Exploring Medication Options for Premature Ejaculation: Clomipramine vs. Sertraline

Q: Exploring Medication Options for Premature Ejaculation: Clomipramine vs. Sertraline

Shrimp： Hello, currently, the medications most commonly used for premature ejaculation are primarily antidepressants, such as Trazodone. <br>The medications you mentioned are also in this category and generally have some side effects related to sleep. <br>Long-term use may not be

Regarding the pharmacological treatment of premature ejaculation?

I have a significant problem with premature ejaculation (ejaculating within 30 seconds of penetration, which has persisted for several years).
Previously, a urologist prescribed antidepressants such as fluoxetine and paroxetine for about three months, but there was no significant improvement, although I did not experience any notable discomfort.
I would like to ask: 1.
I recently read several articles mentioning that continuous use of clomipramine for about one month has shown good efficacy for premature ejaculation, and that sertraline also has a good treatment effect.
Is there any basis for these claims? 2.
If I take clomipramine or sertraline continuously for one month, will it have any adverse and irreversible effects on erectile function? 3.
How do clomipramine and sertraline differ in efficacy compared to the new drug Dapoxetine, which was mentioned in newspapers and magazines as being in human trials in Taiwan? Thank you.

xiazi, 30~39 year old female. Ask Date: 2006/06/07

Dr. Xu Weikai reply Urology

Shrimp: Hello, currently, the medications most commonly used for premature ejaculation are primarily antidepressants, such as Trazodone.
The medications you mentioned are also in this category and generally have some side effects related to sleep.
Long-term use may not be suitable, and as for irreversible effects on erection, I don't recall any evidence suggesting that.
The new medication Dapoxetine is something I'm not familiar with; I only know that there are clinical trials currently being conducted in Taiwan involving 200 participants across 12 hospitals.
It is expected to take about 1-2 years before it may receive approval from the health authorities for official market release.
If you are interested, you can join the testing (contact the hospitals directly).
The clinical trial for Dapoxetine for the treatment of premature ejaculation is currently underway in Taiwan, with participation from hospitals such as National Taiwan University Hospital, Taipei Veterans General Hospital, Chang Gung Memorial Hospital, and Shin Kong Wu Ho-Su Memorial Hospital, among others.
Participants must be between 18 and 70 years old and have a time of less than two minutes from vaginal penetration to ejaculation.
Otherwise, current antidepressant medications can be used as an adjunct treatment.
This is a response from Dr.
Hsu Wei-Kai, Head of Urology, Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2006/06/07

More Info

When considering medication options for premature ejaculation (PE), both Clomipramine and Sertraline have been studied and shown to have efficacy in managing this condition.
1. Efficacy of Clomipramine and Sertraline: Clomipramine, a tricyclic antidepressant, has been found to delay ejaculation in some studies. It works by increasing serotonin levels in the brain, which can help prolong the time to ejaculation. Similarly, Sertraline, a selective serotonin reuptake inhibitor (SSRI), is also effective for PE due to its ability to enhance serotonin activity. Research indicates that both medications can be beneficial for men suffering from PE, particularly when used over a period of several weeks. The typical duration for observing significant effects is around 4 to 6 weeks, which aligns with your findings from recent articles.
2. Safety and Side Effects: Regarding the concern about addiction or adverse effects from long-term use, both Clomipramine and Sertraline have a low potential for addiction. However, they can cause side effects. Clomipramine may lead to dry mouth, constipation, weight gain, and orthostatic hypotension, while Sertraline can cause headaches, gastrointestinal issues, and diarrhea. Importantly, there is no strong evidence to suggest that either medication will cause irreversible erectile dysfunction when used appropriately. However, some individuals may experience transient sexual side effects, such as decreased libido or delayed ejaculation, which are usually reversible upon discontinuation or dosage adjustment.

3. Comparison with Dapoxetine: Dapoxetine is a newer medication specifically developed for the treatment of PE. It is a short-acting SSRI that is taken on-demand, about 1-3 hours before sexual activity. Unlike Clomipramine and Sertraline, which are typically taken daily, Dapoxetine's unique pharmacokinetics allow for a more flexible approach to treatment. Clinical trials have shown that Dapoxetine can significantly improve control over ejaculation and increase the time to ejaculation. While Clomipramine and Sertraline may require a longer duration to achieve their effects, Dapoxetine can provide more immediate results, making it a suitable option for men seeking quick relief from PE symptoms.

In summary, both Clomipramine and Sertraline are viable options for treating premature ejaculation, with evidence supporting their efficacy. While they have side effects, the risk of addiction is low, and concerns about irreversible erectile dysfunction are not substantiated. Dapoxetine offers a different approach with its on-demand use, providing an alternative for those who prefer not to take daily medication. It is essential to consult with a healthcare provider to determine the most appropriate treatment based on individual circumstances and medical history.

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