From the Guidelines
Daily SSRIs, such as paroxetine, sertraline, fluoxetine, and citalopram, are the most effective medications for treating premature ejaculation, and should be considered as the first-line treatment. These medications work by increasing serotonin levels in the brain, which helps to delay ejaculation 1. The recommended dosages for these medications are: paroxetine 10-40 mg, sertraline 50-200 mg, fluoxetine 20-40 mg, and citalopram 20-40 mg.
Treatment Options
- Daily SSRIs: paroxetine, sertraline, fluoxetine, and citalopram
- On-demand SSRIs: dapoxetine, clomipramine
- Topical anesthetics: lidocaine-prilocaine cream
- PDE5 inhibitors: sildenafil (for premature ejaculation accompanied by erectile dysfunction)
Important Considerations
- Patients should be advised to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs, as this may precipitate SSRI withdrawal syndrome 1.
- Topical anesthetics may be associated with significant penile hypoesthesia and possible absorption by the receptive partner, resulting in discomfort and/or numbness 1.
- The use of SSRIs should be avoided in men with a history of bipolar depression due to the risk of mania 1.
Side Effects
- Nausea
- Headache
- Drowsiness
- Decreased libido
It is essential for patients to consult with their healthcare providers before starting any treatment for premature ejaculation, as the most suitable medication and dosage may vary depending on individual circumstances 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
Ejaculation Failure is reported as an adverse event in the studies, with an incidence of 14% in male patients taking sertraline, compared to 1% in those taking placebo 2.
The studies suggest that sertraline, an SSRI, can be used to treat premature ejaculation, as it is reported to cause ejaculatory delay in some patients 2 2.
- Key points:
- Sertraline is associated with an increased incidence of ejaculation failure, which may be beneficial in treating premature ejaculation.
- The exact mechanism of sertraline in treating premature ejaculation is not explicitly stated in the studies, but it is thought to be related to its effects on serotonin levels.
- Sertraline is not explicitly approved for the treatment of premature ejaculation, but it may be used off-label for this purpose.
From the Research
Medications for Premature Ejaculation
- Dapoxetine is a selective serotonin reuptake inhibitor that has been shown to be effective in treating premature ejaculation 3, 4, 5, 6.
- It is administered on-demand, 1-3 hours prior to planned sexual contact, and is available in 30mg and 60mg doses 3, 4, 5, 6.
- Studies have demonstrated that dapoxetine significantly prolongs intravaginal ejaculatory latency time (IELT) and improves patient-reported outcomes, such as the Premature Ejaculation Profile (PEP) and Clinical Global Impression of Change (CGIC) 3, 4, 5, 6.
- Common adverse events associated with dapoxetine include nausea, dizziness, and headache 3, 4, 5, 6.
- Other medications, such as topical anaesthetics and other selective serotonin reuptake inhibitors (SSRIs), are also used to treat premature ejaculation, although their efficacy and safety may vary 7.
- Emerging treatment options, including new-generation SSRIs, α1-adrenoceptor antagonists, and oxytocin antagonists, are being researched and may offer alternative therapies for premature ejaculation in the future 7.