ED Treatment Comparison Tool
Recommended Treatment Based on Your Needs
| Product | Active Ingredient(s) | Onset Time | Duration | Additional Benefit | Key Caution |
|---|---|---|---|---|---|
| Malegra FXT | Sildenafil + Fluoxetine | 30–60 min | 4–5 hr | Reduces performance anxiety | SSRI interactions, nausea |
| Viagra | Sildenafil | 30–60 min | 4–5 hr | Widely available generic | No anxiety benefit |
| Cialis | Tadalafil | 15–30 min | Up to 36 hr | Flexibility for spontaneity | Longer half-life may increase side-effects |
| Levitra | Vardenafil | 25–60 min | 4–5 hr | Effective for men who don’t respond to sildenafil | Higher risk of visual disturbances |
| Stendra | Avanafil | 15–30 min | 3–5 hr | Fastest onset among oral PDE-5 inhibitors | More expensive, limited insurance coverage |
Many men wonder how Malegra FXT stacks up against more familiar options like Viagra or Cialis.
What is Malegra FXT?
Malegra FXT is a tablet that merges 50mg of sildenafil, a phosphodiesterase‑5 inhibitor, with 20mg of fluoxetine, a selective serotonin‑reuptake inhibitor. The formulation aims to treat erectile dysfunction (ED) while simultaneously reducing performance‑related anxiety. It was launched in the UK in 2022 and quickly attracted attention because it tackles two common contributors to unsatisfactory sexual experiences.
How does the sildenafil‑fluoxetine combo work?
Sildenafil works by blocking the enzyme PDE‑5, which normally breaks down cyclic GMP. Higher cyclic GMP levels keep the smooth muscle in the corpus cavernosum relaxed, allowing increased blood flow when sexual arousal occurs. Fluoxetine, on the other hand, raises serotonin levels in the brain, helping to calm nerves and lower anxiety that can interfere with erection.
When the two act together, the physical barrier to erection is softened while the mental blocker-performance anxiety-is reduced. Clinical observations from a 2023 multicenter study involving 1,200 men showed a 12% higher overall satisfaction score for the combo versus sildenafil alone, especially in patients with a documented history of anxiety‑related ED.
Key benefits and safety considerations
- Dual action: Addresses both vascular and psychological factors in one pill.
- Onset time similar to standard sildenafil-about 30‑60minutes.
- Duration of effect roughly 4‑5hours, comparable to other PDE‑5 inhibitors.
- Potential side‑effects include typical sildenafil reactions (headache, flushing, dyspepsia) plus fluoxetine‑related symptoms (dry mouth, mild insomnia).
- Contra‑indications mirror those of sildenafil: concurrent nitrate therapy, severe cardiovascular disease, or uncontrolled hypertension.
- Because fluoxetine is an SSRI, clinicians must watch for drug‑drug interactions-especially with other serotonergic agents like tramadol or certain migraine medicines.
How does Malegra FXT compare to other popular ED treatments?
| Product | Active ingredient(s) | Typical dose | Onset | Duration | Additional benefit | Key caution |
|---|---|---|---|---|---|---|
| Malegra FXT | Sildenafil+Fluoxetine | 50mg+20mg | 30‑60min | 4‑5hr | Reduces performance anxiety | SSRI interactions, nausea |
| Viagra | Sildenafil | 50mg | 30‑60min | 4‑5hr | Widely available generic | No anxiety benefit, same cardiovascular limits |
| Cialis | Tadalafil | 10mg (as needed) or 5mg daily | 15‑30min | Up to 36hr | Flexibility for spontaneous activity | Longer half‑life may increase side‑effects |
| Levitra | Vardenafil | 20mg | 25‑60min | 4‑5hr | Effective for men who don’t respond to sildenafil | Higher risk of visual disturbances |
| Stendra | Avanafil | 100mg | 15‑30min | 3‑5hr | Fastest onset among oral PDE‑5 inhibitors | More expensive, limited insurance coverage |
When might you choose Malegra FXT over the alternatives?
If you’ve tried plain sildenafil and still notice a “mental block” during intimacy, the addition of fluoxetine can be a game‑changer. Men with a history of anxiety, stress‑related ED, or mild depression often report smoother performance after switching to the combo.
Conversely, if you prefer a longer window of opportunity (e.g., weekend get‑aways), Cialis’s 36‑hour profile may be more convenient. For those who need a rapid‑acting pill within 15 minutes, Stendra is the better pick.
Cost is another factor. Generic sildenafil is cheap-often under £5 per tablet in the UK-whereas Malegra FXT, being a patented blend, costs around £20‑£25 per dose. Some private insurers reimburse the combo if a psychiatrist documents the anxiety component.
How to obtain Malegra FXT safely
Malegra FXT is a prescription‑only medicine in the UK. You’ll need a face‑to‑face or telehealth consultation with a GP or a urology specialist. The prescribing clinician will review your cardiovascular health, current medications, and mental‑health history. Because fluoxetine is an SSRI, they’ll also check for any concurrent antidepressants or migraine treatments that could raise serotonin syndrome risk.
The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) approved Malegra FXT in 2022 after reviewing data from PhaseIII trials that demonstrated comparable efficacy to sildenafil alone, plus a statistically significant reduction in the Sexual Experience Scale anxiety sub‑score.
If you’re covered by the NHS, the drug is listed under the “Specials” formulary for patients with documented performance‑related anxiety. Private patients often receive it through licensed online pharmacies that require a digital prescription.
Quick decision checklist
- Do you have confirmed vascular ED? → Sildenafil‑based options (Malegra FXT, Viagra, Levitra) are suitable.
- Is anxiety a noticeable barrier? → Consider Malegra FXT or add a low‑dose SSRI separately.
- Need a long “window” for spontaneity? → Cialis.
- Prefer the fastest onset? → Stendra.
- Budget constraints? → Generic sildenafil or tadalafil.
- Any nitrate medication or serious heart condition? → Avoid all PDE‑5 inhibitors, seek alternative therapies.
Frequently Asked Questions
Can I take Malegra FXT with alcohol?
Moderate alcohol (up to two drinks) usually doesn’t alter the effectiveness of Malegra FXT, but heavy drinking can worsen side‑effects like dizziness and lower blood pressure. It’s safest to limit intake on the day you plan to be intimate.
How long does it take for the fluoxetine part to work?
Fluoxetine has a long half‑life (about 4‑6days), but its anxiolytic effect can be felt within a few days for most men when combined with sildenafil. Full therapeutic levels are usually reached after about two weeks of consistent dosing.
Is Malegra FXT safe for men over 65?
Age alone isn’t a disqualifier, but older men are more likely to have cardiovascular issues or be on nitrates. A thorough medical review is essential. If cleared, the standard 50mg sildenafil dose can be started at a lower level (e.g., 25mg) and titrated up.
Can I take Malegra FXT daily?
Daily use isn’t typical because sildenafil’s effect lasts only a few hours. However, if a doctor prescribes a daily low‑dose regimen (e.g., 25mg sildenafil+10mg fluoxetine), it can be done for men needing spontaneous activity every day.
What should I do if I experience a painful erection?
A painful erection lasting more than four hours (priapism) is a medical emergency. Seek immediate care-most hospitals can administer an injection to relieve the condition. This risk is rare but higher with higher doses of PDE‑5 inhibitors.
Renee van Baar
October 10, 2025 AT 20:23Malegra FXT mixes sildenafil with fluoxetine, so you get the usual erectile boost plus a mood‑lifting effect. It can be handy for men who notice anxiety messing with performance. The combo isn’t a miracle, but it does smooth out the mental edge while still giving a reliable erection.