An up-to-date overview of the pharmacotherapeutic options for premature ejaculation

ABSTRACT

Introduction

Premature ejaculation (PE) is a sexual dysfunction of unknown etiology affecting a substantial number of males and deteriorating sexual health and quality of life of the patient and his partner. Treatment still remains challenging; however, pharmacotherapy is considered the mainstay of therapy with behavioral and psychosexual interventions being particularly important as adjudicate procedures, within the context of a holistic approach.

Areas covered

The authors review the literature on the available medications for PE, both officially registered and non-registered. Currently, only dapoxetine and an anesthetic spray containing lidocaine and prilocaine (Fortacin™) are officially approved, with the rest being used off-label. Herein, updated data regarding the efficacy and safety of the pharmaceutical agents are presented.

Expert opinion

On-demand dapoxetine is reportedly efficacious and safe in treating lifelong PE and is the first medication to be approved for this purpose. Fortacin has also shown considerable efficacy and may be reliably used on-demand. Phosphodiesterase type 5 inhibitors (PDE5Is) have been found to be effective in the treatment of PE and are therefore recommended either as monotherapy or combined with other therapies (i.e. dapoxetine). Adverse events of any therapy should be taken under consideration. Physicians should encourage patients to discuss their needs and expectations and grade any improvement of their condition with treatment.

KEYWORDS:

• Premature ejaculation
• dapoxetine
• tramadol
• tricyclic antidepressants
• PDE5Is
• SSRIs

Article highlights

• Despite long-standing efforts treatment of premature ejaculation still remains challenging

• Dapoxetine is the first drug to be officially approved for the treatment of lifelong premature ejaculation, as studies have demonstrated it to be efficacious and safe

• The combination of dapoxetine plus a PDE5I has been found efficient not only in patients with acquired, secondary to erectile dysfunction, premature ejaculation, but also in lifelong disease as well.

• Fortacin is a safe and efficient form of topical treatment, which has also been approved for the treatment of premature ejaculation

• The majority of medications for the disorder is used as off-label treatment

• Patients with premature ejaculation may be aided by psychosexual and behavioral interventions within the context of a holistic approach of the disorder.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One reviewer discloses that they have authored two major clinical trials papers on Fortacin. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.