From the Guidelines
Selective Serotonin Reuptake Inhibitors (SSRIs) used for premature ejaculation can cause several side effects, including nausea, headache, dry mouth, insomnia, drowsiness, dizziness, and decreased libido, as reported in a recent guideline by the American Urological Association and the Society for Male Reproductive and Urology 1.
Common Side Effects
- Nausea
- Headache
- Dry mouth
- Insomnia
- Drowsiness
- Dizziness
- Decreased libido Some men may experience erectile dysfunction or difficulty achieving orgasm, which can counteract the desired treatment effect.
Medications and Dosage
Medications like paroxetine (10-40mg daily), sertraline (50-200mg daily), fluoxetine (20-40mg daily), and dapoxetine (30-60mg on-demand) are commonly prescribed, with dapoxetine being the only SSRI specifically approved for premature ejaculation in some countries.
Mechanism of Action
These medications work by increasing serotonin levels in the brain, which delays ejaculation by inhibiting the ejaculatory reflex.
Important Considerations
Side effects typically appear within the first two weeks of treatment and may diminish over time. Some men experience discontinuation symptoms if stopping abruptly, so tapering off is recommended. Patients should inform their doctor about any other medications they're taking to avoid potential interactions, particularly with MAOIs or triptans, which could cause serotonin syndrome, a potentially serious condition, as noted in a previous guideline by the American Urological Association 1.
Serious Complications
Serotonin syndrome is a potentially serious complication most often associated with simultaneous use of multiple serotonergic drugs, and common symptoms include clonus, tremor, hyperreflexia, agitation, mental status changes, diaphoresis, and fever, as reported in the recent guideline 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 Reliable estimates of the incidence and severity of untoward experiences involving sexual desire, performance and satisfaction are difficult to obtain, however, in part because patients and physicians may be reluctant to discuss them. Accordingly, estimates of the incidence of untoward sexual experience and performance cited in product labeling, are likely to underestimate their actual incidence 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 Event | Sertraline Hydrochloride Tablets | Placebo Ejaculation Failure (Primarily Delayed Ejaculation) | 14% | 1% Decreased Libido | 26% | 1%
Potential side effects of using SSRIs to treat premature ejaculation include:
- Ejaculation Failure (Primarily Delayed Ejaculation): 14% of patients taking sertraline reported this side effect, compared to 1% of patients taking placebo.
- Decreased Libido: 26% of patients taking sertraline reported this side effect, compared to 1% of patients taking placebo. These side effects are likely underreported due to patient and physician reluctance to discuss them 2.
From the Research
Potential Side Effects of SSRIs for Premature Ejaculation
- Delayed ejaculation: SSRIs can cause delayed ejaculation, which may be beneficial for men with premature ejaculation, but can also be a side effect for some men 3, 4, 5, 6.
- Decreased libido: Some men may experience decreased libido or sexual desire while taking SSRIs 3, 5.
- Erectile dysfunction: SSRIs can cause erectile dysfunction or impotence in some men 3, 5.
- Fatigue: Fatigue is a potential side effect of SSRIs, as reported in one study 4.
- Numbness: Numbness is another potential side effect of SSRIs, as reported in one study 4.
- Increased risk of treatment cessation due to adverse events: SSRIs may increase the risk of treatment cessation due to adverse events compared to placebo 7.
- Adverse events: SSRIs may increase the risk of adverse events, such as nausea, headache, and dizziness, compared to placebo 7.
Factors Influencing Side Effects
- Dose: The risk of side effects may be dose-related, with higher doses increasing the risk of side effects 3, 5.
- Type of SSRI: Different SSRIs may have different side effect profiles, with some causing more delayed ejaculation or erectile dysfunction than others 3, 6.
- Individual response: Men may respond differently to SSRIs, with some experiencing more side effects than others 3, 4, 5, 6, 7.