Malegra FXT 100/40 mg (Sildenafil + Fluoxetine): Dosing, Side Effects & How It Compares

✓ Medically reviewed by  ·  Last reviewed: May 2026

Morgan Ellis

Pharmacy Researcher · 8 years experience

Pharmacy researcher with 8 years reviewing clinical drug information, generic formulation equivalence, and international pharmaceutical standards. Focuses on patient-facing accuracy in medication education.

Most ED-plus-PE combination tablets on the market lean on dapoxetine, a short-acting SSRI engineered for on-demand premature-ejaculation use. Malegra FXT does something different. It pairs sildenafil 100 mg with fluoxetine 40 mg, the longest-half-life SSRI in routine clinical use. That single mechanism choice changes how you dose it, how quickly it starts working, and what side-effect pattern you should expect. The trade-off is real: fluoxetine takes weeks to reach steady state, but once it does, the ejaculation-delay effect is constant rather than session-by-session. This guide walks through the pharmacology, the dosing reality of an SSRI with a 7–15 day washout, and lays Malegra FXT side-by-side with the duloxetine and dapoxetine combos so you can match the right tool to your pattern of dysfunction.

Malegra FXT: What It Is and Where It Fits

Jump to a section:

• What Malegra FXT is
• Mechanism — how sildenafil + fluoxetine work together
• Why fluoxetine’s half-life matters
• Dosing, timing and the build-up phase
• Side effects and contraindications
• Drug interactions worth knowing
• Malegra FXT vs DXT vs dapoxetine combos
• Who is this for?
• Buying considerations
• Frequently asked questions
• The bottom line

What Is Malegra FXT?

Malegra FXT is a fixed-dose combination tablet manufactured by Sunrise Remedies (a WHO-GMP-certified manufacturer in India), intended for men who experience erectile dysfunction (ED) and chronic, daily-pattern premature ejaculation (PE) together. Each 100/40 mg tablet contains:

• Sildenafil citrate 100 mg — the same active ingredient as branded Viagra, a phosphodiesterase type-5 (PDE5) inhibitor for the erection side.
• Fluoxetine 40 mg — a selective serotonin reuptake inhibitor (SSRI) that has been used since 1987 for depression, and at lower doses off-label for premature ejaculation.

The combination is sold in pack sizes of 10, 30, 60, 90 and 180 tablets. Because fluoxetine is a daily-dose drug, the smaller packs are essentially a tolerability trial — most men will move to the 90- or 180-tablet pack once they are sure the side-effect profile is acceptable. Branded fluoxetine you may recognise includes Prozac (Eli Lilly) and Sarafem; the same molecule has been off-patent and widely generic since 2001.
Malegra FXT 100/40 mg sits in our erectile dysfunction shelf next to other ED-plus-PE combos like Malegra DXT (sildenafil + duloxetine) and Super Vidalista (tadalafil + dapoxetine).

How It Works — Two Different Clocks

The two molecules in Malegra FXT operate on completely different timescales, which is the most common source of confusion for men switching from a dapoxetine combination.
Sildenafil blocks PDE5, the enzyme that breaks down cyclic GMP in the smooth muscle of the corpus cavernosum. With cGMP allowed to accumulate, the cavernosal arteries dilate and venous outflow is restricted — that is the erection. The mechanism is on-demand and session-bounded: peak plasma concentration in 30–120 minutes, useful clinical effect for roughly 4–6 hours, then the molecule is cleared by CYP3A4 metabolism in the liver.
Fluoxetine blocks the serotonin reuptake transporter, increasing synaptic serotonin. In the dorsal raphe nucleus and lumbar spinal pathways involved in ejaculatory reflex, sustained higher serotonin levels raise the threshold for ejaculation — but only after the post-synaptic 5-HT receptors down-regulate, which takes 2–4 weeks. Take fluoxetine on Monday and you will not delay ejaculation on Monday night. Take it every day for a month and the effect builds gradually.
This is the most important thing to understand: the PE side of Malegra FXT is not active on day one. Men who expect a dapoxetine-style same-night effect are usually disappointed in week one and stop too early. The fluoxetine component needs daily dosing, three to four weeks, before judgement.

Why Fluoxetine’s Half-Life Is the Headline Detail

Half-life is normally a footnote in a drug guide. For fluoxetine, it is the headline.

• Fluoxetine parent drug: elimination half-life of 1–3 days after a single dose, extending to 4–6 days at steady state.
• Norfluoxetine (the active metabolite, equipotent at the serotonin transporter): half-life of 7–15 days.

By comparison, dapoxetine has a 1.5-hour half-life. Sertraline is roughly 26 hours. Duloxetine is 12 hours. Fluoxetine is in a class of its own. Three practical consequences flow from this:

1. Steady state takes 4–5 weeks, not 1–2. The drug accumulates predictably over that window. Most prescribing references quote 4 weeks of daily dosing before assessing response.
2. Discontinuation is gentle. Stop fluoxetine and the molecule self-tapers over 2–3 weeks as norfluoxetine slowly clears. SSRI discontinuation syndrome — the dizziness, “brain zaps,” and irritability that hit hard with paroxetine or duloxetine — is rare with fluoxetine because the body cannot drop blood levels fast enough.
3. Drug interactions persist for 5+ weeks after the last dose. If you stop Malegra FXT on January 1, the fluoxetine washout for interaction purposes does not finish until early February. This matters most for switching to an MAOI, starting linezolid, or beginning chemotherapy with tamoxifen (where strong CYP2D6 inhibition by fluoxetine can blunt drug activation).

Dosing, Timing and the Build-Up Phase

Malegra FXT is a one-tablet-per-day medicine. Take it at the same time each day, with or without food. Most men prefer mornings because fluoxetine can be activating and disrupt sleep if taken late.

One tablet per 24 hours is the maximum. Do not stack Malegra FXT with another sildenafil, tadalafil or vardenafil product on the same day. Do not double-dose if you miss a day — just take the next dose at the usual time.

Side Effects and Contraindications

The combination tablet inherits side-effect profiles from both molecules.
From sildenafil 100 mg (common, dose-related, usually transient):

• Headache, facial flushing, nasal congestion
• Indigestion or reflux
• Visual disturbance (blue-tint, light sensitivity) — usually mild
• Dizziness or postural lightheadedness

From fluoxetine 40 mg (peaks early, often settles by week 3–4):

• Nausea, reduced appetite, mild weight loss
• Insomnia or vivid dreams (the activating SSRI signature — worst if dosed late)
• Restlessness, jitteriness, or akathisia in sensitive patients
• Sweating, dry mouth
• Reduced libido or anorgasmia in a minority — paradoxical alongside the PE benefit

Hard contraindications — do not take Malegra FXT if any of the following apply:

• You take any nitrate medication (nitroglycerin, isosorbide mononitrate or dinitrate, amyl nitrite “poppers”)
• You have had a heart attack, stroke or life-threatening arrhythmia in the last 6 months
• You take or have taken an MAOI (phenelzine, tranylcypromine, moclobemide, selegiline) within the last 14 days, or linezolid, or methylene blue
• You have known severe hepatic impairment
• You have a history of bipolar disorder with manic episodes triggered by serotonergic drugs

Drug Interactions Worth Knowing

Beyond the absolute contraindications above, three interaction categories are worth understanding because they catch men out:

1. Other serotonergic drugs. Tramadol, fentanyl, ondansetron, triptans (sumatriptan, rizatriptan), St John’s Wort, 5-HTP, and other SSRIs/SNRIs all add serotonin tone. Combining them with fluoxetine 40 mg meaningfully raises serotonin-syndrome risk. Avoid the combination, or talk to a clinician about dose-spacing if a triptan is needed for migraines.
2. CYP2D6 substrates. Fluoxetine is a strong CYP2D6 inhibitor. Codeine and tramadol depend on CYP2D6 to convert to their active forms — fluoxetine blunts pain relief from both. Tamoxifen depends on CYP2D6 to activate; fluoxetine reduces breast-cancer-prevention efficacy and should be avoided in patients on tamoxifen. Some beta-blockers (metoprolol, propranolol) reach higher levels.
3. Alpha-blockers and antihypertensives. The sildenafil component lowers blood pressure modestly. Combining with tamsulosin, alfuzosin, doxazosin or other antihypertensives raises the risk of postural hypotension. Take the alpha-blocker and the sildenafil at least 4 hours apart.

Alcohol. Sildenafil plus moderate alcohol is generally fine, though alcohol itself can blunt erectile response. Fluoxetine plus heavy drinking raises the risk of behavioural disinhibition and sleep disruption. Keep it modest.

Malegra FXT vs DXT vs Dapoxetine Combos

This is where most buyers actually need help. Three distinct strategies exist for treating ED-plus-PE; they are not interchangeable.

The shortcut decision rule:

• PE that happens almost every time, has been there since first sexual experience, no obvious trigger → daily SSRI/SNRI strategy. Choose Malegra FXT if you prefer a gentle stop and don’t mind a 4-week ramp; choose Malegra DXT if 1–2 weeks to effect matters more or you have co-existing low mood.
• PE that’s situational, came on later in life, or only with new partners → on-demand dapoxetine combo. Super P-Force for 4–6 hours of ED cover; Super Vidalista if you want a 24–36 hour ED window.
• ED-only, no PE → standalone PDE5 inhibitor. Cenforce (sildenafil) for 4–6 hours; tadalafil for 24–36 hours. No SSRI component needed.

Who Is Malegra FXT Actually For?

Malegra FXT is a poor fit for men who want session-by-session control, who have intermittent or situational PE, who already take an SSRI or SNRI for depression (stacking risks serotonin syndrome), or who cannot tolerate the activating side-effect window of fluoxetine in weeks 1–2. It is also not the right tool for ED alone — the fluoxetine is dead weight if PE is not part of the picture.

Buying Malegra FXT From MedsBase

We stock Malegra FXT 100/40 mg in pack sizes of 10, 30, 60, 90 and 180 tablets. The 10-pack works as a tolerability trial, but daily dosing means a 90- or 180-tablet pack is the practical sweet spot for ongoing use. Tablets are sourced directly from Sunrise Remedies, a WHO-GMP-certified manufacturer, and shipped worldwide in plain, discreet packaging — no medication name on the parcel exterior.
Card payments are processed through a regulated on-ramp; the descriptor that lands on your bank statement is one of a regulated card-payment processor, never “MedsBase” or any medication name. Crypto and SEPA bank transfer are also accepted. Every order is covered by our Reshipment Assurance Policy: if your parcel does not arrive within 20 business days, we reship it free.
For US-based buyers, see our specific US shipping page for the current available products.

Frequently Asked Questions

Will Malegra FXT delay ejaculation the first time I take it?

No — that is the most common source of confusion. The sildenafil component works the first time for the ED side, but the fluoxetine component needs 2–4 weeks of daily dosing to build the ejaculation-delay effect. Men who quit after a week typically conclude the drug doesn’t work, when in reality they stopped before steady state. Plan for four weeks of daily dosing before judgement.

Can I take Malegra FXT only on the days I expect sex?

No. Fluoxetine doesn’t work that way. The half-life is so long that you can miss a single dose without the level dropping much, but skipping multiple days defeats the daily-accumulation strategy. If you want pre-sex dosing, you want a dapoxetine combo like Super P-Force instead.

How does fluoxetine compare to dapoxetine for PE?

Different tools for different problems. Dapoxetine is short-acting (1.5 hr half-life) and works on-demand — take it 1–3 hours before sex. Fluoxetine is long-acting (parent 4–6 days, metabolite 7–15 days) and works only when taken every day for several weeks. Daily dosing gives more reliable ejaculation control session-by-session; on-demand dosing avoids continuous medication.

What if I want to stop Malegra FXT?

Fluoxetine self-tapers because the half-life of the active metabolite is so long. Most men can simply stop, and the drug will gradually clear over 2–3 weeks. SSRI discontinuation syndrome — the dizziness, headaches and irritability that can accompany sudden stop of paroxetine or duloxetine — is rare with fluoxetine. That said, do not start an MAOI for at least 5 weeks after the last dose.

Is Malegra FXT FDA-approved?

The combination tablet itself is not approved by any Western regulator, but both individual molecules are. Sildenafil 100 mg is FDA-approved as Viagra and as generic sildenafil (Pfizer’s patent expired in 2017). Fluoxetine 20 mg and 40 mg are FDA-approved as Prozac and as generic fluoxetine. The Malegra FXT formulation is approved by the Indian FDA (CDSCO) and is manufactured by Sunrise Remedies under WHO-GMP standards.

Can I drink alcohol on Malegra FXT?

Light to moderate drinking is generally fine. Heavy drinking blunts erectile response (working against the sildenafil), worsens fluoxetine-related sleep disruption, and raises the risk of behavioural disinhibition. A glass of wine with dinner is not a problem; a heavy session before sex tends to undo what the medication is doing.

Will Malegra FXT help with depression too?

Possibly, but it is not the right tool for that purpose. Fluoxetine 40 mg is at the upper end of the SSRI dose range used for depression, and 6–8 weeks of daily dosing produces a meaningful antidepressant effect in most patients. If depression is the primary problem, see a clinician — there are situations where a different SSRI or SNRI is a better first choice, and the ED component of Malegra FXT is unnecessary if you do not have ED.

What’s the difference between Malegra FXT and Malegra DXT?

The PE molecule. FXT uses fluoxetine, an SSRI with a 7–15 day metabolite half-life. DXT uses duloxetine, an SNRI with a 12-hour half-life. DXT reaches steady state faster (1–2 weeks vs 4 weeks), has a stronger noradrenergic activation profile (more useful if low mood or chronic pain coexists), but requires careful tapering on stop. FXT is gentler at both ends — slower to start, slower to stop.

Are there any sildenafil-fluoxetine drug interactions I should worry about?

Sildenafil and fluoxetine are independently metabolised — sildenafil mainly via CYP3A4, fluoxetine via CYP2D6 — so there is no major direct PK interaction between them. The interaction footprint that matters is fluoxetine plus other serotonergic drugs (tramadol, triptans, MAOIs), and sildenafil plus nitrates. The molecules don’t fight each other; they each have their own caution list.

Is 100/40 mg the only strength Malegra FXT comes in?

The standard Malegra FXT tablet is fixed at sildenafil 100 mg plus fluoxetine 40 mg — there is no lower or higher single-tablet version of plain Malegra FXT. If you need a stronger SSRI component, Malegra FXT Plus pairs the same 100 mg sildenafil with fluoxetine 60 mg. Because this is a fixed-combination tablet, you cannot adjust the sildenafil and fluoxetine doses independently — which is one reason some clinicians prefer to titrate the two molecules separately before moving to the combo.

Can I split a Malegra FXT 100/40 mg tablet in half?

Splitting is not recommended unless the tablet is scored, and even then half a tablet gives you roughly sildenafil 50 mg plus fluoxetine 20 mg — a different therapeutic profile, not simply “half a dose.” Fluoxetine 20 mg is a recognised starting dose, so some men do split as a tolerability step, but sildenafil 50 mg may then be too low for reliable ED cover. A cleaner way to ease in is to start with a standalone fluoxetine 20 mg product for two weeks, then move to the full Malegra FXT 100/40 mg tablet once the SSRI is tolerated.

The Bottom Line

Malegra FXT is the daily-SSRI option in our ED-plus-PE shelf. It is the right tool for men with lifelong, daily-pattern PE who want a single tablet routine, and who are willing to wait four weeks for the full effect to emerge. Its biggest advantages over Malegra DXT are a gentler discontinuation and slightly fewer drug-interaction conflicts; its biggest disadvantage is the slower onset and the 5-week post-stop interaction window. Compared with dapoxetine combos like Super P-Force, the trade-off is reliability versus on-demand convenience. Match the tool to the pattern of the dysfunction, not to the catalogue page that loaded first. If you are still working out which combination is the right starting point, our broader review of best medicine for erectile dysfunction without side effects walks through the side-effect ladder across the whole shelf.

📦 Every order is covered by our Reshipment Assurance Policy — if your parcel does not arrive within 20 business days, we reship it.

Written by

Sophie Chen

Pharmaceutical Content Researcher · 8 years experience

Sophie Chen is a pharmaceutical content researcher with 8 years covering generic medication access and clinical pharmacology. She specialises in international regulatory frameworks, bioequivalence standards, and patient-facing education on therapeutic drug classes. She is not a clinician.