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Sildenafil citrate + duloxetine is a combination of well-known sildenafil citrate (Viagra) and duloxetine, a serotonin-norepinephrine reuptake inhibitors (SNRI).
Antidepressants of the SNRI and SSRI classes including duloxetine have long been used off-label to treat premature ejaculation. Delayed orgasm is a well known effect of such drugs.
Duloxetine in combination with sildenafil citrate has been shown to be more effective than duloxetine alone in delaying ejaculation and providing sexual satisfaction.
Usually a single dose before having sex is enough to achieve a satisfactory length of intercourse.