From the Guidelines
Paroxetine (Paxil) is generally considered more effective than fluoxetine (Prozac) for treating premature ejaculation, with a meta-analysis suggesting that daily paroxetine exerts the strongest ejaculation delay, increasing ejaculatory latency time (ELT) a mean of 8.8-fold over baseline 1.
Key Points to Consider
- The American Urological Association (AUA) and the Society for Male Sexual Medicine (SMSNA) recommend daily selective serotonin reuptake inhibitors (SSRIs), including paroxetine and fluoxetine, as first-line agents for the treatment of premature ejaculation 1.
- Paroxetine is typically prescribed at 10-40mg daily, while fluoxetine is usually prescribed at 20-40mg daily 1.
- Regarding side effects, both medications can cause decreased libido, erectile dysfunction, fatigue, and nausea, but the frequency and severity of these adverse events may differ between the two medications 1.
- It's essential to note that these medications should be tapered when discontinuing to avoid withdrawal symptoms, and patients should discuss their complete medical history with their doctor as these SSRIs can interact with other medications and aren't suitable for everyone, particularly those with certain heart conditions or bipolar disorder 1.
Comparison of Paroxetine and Fluoxetine
- A meta-analysis of published data suggests that daily paroxetine exerts the strongest ejaculation delay, increasing ELT a mean of 8.8-fold over baseline, compared to fluoxetine's 5-7 minutes 1.
- Paroxetine has a higher rate of sexual dysfunction than fluoxetine, but fluoxetine tends to have fewer sexual side effects overall and may be better tolerated by some patients 1.
- The choice of medication ultimately depends on the individual patient's needs and medical history, and patients should be advised to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs to prevent SSRI withdrawal syndrome 1.
From the Research
Efficacy of Fluoxetine and Paroxetine for Premature Ejaculation
- Paroxetine is more effective than fluoxetine in treating premature ejaculation, as shown in a systematic review and meta-analysis 2.
- The study found that paroxetine was more effective than placebo, fluoxetine, and escitalopram at increasing intra-vaginal ejaculatory latency time (IELT) 2.
- Another study found that 20 mg paroxetine daily was significantly better than fluoxetine and tramadol in improving IELT 3.
Side Effects of Fluoxetine and Paroxetine
- Paroxetine has well-tolerated side effects, with the most common adverse events being nausea, muscle soreness, palpitation, and flushing 2.
- Fluoxetine has side effects including headache, dizziness, nausea, nervousness, and sleepiness, with moderate to severe side effects reported in a small percentage of patients 4.
- The common adverse events related to paroxetine were fatigue, yawning, and abnormal sleep, as well as gastrointestinal upset 3.
Comparison of Fluoxetine and Paroxetine
- Paroxetine combined with tadalafil or behavior therapy was more efficacious than paroxetine alone, although the side effects in the combination group were more common 2.
- Fluoxetine is an effective agent for the treatment of premature ejaculation, but continued use beyond 6 months is poor due to high dropout rates 4.
- A network meta-analysis found that paroxetine (daily or on-demand) was superior to placebo at increasing IELT, and 20 mg paroxetine daily was significantly better than fluoxetine and tramadol in improving IELT 3.