PHARMACOTHERAPY IN PREMATURE EJACULATION: AN EVIDENCE-BASED APPROACH
Helien, A(1); Cenice, F(1); Rosenfeld, C(1); Gindin, L(1)
(1)Sociedad Argentina de Urología/ Comité de Disfunciones Sexuales
Introduction and objective: Disturbances of serotonergic neurotransmission and 5-HT receptors have been associated with premature ejaculation (PE) and a number of antidepressants paroxetine, clomipramine, sertraline and fluoxetina have been proposed as drug treatment. Based on a systematic review published by Waldinger et al in 2004 we aimed to update the bibliography on efficacy and safety of the abovementioned agents and suggest a degree of recommendation for their use as PE pharmacotherapy following the principles of evidence based medicine (EBM).
Material and Method: We searched the efficacy and safety of the pharmacologic treatments of PE (daily and on demand) at MEDLINE, Web of Science, PICA, and EMBASE answering the PIOC-structured-question of EBM to give a degree of recommendation (DR) for their use. In total we reviewed 89 studies (including two meta-analysis) published between years 1943 and 2006.
Results: Efficacy was expressed as the difference between follow up and baseline intravaginal ejaculatory latency time (IELT) being paroxetine, clorimipramine, sertraline and fluoxetina efficacious (level of evidence 2). Regarding safety, there were no long-term studies for these drugs as PE treatment. Most of the studies (level of evidence 2) acknowledged toxicity and adverse events of the aforementioned drugs for the treatment of depression (nausea, sleep disturbances, sexual dysfunctions, anxiety, cytochrome P450 inhibition, among others).
Conclusion: Daily dose treatment with paroxetine, clorimipramine, sertraline or fluoxetina for PE and on demand treatment with clorimipramine or paroxetine (4-6hs before sexual intercourse) were efficacious and safe (DR B). Dapoxetine seems a promising drug but it is not yet approved by the FDA.
Key words: premature ejaculation-pharmacologic treatment-pharmacotherapy-paroxetine, clorimipramine, sertraline , fluoxetina- evidence based medicine
