Brief Answer:
you can try clomipramine

Detailed Answer:
Hello,

Thanks for writing to us.

Duralast contains depoxetine. It is a drug used for treatment of premature ejaculation. It should be taken before 2 hours of sex. It extends the ejaculation time and provide better sexual relationship. It is a prescription drug without significant side effects.
If you cannot find improvement I recommend clomipramine.

I also want to mention treatment for premature ejaculation in brief.
Treatment for PME:

Medicines:
Clomipramine and paroxetine are choice of medicines which are used as antidepressants (For depression dose is higher).
I prefer clomipramine for PME. No significant side effects with these medicines. Initially say for 0-30 days daily after dinner and later on just on the day when you do the sex.
Paroxetine is more potent but it may cause side effects like headache, gastric discomfort, giddiness and sedation. In patients with blood pressure it should be used in consultation with physician/cardiologist.

These medicines are prescription medicines and you need to consult doctor/psychiatrist/sexologist for prescription.


Behavioral approaches are as follows for your information:

1. Stop and Squeeze technique can be applied which you can learn from internet and ask me if any query in that.(In brief, method suggests that you should try to divert your mind for a moment when you feel ejaculation arousal and penis should be tightly squeezed with hand inwards by your partner preferably).

2. Kegel exercise also helps in some cases. You can learn the same from internet.

3. Sex counselling of your sexual behavior and methods. Like if you are down and female partner on top, gravity is going to help you for lengthening the time.

4. You should do masturbation before sex (at least 2 hours before ). It will make seminal vesicles somewhat empty and at time of sex semen will take more time to come out.

Another approach:
-Use of condoms. Sometime use of condom, while sex, helps in delaying ejaculation by reducing sensitivity of glans penis.

--Topical application of lignocaine anesthetic gel/spray. For this you have to consult doctor.

Confido is an ayurvedic product and recommended for premature ejaculation.
You can take it with milk every day for 2 months.

If I were your treating doctor I would recommend clomipramine and confido at present with behavioral approach whichever applicable.


Hope I have answered your query, I will be happy to help further.


Regards,
Dr Chintan Solanki.

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