Polypharmacy in men over 65 is very common. Drug-to-drug interactions must be taken into account every time an old, sexually active man, comes in the office with premature ejaculation. Dapoxetine has good efficacy in delaying ejaculation, but may interfere with hypotensive and antidepressant drugs, causing severe side effects. I believe that short-acting PDE5 inhibitors, i.e. vardenafil and avanafil, may represent a valid alternative to treat premature ejaculation in the elderly