Description

Malegra FXT (sildenafil + fluoxetine)

Malegra FXT combines sildenafil with fluoxetine — a PDE5 inhibitor for erectile dysfunction alongside an SSRI for premature ejaculation — in a single tablet. The standard formulation contains sildenafil 100 mg and fluoxetine 40 mg.

Fluoxetine’s mechanism for delaying ejaculation works through central serotonin reuptake inhibition. Increased serotonergic activity raises the ejaculatory threshold. Unlike sildenafil, which takes effect within the hour, fluoxetine requires sustained use to produce its PE benefit — clinical data shows meaningful improvement typically appearing at 3 to 6 weeks of regular use. Someone expecting the same immediate onset from both components will be disappointed with the ejaculatory control side until the SSRI has had time to build up.

Dosing and timing

One tablet taken 30 to 60 minutes before sexual activity, swallowed whole with water. Take on a light or empty stomach for best sildenafil absorption. Maximum dose: 100 mg sildenafil / 40 mg fluoxetine per 24-hour period.

Higher-strength variants — described in some sources as 140 mg and 160 mg sildenafil equivalents — exceed the FDA-approved maximum of 100 mg for sildenafil. These are above-label doses. The clinical evidence for sildenafil above 100 mg shows no additional benefit and increasing side effect burden. Patients should not exceed the standard 100 mg sildenafil component.

Nitrates

Sildenafil in any combination — including this one — is absolutely contraindicated with nitrates: nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, amyl nitrate. The resulting blood pressure drop can be severe and fatal. There is no safe version of this combination.

Contraindications

All nitrates. MAO inhibitors — combining fluoxetine with MAOIs carries serious risk of serotonin syndrome; a washout period is required before switching. Peyronie’s disease. Mania or bipolar disorder. Recent stroke or heart attack. Significant kidney, liver, or heart disease. Retinitis pigmentosa. Sickle cell disease, multiple myeloma. Ulcers.

Drug interactions

Fluoxetine interacts with anticoagulants, tricyclic antidepressants, antifungals (ketoconazole, itraconazole), HIV medications, and tramadol. The sildenafil component interacts with CYP3A4 inhibitors — which include several antifungals and HIV medications already listed — raising sildenafil blood levels. This overlap means the drug interaction profile of this combination is broader than either drug alone.

Side effects

Headache, facial flushing, nausea, indigestion, and muscle pain are the most commonly reported. Fluoxetine adds insomnia, drowsiness, and dry mouth to the typical sildenafil side effect picture. Visual disturbances reflect PDE6 retinal involvement. Drowsiness may affect driving ability.

Priapism — erection lasting more than 4 hours — is a medical emergency requiring immediate treatment. Delay results in permanent tissue damage.