Extra Super Enjofil (Sildenafil/Dapoxetine)

It is a combination tablet with two active ingredients.

It contains sildenafil, a PDE-5 inhibitor for erectile dysfunction.

It also contains dapoxetine, a short-acting SSRI for premature ejaculation. 

The exact strengths vary between listings and must be read from the pack.

Sildenafil helps achieve and maintain an erection. 

Dapoxetine increases the time it takes to ejaculate. 

Super enjofil 160 mg is administered only as on-demand treatment. 

It must not be taken more than once every 24 hours. 

Sexual stimulation is required for sildenafil to work. 

It does not increase sexual desire or libido.

It does not cure either underlying condition.

It offers no protection against sexually transmitted infections.

Dapoxetine is licensed only for men aged 18 to 64.

Efficacy and safety have not been established in men aged 65 and over. 

Dapoxetine should not be prescribed to delay ejaculation in men who have not been diagnosed with premature ejaculation. 

Sexual stimulation releases nitric oxide in the corpus cavernosum.

Nitric oxide activates the enzyme guanylate cyclase

This increases levels of cyclic guanosine monophosphate (cGMP).

cGMP relaxes smooth muscle in the corpus cavernosum.

Relaxed muscle allows blood to flow into the penis.

Sildenafil inhibits PDE-5, which would otherwise break cGMP down.

Blood flow is therefore maintained during sexual activity.

Human ejaculation is primarily mediated by the sympathetic nervous system.

Dapoxetine is a short-acting selective serotonin reuptake inhibitor.

It inhibits neuronal reuptake of serotonin.

This potentiates serotonin’s action at pre- and postsynaptic receptors.

The ejaculation reflex is thereby delayed.

Time to maximum plasma concentration is about 1 to 2 hours.

Plasma levels are under 5% of peak by 24 hours post-dose.

Both drugs affect blood pressure regulation. The dapoxetine product information specifically advises against use with PDE-5 inhibitors because of increased syncope risk. 

This is the recommended starting dose. 

Take it 1 to 3 hours before anticipated sexual activity. 

Do not exceed one tablet in 24 hours. 

This is the maximum recommended dose. 

Treatment should never be started at this strength. 

It is appropriate only if 30 mg proved insufficient and caused no moderate or severe adverse reactions or prodromal syncope symptoms. 

Adverse events and their severity are higher at this dose.

This exceeds the approved maximum. 

No approved dapoxetine product exists at this strength.

No efficacy or safety data exists at this dose.

Discuss it with a doctor before taking it at all.

A careful appraisal of the individual benefit/risk ratio should be performed after the first 4 weeks of treatment, or at least after 6 doses. If continued, the balance should be re-evaluated at least every 6 months. 

Evidence beyond 24 weeks is limited. 

Read the strengths printed on the pack before anything else.

Do not take it if both strengths are not clearly stated.

Take the tablet only as a doctor has directed.

Swallow the tablet whole with a full glass of water.

Do not chew, crush, or split the tablet.

Take it 1 to 3 hours before anticipated sexual activity. 

Stay well hydrated before and after the dose.

Avoid alcohol entirely on dosing days. 

Sexual stimulation is required for the erection effect.

Take no more than one tablet in 24 hours.

Do not combine it with any other ED or PE medicine.

Sit or lie down immediately if you feel light-headed. 

Avoid situations where fainting could cause injury.

Do not drive or operate machinery after dosing.

Do not share your tablets with anyone else.

Attend the 4-week review with your doctor. 

Are hypersensitive to sildenafil or any excipient.

Take nitrates in any form, or nitric oxide donors such as amyl nitrite.

Take riociguat or another guanylate cyclase stimulator.

Have a condition making sexual activity inadvisable.

Have lost vision in one eye from NAION.

Have severe hepatic impairment.

Have hypotension below 90/50 mmHg.

Have had a recent stroke or myocardial infarction.

Have a hereditary degenerative retinal disorder such as retinitis pigmentosa.

Have significant pathological cardiac conditions.

This includes heart failure and significant ischaemic heart disease.

Have any history of syncope.

Have a history of mania or severe depression.

Take thioridazine.

Take monoamine oxidase inhibitors (MAOIs).

Take any SSRI or tricyclic antidepressant.

Take other herbal or medicinal products with serotonergic effects.

Take potent CYP3A4 inhibitors.

Have moderate or severe hepatic impairment.

Take a phosphodiesterase type 5 inhibitor, such as sildenafil. 

Are aged under 18 or over 64. 

Are a woman.

Sildenafil potentiates the hypotensive effects of nitrates. Co-administration is contraindicated

Dapoxetine must not be taken at the same time as MAOIs, SSRIs, tricyclics, or other serotonergic products. If you have taken any of these, wait 14 days after stopping before starting dapoxetine. 

The dapoxetine product information states it should not be used in men taking a PDE-5 inhibitor, as this increases the risk of syncope. 

Any cardiac condition, including heart failure or ischaemic heart disease.

Any episode of fainting, however long ago. 

Dizziness or light-headedness on standing. 

Any previous heart attack, stroke, or bypass surgery. 

Angina, or any prescription for nitrates in the past.

Any mental health condition, including depression or anxiety. 

Any history of mania or hypomania. 

Any past thoughts of self-harm or suicide. 

Epilepsy or any seizure disorder. 

Liver disease of any severity. 

Kidney disease or reduced kidney function.

Any eye disease or sudden vision loss previously.

Hearing loss or tinnitus. 

Sickle cell anaemia, multiple myeloma, or leukaemia. 

Any bleeding disorder or active peptic ulceration. 

Diabetes, especially if poorly controlled.

Any recreational drug use.

Your usual alcohol intake.

I have read both strengths from the physical pack.

I know how much dapoxetine this tablet contains.

A doctor has prescribed this specific product for me.

I have had an orthostatic test before starting. 

I have no history of fainting. 

I have no significant cardiac condition. 

I have no history of mania or severe depression. 

I take no antidepressant of any kind. 

I stopped any MAOI or SSRI more than 14 days ago. 

I take no thioridazine or serotonergic products. 

I have taken no nitrate medicine in 24 hours. 

I have not used poppers or amyl nitrite. 

I take no potent CYP3A4 inhibitor. 

I have drunk no alcohol today. 

I have used no recreational drugs. 

I am aged between 18 and 64. 

I have a 4-week review arranged. 

Antidepressants including SSRIs increased the risk of suicidal thinking compared with placebo in short-term studies in children and young people. Short-term studies did not show an increased risk in adults over 24. In the pooled dapoxetine analysis there was no evidence of men feeling suicidal on treatment. 

Monoamine oxidase inhibitors (MAOIs).

SSRIs and tricyclic antidepressants.

Thioridazine.

Other herbal or medicinal products with serotonergic effects.

Potent CYP3A4 inhibitors.

Phosphodiesterase type 5 inhibitors, including sildenafil.

Nitrates in any form.

Nitric oxide donors such as amyl nitrite.

Riociguat and other guanylate cyclase stimulators.

Moderate CYP3A4 inhibitors including erythromycin, clarithromycin, fluconazole, amprenavir, fosamprenavir, aprepitant and verapamil – dapoxetine restricted to 30 mg.

Potent CYP2D6 inhibitors, or CYP2D6 poor metaboliser genotype – caution before any increase.

Alpha adrenergic receptor antagonists and nitrates, due to possible reduced orthostatic tolerance.

Alcohol.

Recreational drugs with serotonergic activity: ketamine, MDMA, LSD.

Recreational drugs with sedative properties: narcotics, benzodiazepines.

Fainting, blackout, or loss of consciousness. 

Severe dizziness where you cannot stay standing. 

Chest pain, pressure, or tightness during or after sex.

Pain spreading to the jaw, neck, or left arm.

An erection lasting longer than 4 hours. 

A painful erection that will not subside.

Any sudden visual defect or loss of vision. 

Sudden decrease or loss of hearing. 

A very fast, slow, or irregular heartbeat.

Swelling of the face, lips, tongue, or throat.

Widespread rash with blistering or peeling skin.

A seizure or convulsion.

Signs of stroke: sudden weakness, slurred speech, facial droop.

Agitation, confusion, or restlessness.

Muscle twitching, stiffness, or loss of coordination.

Rapid heartbeat with high blood pressure.

Heavy sweating with fever or shivering.

Severe diarrhoea with nausea and vomiting.

New or worsening thoughts of suicide or self-harm.

Sudden severe low mood or hopelessness.

Unusually elevated mood, racing thoughts, or reckless behaviour.

If an erection persists longer than 4 hours, seek immediate medical assistance. If not treated immediately, penile tissue damage and permanent loss of potency could result. 

In the UK, suspected side effects can be reported through the MHRA Yellow Card scheme. 

A doctor has prescribed this medicine for me. 

Dapoxetine 30 mg: mean time to ejaculation rose from 0.9 to 3.1 minutes, versus 1.9 minutes on placebo.

Dapoxetine 30 mg: 26.2% reported good or very good ejaculatory control, versus 11.2% on placebo.

A verifiable strength. Published sources disagree.

An established manufacturer. Sources name different companies.

An approved combination. No such fixed-dose product is licensed anywhere.

The dapoxetine product information advises against use with PDE-5 inhibitors due to increased syncope risk. 

The safety and efficacy of the combination has not been established. 

Treat the erectile dysfunction before or at the same time as the premature ejaculation. 

Start dapoxetine at 30 mg, never 60 mg. 

Perform an orthostatic test before treatment. 

Review benefit and risk after 4 weeks or 6 doses. 

Both conditions are treatable and both molecules have good evidence at their approved doses. This particular product cannot be assessed properly without knowing what it contains. Read the pack, and take the strengths to a doctor before using it.

Store below 30°C in a cool, dry place.

Protect tablets from direct sunlight and heat.

Keep tablets sealed in the original blister until use.

Retain the pack, since it carries the only reliable strength information.

Do not store in the bathroom or near a sink.

Do not transfer tablets into unlabelled containers.

Never store these alongside other ED or PE products.

Do not freeze or refrigerate this product.

Keep it out of the sight and reach of children.

Accidental ingestion by a child is a medical emergency.

Check the expiry date printed on the pack.

Never use tablets after the expiry date.

Discard damaged, cracked, or discoloured tablets.

Dispose of unused medicine in accordance with local requirements.

Do not flush tablets or throw them in household waste.