after prolonged lying or sitting and do not drive or operate machinery if you experience these symptoms.

An uncommon side effect of Priligy is that it can reduce your blood pressure and cause symptoms of light headedness. If you experience these symptoms, you must understand how to manage it and must discontinue the medication and seek medical attention immediately. You must agree to this before continuing.
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Do you agree to the following?

  • You will read the patient information leaflet supplied with your medication
  • You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • The treatment is solely for your own use
  • You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.
You must agree to this before continuing. If you need assistance contact customer support.
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