From the Guidelines
The recommended dose of fluoxetine for treating premature ejaculation is 20-40 mg taken daily, as supported by the most recent and highest quality study 1. When considering treatment options for premature ejaculation, it's essential to weigh the benefits and risks of each medication.
- The American Urological Association (AUA) and the Sexual Medicine Society of North America (SMSNA) recommend daily SSRIs, including fluoxetine, as a first-line treatment for premature ejaculation 1.
- A meta-analysis of published data suggests that daily paroxetine exerts the strongest ejaculation delay, but fluoxetine is also effective in delaying ejaculation 1.
- The optimal dose of fluoxetine for premature ejaculation is typically in the range of 20-40 mg per day, with some studies suggesting that higher doses may be more effective but also increase the risk of side effects 1.
- Common side effects of fluoxetine include nausea, headache, insomnia, and potential sexual side effects like decreased libido 1.
- Patients should be aware that fluoxetine is used off-label for premature ejaculation, as its FDA-approved indications are for depression, OCD, and other psychiatric conditions 1.
- Treatment duration varies, with some patients using it for several months while others may require longer-term therapy 1.
- It's crucial to monitor patients for potential complications, such as serotonin syndrome, and to advise them to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs to prevent withdrawal syndrome 1.
From the Research
Fluoxetine Dose for Premature Ejaculation
- The recommended dose of fluoxetine for the treatment of premature ejaculation is 20 mg daily, with the possibility of dose titration up or down based on efficacy and side effects 2.
- A study found that fluoxetine 20 mg/day was effective in delaying ejaculation, with a gradual increase in intravaginal ejaculation latency time (IELT) to about 110 seconds 3.
- Another study compared the efficacy of different selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, and found that paroxetine exerted the strongest delay in ejaculation, followed by fluoxetine and sertraline 3.
- The efficacy and safety of fluoxetine in delaying ejaculation have been confirmed in many well-designed controlled trials, and it is considered a safe treatment option for patients with premature ejaculation 4, 5.
- However, it is noted that compliance with fluoxetine use in men with primary premature ejaculation is poor, with dropout rates at 6 and 12 months being 56% and 72%, respectively 2.
Comparison with Other Treatments
- A systematic review and meta-analysis found that paroxetine was more effective than fluoxetine at increasing IELT, but the combination of paroxetine with other treatments, such as tadalafil or behavior therapy, was more efficacious than paroxetine alone 6.
- Another study found that fluoxetine, paroxetine, and sertraline were effective in delaying ejaculation, but fluvoxamine delayed ejaculation the least 3.
- The choice of treatment for premature ejaculation should be based on individual patient needs and preferences, and may involve a combination of pharmacological and behavioral therapies 4.