About the Condition and Treatment
To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.
Do you have renal impairment (Kidney Problems)?
Have you ever had an allergic or anaphylactic reaction to tablets containing dapoxetine?
Do you have any severe allergies?
If yes, please describe the allergy/reaction
Please provide details in this box here...
Do you have a history of mania, bipolar disorder or severe depression?
Do you have any problems of galactose intolerance, Lapp lactase deficiency or glucose?galactose malabsorption?
Have you been previously diagnosed with Glaucoma?
Do you have any significant pathological cardiac conditions such as: • Heart failure (NYHA class II-IV) • Conduction abnormalities such as AV block or sick sinus syndrome • Significant ischemic heart disease • Significant valvular disease • A history of syncope.
Do you have hepatic impairment (liver problems)?
Are you taking any drugs for erectile dysfunction?
Have you been diagnosed with premature ejaculation problems?
Do you have any other forms of sexual dysfunction?
Have you ever experienced Orthostatic hypotension?
Please list all your current prescription medication including any medication you buy over the counter...
Do you take any current or repeat medicines? (eg. oral asthma tablets) If yes, please list them below...