Premature ejaculation is a frequent male sexual complaint that is mediated mainly by disturbances of serotonergic neurotransmission and certain serotonin ( 5-HT ) receptors and, to a lesser extent, oxytocinergic neurotransmission in the CNS.

A meta-analysis of studies demonstrated similar efficacies for daily treatment with the serotonergic antidepressants Paroxetine, Clomipramine ( Anafranil ), Sertraline ( Zoloft ) and Fluoxetine ( Prozac ), with Paroxetine ( Paxil, Seroxat ) exerting the strongest effect on ejaculation.

On the basis of fundamental insights into serotonergic neurotransmission, it has been suggested that on-demand selective serotonin reuptake inhibitor ( SSRI ) treatment will not lead to similarly impressive delays in ejaculation as has been observed with daily SSRI treatment. Indeed, some on-demand studies with SSRIs and studies with the new SSRI Dapoxetine have shown a weak ejaculation-delaying effect after 1-2 hours of drug intake.

Apart from daily treatment with SSRIs, premature ejaculation can be delayed by on-demand use of topical anaesthetics and Tramadol ( Contramal ).

Treatment with phosphodiesterase type 5 inhibitors should not be prescribed to men with premature ejaculation with normal erectile function, but may be used if premature ejaculation is accompanied by erectile difficulties.

There is no scientific support for treatment of premature ejaculation with intracavernous injection of vasoactive drugs.

Animal studies have shown that strong immediate ejaculation delay may be induced by administration of a combination of an SSRI with a serotonin 5-HT(1A) receptor antagonist.

The combination of an SSRI and any other compound that immediately and potently raises serotonin neurotransmission and/or use of oxytocin receptor antagonists may form the basis for the development of new on-demand and/or daily drugs for the treatment of premature ejaculation.

Source: Drugs, 2007

XagenaMedicine2007



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