Is meloxicam (a nonsteroidal anti-inflammatory drug (NSAID)) effective in treating premature ejaculation?

Meloxicam Does Not Help Premature Ejaculation

Meloxicam, an NSAID, has no role in treating premature ejaculation and should not be used for this indication. There is no evidence supporting its efficacy, and it does not target any of the neurotransmitter systems involved in ejaculatory control.

Evidence-Based Treatment Options

The American Urological Association guidelines clearly define effective pharmacologic treatments for premature ejaculation, and meloxicam is not among them 1, 2.

First-Line Pharmacologic Therapy

Daily selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacologic treatment for premature ejaculation 2:

• Paroxetine 10-40 mg/day provides the greatest ejaculatory delay, increasing ejaculatory latency time by a mean of 8.8-fold over baseline 2
• Sertraline 25-200 mg/day is effective with evidence supporting dose titration based on response 1
• Fluoxetine 5-20 mg/day shows clinical benefit even at doses as low as 5 mg daily 1
• Clomipramine 25-50 mg/day (a tricyclic antidepressant with serotonin reuptake inhibition) is also effective 1

Topical Anesthetic Therapy

Lidocaine/prilocaine cream 2.5%/2.5% applied 20-30 minutes before intercourse is an effective alternative or adjunctive treatment 1, 2:

• Application for exactly 20 minutes is optimal—longer application (30-45 minutes) causes excessive penile numbness and loss of erection 2, 3
• This approach has minimal systemic side effects and increases ejaculatory latency time 2, 3

Critical Safety Information

None of the pharmacologic therapies for premature ejaculation are FDA-approved for this specific indication 1, 2. When prescribing SSRIs off-label:

• Common adverse effects include ejaculation failure, decreased libido, nausea, insomnia, and dry mouth 2
• Exercise caution in adolescents and men with comorbid depression regarding suicidal ideation 2
• Safety should be the primary consideration since premature ejaculation is not life-threatening 1

Treatment Algorithm

1. Assess for concomitant erectile dysfunction first—if present, treat the erectile dysfunction initially as premature ejaculation may improve when erectile dysfunction is effectively managed 1, 2

2. Start with daily SSRI therapy (paroxetine preferred for maximal delay) or topical anesthetics based on patient preference and sexual activity frequency 1, 2

3. Begin at the lowest effective dose and titrate based on response and tolerability 2

4. Consider combination therapy if monotherapy fails—combining behavioral and pharmacological approaches is more effective than either alone 2

5. For refractory cases, alpha-1 adrenoceptor antagonists may be considered, though efficacy data remains limited 2, 4

Why Meloxicam Is Not Appropriate

Premature ejaculation treatment targets neurotransmitters involved in ejaculatory control—primarily serotonin, but also dopamine, oxytocin, norepinephrine, GABA, and nitric oxide 5, 6. Meloxicam, as an NSAID that inhibits cyclooxygenase enzymes, has no mechanism of action relevant to these neurotransmitter systems and therefore cannot address the underlying pathophysiology of premature ejaculation.

Treatment Goals

Patient and partner satisfaction is the primary target outcome, not just ejaculatory latency time 1, 2. Discuss all risks and benefits before initiating any intervention, emphasizing the off-label nature of pharmacologic therapies 1, 2.