EnduraPro

• May help extend the time before ejaculation^1,2,3
• May help support blood flow involved in erections^7,9
• May help ease tension and racing thoughts in the moments before sex^5,6
• Brings nerve-signaling, blood-flow, and stress-response support together in a single tablet^1,4
• Some patients report feeling calmer and more present during intimacy^5,6
• May help some men feel they have more say over the timing of ejaculation^1,2,3

Possible Side Effects

• Nausea, upset stomach, or dry mouth⁸
• Drowsiness, dizziness, or sweating⁸
• Changes in sex drive, or delayed ejaculation beyond what's intended⁸
• Headache, one of the most commonly reported effects, more often linked to tadalafil⁹
• Flushing, stuffy nose, or mild indigestion, linked to tadalafil⁹
• Back or muscle discomfort, more common with tadalafil than with paroxetine⁹
• Mild, infrequent headache or stomach upset, occasionally reported with L-theanine

Warnings & Precautions

• Don't use more than one tablet in a 24-hour period.
• Keep alcohol to a minimum around the time you use this medication; both alcohol and tadalafil can lower blood pressure.
• Tell your provider about your full heart health history before starting. Sexual activity itself places a demand on the heart, and your provider needs the full picture to weigh in safely.
• Seek emergency care for an erection lasting longer than 4 hours, chest pain, or sudden vision or hearing changes.
• Because paroxetine is an SSRI, this class of medication carries an FDA-required warning about increased risk of suicidal thoughts in children, teens, and young adults, most established in the context of depression treatment. Tell your provider right away about any new or worsening mood changes.⁸
• If you use a daily SSRI or have been using paroxetine regularly, don't stop suddenly without talking to your provider; stopping abruptly can cause withdrawal-like symptoms.
• Let your provider know about all medications and supplements you take, since paroxetine and tadalafil can each interact with other things in ways that matter.

Contraindications

• Known allergy to paroxetine, tadalafil, L-theanine, or any other ingredient in this tablet.
• Use of nitrate medications in any form, including recreational nitrites sometimes called “poppers.” Combined with tadalafil, this can cause a dangerous, potentially life-threatening drop in blood pressure.⁹
• Use of monoamine oxidase inhibitors (MAOIs), or use within 14 days of stopping one. Combined with paroxetine, this can cause a serious, potentially life-threatening reaction.⁸
• Use of guanylate cyclase (GC) stimulators, such as riociguat.⁹
• A recent heart attack, stroke, unstable chest pain (angina), uncontrolled arrhythmia, or heart failure. For patients with any of these, a provider needs to evaluate whether sexual activity is advisable at all before this or any similar medication is considered.

Drug Interactions

• Nitrates (for chest pain): combined with tadalafil, this can cause a severe, potentially life-threatening drop in blood pressure.⁹
• MAOIs: combined with paroxetine, this combination is avoided due to the risk of a serious reaction.⁸
• Other serotonergic medications (other antidepressants, triptans for migraines, tramadol, St. John's Wort, lithium): combining these with paroxetine raises the risk of serotonin syndrome, a rare but serious reaction.⁸
• Alpha-blockers (often used for blood pressure or prostate symptoms): combined with tadalafil, these can cause a drop in blood pressure.⁹
• Blood thinners or regular NSAID use: paroxetine may add to bleeding risk when combined with these.⁸
• Other erectile dysfunction medications: don't combine tadalafil with other PDE5 inhibitors, such as sildenafil.

Paroxetine belongs to a family of medications called SSRIs, best known for supporting mood. In the body, SSRIs slow down how quickly a chemical messenger called serotonin gets reabsorbed by nerve cells, so more of it stays active in the spaces between them. Researchers believe this shift in serotonin activity plays a role in the timing of ejaculation: think of serotonin as one of the signals the body uses to decide when to reach that point, and paroxetine is thought to turn that signal down slightly, creating more space beforehand.^1,3 This effect was actually noticed somewhat by accident, in patients taking SSRIs for mood support, long before it was studied on its own.

Tadalafil works differently. It belongs to a group of medications called PDE5 inhibitors, which help relax smooth muscle in blood vessels so more blood can flow in when a man is aroused. A helpful way to picture it: think of the blood vessels involved in an erection like a hose with a kink in it, and tadalafil is designed to help ease that kink so blood moves more freely. Tadalafil's effects on blood flow are well documented for erectile dysfunction, its FDA-approved use. Its possible role in easing early ejaculation is less established on its own, though researchers have proposed that firmer, more reliable erections may lower performance-related anxiety, which in turn may play a supporting role in ejaculation timing.^1,7

L-theanine is an amino acid found naturally in tea leaves. It's included here for a different reason than the other two ingredients: not for a direct effect on ejaculation or blood flow, but for the sense of calm some people notice after taking it. Research suggests L-theanine may increase alpha brain wave activity, a pattern associated with relaxed alertness, and may gently support the body's stress response.^5,6 Think of it like turning down background noise in a room: L-theanine isn't sedating, but some people find it easier to stay present and relaxed with it on board.

Because EnduraPro dissolves under the tongue rather than being swallowed, its ingredients are absorbed through the tissue of the mouth and can enter the bloodstream directly, bypassing initial digestion. This route is intended to work more quickly than a tablet that first has to pass through the stomach. It's worth noting that most of the research on paroxetine and ejaculation timing has studied standard tablets taken by mouth; the sublingual route is intended to allow faster, as-needed use, though this specific sublingual combination hasn't been separately studied on its own. Combining ingredients that touch on nerve signaling, blood flow, and stress response in one tablet reflects a whole-picture approach to a concern that often has more than one contributing factor. A small number of clinical studies have looked at pairing an SSRI with a PDE5 inhibitor specifically for ejaculation timing; results have been mixed, with some studies showing a modest added benefit and others showing no significant difference compared to an SSRI on its own.^1,2,4

Q: What does EnduraPro do?

A: EnduraPro combines three ingredients that each play a different role: one works with brain chemistry tied to ejaculation timing, one supports blood flow involved in erections, and one is included to help take the edge off nerves before sex. Together, they're designed to support several sides of the same concern in a single tablet.

Q: Why do some men experience early ejaculation in the first place?

A: It's more common than most people realize. Research suggests it affects around 3 in 10 men at some point, especially before age 40.¹ It's usually tied to a mix of factors: how sensitive the nervous system is to stimulation, serotonin activity in the brain, and psychological factors like performance anxiety or a new relationship. For most men, it isn't caused by anything they did wrong, and it often responds to a combination of approaches.

Q: Why is EnduraPro a sublingual tablet instead of a pill you swallow?

A: Dissolving under the tongue lets the ingredients pass directly into the bloodstream through the tissue of the mouth, skipping the trip through the stomach first. That's part of why the tablet is designed for as-needed use timed to sexual activity, rather than a pill swallowed every day.

Q: How soon might I notice a difference?

A: This varies from person to person. Because EnduraPro is used on demand, some men notice a difference the first few times they use it, while others need a few tries, alongside some trial and error with their provider on timing and dose, to find what works best. Everyone's body responds differently.

Q: Is EnduraPro FDA-approved?

A: No. EnduraPro is a compounded medication, which means it's prepared by a pharmacy for an individual patient based on a provider's prescription, rather than mass-manufactured. Compounded medications are not reviewed or approved by the FDA for safety or effectiveness the way commercial drugs are. You can find more on this at the end of this document.

Q: Can I drink alcohol while using EnduraPro?

A: It's best to keep alcohol to a minimum around the time you use this medication. Both alcohol and tadalafil can lower blood pressure, and combining them may increase side effects like dizziness or lightheadedness.

Q: I already take a daily antidepressant. Can I still use EnduraPro?

A: This is an important conversation to have with your provider before starting. Paroxetine is itself an SSRI, so combining it with another antidepressant, or certain other medications, can raise the risk of a rare but serious reaction called serotonin syndrome. Bring your full medication list to your provider so they can check for interactions.

IMPORTANT INFORMATION ABOUT COMPOUNDED MEDICATIONS

This medication has been compounded (custom-prepared) by a pharmacy. Compounded medications are specially prepared for individual patient needs based on a valid prescription and, as such, are not reviewed or approved by the U.S. Food and Drug Administration (FDA) for safety or efficacy. These statements have not been evaluated by the FDA.

This compounded preparation:

• Has not been approved by the FDA
• Has not undergone FDA review for safety, effectiveness, or quality
• Is prepared specifically for you based on your prescriber's order
• Individual outcomes may vary

Dosing is determined by the prescribing provider based on patient-specific factors. Always follow your healthcare provider's instructions. Compounded medications are not subject to FDA approval and lack the same safety and efficacy data as FDA-approved commercial medications. This medication should be prescribed and monitored by a licensed healthcare professional familiar with the condition being addressed and the specific applications of the medication.

1. Moudi E, Kasaeeyan AA. Comparison Between Tadalafil Plus Paroxetine and Paroxetine Alone in the Treatment of Premature Ejaculation. Nephro-Urol Mon. 2016;8(1):e32286. doi:10.5812/numonthly.32286
2. Zhou Z, Yang Z, Cui Y, Zhang X, Wang Y, Zhang Y. The network meta-analysis of “on-demand” and “daily” use of paroxetine in treating men with premature ejaculation from randomized controlled trials. Andrologia. 2022;54. doi:10.1111/and.14388
3. Waldinger MD, Zwinderman AH, Olivier B. On-demand treatment of premature ejaculation with clomipramine and paroxetine: a randomized, double-blind fixed-dose study with stopwatch assessment. Eur Urol. 2004;46(4):510-516.
4. Mattos RM, Marmo Lucon A, Srougi M. Tadalafil and Fluoxetine in Premature Ejaculation: Prospective, Randomized, Double-Blind, Placebo-Controlled Study. Urol Int. 2008;80(2):162-165. doi:10.1159/000112607
5. Hidese S, Ogawa S, Ota M, Ishida I, Yasukawa Z, Ozeki M, Kunugi H. Effects of L-Theanine Administration on Stress-Related Symptoms and Cognitive Functions in Healthy Adults: A Randomized Controlled Trial. Nutrients. 2019;11(10):2362. doi:10.3390/nu11102362
6. White DJ, de Klerk S, Woods W, Gondalia S, Noonan C, Scholey AB. Anti-Stress, Behavioural and Magnetoencephalography Effects of an L-Theanine-Based Nutrient Drink: A Randomised, Double-Blind, Placebo-Controlled, Crossover Trial. Nutrients. 2016;8(1):53. doi:10.3390/nu8010053
7. McMahon CG, McMahon CN, Leow LJ, Winestock CG. Efficacy of type-5 phosphodiesterase inhibitors in the drug treatment of premature ejaculation: a systematic review. BJU Int. 2006;98(2):259-272. doi:10.1111/j.1464-410X.2006.06290.x
8. Paroxetine Tablets: Prescribing Information. U.S. Food and Drug Administration, Center for Drug Evaluation and Research. Revised 2021.
9. Tadalafil Tablets: Prescribing Information. U.S. Food and Drug Administration, Center for Drug Evaluation and Research. Revised 2018.