From the Guidelines
The most effective medication for premature ejaculation is daily selective serotonin reuptake inhibitors (SSRIs), with dapoxetine being specifically approved for this condition in many countries, as recommended by the AUA/SMSNA guideline 1. The AUA/SMSNA guideline suggests that clinicians should recommend daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics as first-line agents of choice in the treatment of premature ejaculation 1. Some key points to consider when prescribing SSRIs for premature ejaculation include:
- Daily treatment with off-label paroxetine 10-40 mg, sertraline 50-200 mg, fluoxetine 20-40 mg, citalopram 20-40 mg, and clomipramine 12.5-50 mg is effective in delaying ejaculation 1.
- On-demand administration of clomipramine, paroxetine, sertraline, and fluoxetine 3-6 hours before intercourse is modestly efficacious and well-tolerated but is associated with substantially less ejaculatory delay than daily treatment in most studies 1.
- Topical anesthetics like lidocaine-prilocaine cream (EMLA) applied 20-30 minutes before intercourse can also help by reducing penile sensitivity, but may cause temporary numbness that can affect both partners 1. It's essential to consult with a healthcare provider before starting any medication, as they can recommend the most appropriate option based on individual health factors and preferences. Additionally, combining behavioral and pharmacological approaches may be more effective than either modality alone, as suggested by the AUA/SMSNA guideline 1. Some potential side effects of SSRIs to consider include nausea, headache, and occasionally sexual side effects like decreased libido, while topical treatments may cause temporary numbness 1. Overall, the choice of medication for premature ejaculation should be based on individual patient needs and preferences, and should be guided by the most recent and highest-quality evidence available 1.
From the FDA Drug Label
Male and Female Sexual Dysfunction with SSRIs Although changes in sexual desire, sexual performance and sexual satisfaction often occur as manifestations of a psychiatric disorder, they may also be a consequence of pharmacologic treatment. In particular, some evidence suggests that selective serotonin reuptake inhibitors (SSRIs) can cause such untoward sexual experiences Table 5 below displays the incidence of sexual side effects reported by at least 2% of patients taking sertraline in placebo-controlled trials Table 5 Adverse EventSertraline Hydrochloride TabletsPlacebo Ejaculation Failure1(Primarily Delayed Ejaculation) 14% 1% Decreased Libido26%1%
The best medication for premature ejaculation is not directly stated in the provided drug labels. However, sertraline is noted to cause ejaculation failure, primarily delayed ejaculation, in 14% of patients, which may be beneficial for patients with premature ejaculation. It is essential to consult a healthcare professional to determine the most suitable treatment option. 2 2
From the Research
Medications for Premature Ejaculation
- Selective serotonin reuptake inhibitors (SSRIs) have been used effectively for the treatment of premature ejaculation (PE) 3, 4, 5.
- Dapoxetine, an on-demand short-acting SSRI, has been shown to be efficacious and safe in treating lifelong PE 6, 7, 5.
- Phosphodiesterase type 5 inhibitors (PDE5Is) have been found to be effective in the treatment of PE and are recommended either as monotherapy or combined with other therapies 6.
- Topical anesthetics, such as lidocaine and prilocaine, have also been used to treat PE, with Fortacin being a registered medication for this purpose 6, 7.
Efficacy and Safety of Medications
- SSRIs have been shown to improve self-perceived PE symptoms, satisfaction with intercourse, and self-perceived control over ejaculation compared to placebo 4.
- Dapoxetine has been shown to significantly increase intravaginal latency time and improve PE patient-related outcomes 6, 7, 5.
- PDE5Is have been found to be effective in the treatment of PE, but may have adverse events such as headache, dizziness, and nausea 6.
- Topical anesthetics may have adverse events such as numbness, tingling, and decreased libido 6, 7.
Treatment Considerations
- Compliance with SSRI treatment for PE is a significant issue, with dropout rates at 6 and 12 months being 56% and 72%, respectively 3.
- Predictors of continued use of SSRIs for PE include high partner distress, being unpartnered, and having a post-treatment intravaginal ejaculatory latency time (IELT) ≥5 minutes 3.
- Physicians should encourage patients to discuss their needs and expectations and grade any improvement of their condition with treatment 6.