Safety
Boxed warning (sertraline and paroxetine): antidepressants increased suicidal thoughts and behaviors in children, teens and young adults in short-term studies, so watch closely for mood changes. They can also cause sexual side effects, serotonin syndrome with other serotonergic drugs, and withdrawal symptoms if stopped suddenly. Numbing sprays can transfer to a partner and irritate the skin, and prilocaine can rarely cause methemoglobinemia at high exposure.
Talk to a licensed clinician about your health history and every medication you take before you start.
Legal status
Prescription only; FDA-approved for other uses. Using sertraline or paroxetine for premature ejaculation is off-label. No lidocaine-prilocaine spray is FDA-approved in the US: over-the-counter lidocaine and benzocaine desensitizers are allowed under 21 CFR part 348, and a prescription lidocaine-prilocaine spray is compounded or off-label.
What Premature ejaculation treatment is
Premature ejaculation treatment contains sertraline or paroxetine (off-label); lidocaine or lidocaine-prilocaine sprays. Dapoxetine, sold for premature ejaculation in other countries, is not FDA-approved and has no lawful compounding route in the US.
What the FDA has approved
- No drug is FDA-approved for premature ejaculation in the US
- Over-the-counter lidocaine and benzocaine desensitizers are permitted for premature ejaculation under the FDA monograph (21 CFR part 348)
Dosing
Daily or before sex (SSRIs, as prescribed); shortly before sex (sprays). Set by your prescriber. Sertraline and paroxetine are prescribed off-label for premature ejaculation.
How well it works
Sertraline and paroxetine were approved on trials in depression and anxiety disorders, so their labels report no results for premature ejaculation. Individual results vary.
Premature ejaculation treatment cost
Sertraline from $27 a month at Rex MD (Oct 18, 2026). For a full breakdown, read Where is generic Cialis cheapest online?.