From the Guidelines
Bupropion is not recommended as a first-line treatment for premature ejaculation, as the current guidelines suggest daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics as the primary treatment options. According to the American Urological Association (AUA) and the Society for Male Reproductive and Urology (SMSNA) guideline published in 2022 1, these treatments have been shown to be effective in delaying ejaculation. While bupropion may be used off-label for premature ejaculation, its efficacy and safety profile are not as well-established as the recommended treatments. The guideline emphasizes the importance of recommending evidence-based treatments, and bupropion is not included in the list of first-line agents.
Some key points to consider when discussing treatment options with patients include:
- The potential benefits and risks of each treatment, including the risk of serotonin syndrome with SSRIs 1
- The importance of avoiding sudden cessation or rapid dose reduction of daily dosed SSRIs to prevent SSRI withdrawal syndrome 1
- The need for caution when prescribing SSRIs to adolescents with PE and to men with PE and a co-morbid depressive disorder, particularly when associated with suicidal ideation 1
- The potential for off-label use of medications, including bupropion, but only after discussing the risks and benefits with a healthcare provider.
It is essential to prioritize the patient's safety and well-being when selecting a treatment option, and to choose the treatment with the strongest evidence base and the best risk-benefit profile. In this case, the recommended treatments, such as daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics, are preferred over bupropion due to their established efficacy and safety profiles 1.
From the Research
Bupropion for Premature Ejaculation Treatment
- There is limited research on the use of bupropion for premature ejaculation treatment.
- A study published in 2011 2 investigated the use of bupropion for primary lifelong delayed ejaculation, not premature ejaculation, and found that bupropion-SR 150 mg/day for 2 months seemed to be of limited benefit.
- The other studies found 3, 4, 5, 6 focused on the use of selective serotonin reuptake inhibitors (SSRIs) for premature ejaculation treatment, not bupropion.
- Therefore, there is no conclusive evidence to support the use of bupropion for premature ejaculation treatment.
Alternative Treatments
- SSRIs have been shown to be effective in treating premature ejaculation 3, 4, 5, 6.
- These studies found that SSRIs can improve self-perceived PE symptoms, satisfaction with intercourse, and perceived control over ejaculation.
- However, SSRIs may also increase the risk of adverse events and treatment cessations due to these events.