Pharmacotherapy for Premature Ejaculation

Selective serotonin re-uptake inhibitors encompass five compounds (citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline) with a similar pharmacological mechanism of action. Treatment of PE with daily or on-demand selective serotonin reuptake inhibitors offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treating, consequential improvements in sexual desire and other sexual domains and is well tolerated.

Although the methodology of the initial drug treatment studies was rather poor, later double blind and placebo-controlled studies replicated the genuine effect of clomipramine and SSRIs to delay ejaculation. Daily treatment can be performed with paroxetine 20-40 mg, clomipramine 10-50 mg, sertraline 50-100 mg and fluoxetine 20-40 mg. Paroxetine appears to exert the strongest ejaculation delay, increasing IELT approximately 8.8 fold over baseline. Ejaculation delay usually occurs within 5-10 days but may occur earlier. Adverse effects are usually minor, start in the first week of treatment, gradually disappear within 2-3 weeks and include fatigue, yawning, mild nausea, loose stools or perspiration. Daily administration of an SSRI is associated with superior fold increases in IELT compared to on-demand administration due to greatly enhanced 5-HT neurotransmission resulting from several adaptive processes which may include presynaptic 5-HT1a and 5-HT1b/1d receptor desensitisation. A number of rapid acting short half-life SSRIs (Dapoxetine) are under investigation as on-demand treatments for PE. Preliminary data suggest that dapoxetine administered 1-2 hours prior to planned intercourse, is effective and well tolerated, superior to placebo and increases IELT 2-3 fold over baseline in a dose-dependent fashion.