How to Use Premature Ejaculation Pills Effectively
In a placebo-controlled trial in 84 patients, sildenafil proved ineffective, either alone
- Dapoxetine is a fast-acting medication approved for PE.
- Combining medications with therapy enhances results.
- Some pills contain PDE5 inhibitors, like sildenafil, for better control.
- Side effects of pills may include dizziness or nausea.
- Always check for drug interactions before taking PE pills.
or in combination with topical therapy, in the treatment of acquired PE [2].
- Some pills may suppress ejaculation entirely if misused.
- Not all pills are suitable for men with certain health issues.
- Combining medication with pelvic exercises can enhance control.
- Expect gradual improvement; immediate effects are uncommon.
- Open communication with partner improves treatment outcomes.
PDE5 inhibitors may exert a secondary benefit for patients with PE when they (i) allow for a sustained penile erection, even after ejaculation; (ii) facilitate a
| Pill Type | Common Side Effects | Serious Risks | Population Caution | Duration of Side Effects |
|---|---|---|---|---|
| Local Anesthetics | Numbness, irritation | Allergic reactions | Men with allergies to anesthetics | Few hours to a day |
| Prescription Medications | Dizziness, nausea | Serotonin syndrome, depression | Men on SSRIs or antidepressants | Few hours to days |
| Natural Supplements | Gastrointestinal discomfort, headaches | No significant risks | Pregnant or nursing women | Varies |
second intercourse after the initial ejaculation, which is often less prone to PE;
- Pills may work by desensitizing penile nerves temporarily.
- Certain antidepressants are used off-label for PE.
- Not all pills are suitable for every age or health condition.
- Effectiveness varies among individuals; patience is necessary.
- Some formulations combine multiple ingredients for synergy.
and/or (iii) help the patient to overcome performance anxiety, which often exacerbates PE [83,89].
| Mechanism | Description | Example Drugs/Ingredients | Effect Duration | Notes |
|---|---|---|---|---|
| Local Anesthetic Effect | Numbs the penis to temporarily reduce sensitivity | Lidocaine, Prilocaine | 30-60 minutes | Used in creams/spays |
| Serotonin Reuptake Inhibition | Alters neurotransmitter levels to delay ejaculation | Dapoxetine, SSRIs | 1-3 hours | Prescription medications |
| Central Nervous System Modulation | Influences brain pathways controlling ejaculation | Tramadol, certain antidepressants | 2-4 hours | Off-label use |
However, it is deemed unlikely that PDE5 inhibitors have a significant role in the
Are there natural treatments for premature ejaculation besides medications?
A crossover study of 31 potent men with lifelong PE found sildenafil treatment to be associated with a significantly higher IELT and higher sexual satisfaction score than any other therapy including the use of any one of a variety of SSRIs and the use of the squeezepause method [1,86]. Sildenafil was deemed “decidedly the most effective” and was recommended as a valid alternative to the use of SSRIs in the treatment of PE. Conversely, the presence of concomitant PE did not impair patient satisfaction with their improved erections, when men were treated with PDE5 inhibitors for their ED [87]. A recent review found that of five studies, three have concluded that the use of PDE5 inhibitors was helpful, even superior, in treating PE, while two placebo-controlled studies found no such improvement [88]. The single study, which used objective, double-blinded, placebo-controlled measures, found no improvement in PE following PDE5 inhibitors in men who did not also have associated ED [83]. treatment of PE—with the exception of men with acquired PE secondary to ED [1].
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| Cialis Generic | 2.5mg | 360 + 10 Pills | 260.03€ 247.65€ | |
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| Levitra Generic | 20mg | 30 + 4 Pills | 70.59€ 67.23€ | |
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The use of ICI for “treatment” of PE is not supported by a large body of peer-reviewed literature, and is infrequently used in clinical practice.
How Effective are Premature Ejaculation Pills?
Unfortunately, the side effect rate was higher as well. The authors concluded that, while clomipramine was the most efficacious for the treatment of PE, sertraline was nearly as tadalis oral jelly effective and had a lower incidence of side effects [43]. Other studies have similarly shown that sertraline and fluoxetine are comparable to clomipramine in their effect on delaying ejaculation with a lower incidence of side effects [17,19,50]. Side effects from clomipramine include dry mouth, fatigue, nausea, and dizziness [54]. These side effects seem to abate over time, but stopping the medication is also associated with a loss of efficacy [73,74].
1. Zinc
Tricyclic antidepressants seem to share with the SSRIs the risk of increased suicide, when initiated in men under age 24 [70]. At higher doses (75 mg for more than 3 months), clomipramine may have an adverse effect on sperm function [76]. Not only clomipramine, but also SSRIs, by blocking calcium channel mechanisms, may impede both sperm motility and vasal/ epididymal contractility [77]. While none of these agents have been proven to impair male fertility, this potential consequence of long-term, highdose usage should be kept in mind when selecting PE therapy for men who may be contemplating fatherhood in the future. Tramadol, a centrally acting synthetic opioid analgesic, has shown promise as an effective on-demand agent that avoids many of the risks associated with SSRIs.
Why isn’t there a specific FDA-approved medicine for premature ejaculation?
Although the ejaculatorydelaying mechanism of tramadol has not been fully understood, it is hypothesized that this may be related to tramadol’s effect on inhibition of reuptake of norepinephrine and serotonin [78]. In 2006, Safarinejad and Hosseini published the results of their evaluation of the safety and efficacy of this serotonergic drug in delaying ejaculation. A double-blinded, placebo-controlled, fixed-dose study demonstrated a 13-fold increase in IELT with the on-demand use of 50 mg of Tramadol [79]. Among the 57 patients who completed the study, the mean IELT after tramadol and placebo increased from a baseline of 19 and 21 seconds to 243 and 34 seconds, respectively. Although more adverse events were noted when the patients were on tramadol, the authors did not report any study withdrawals because of medication-related adverse events. However, ICI has been used as a strategy in certain cases to allow men
| Medication Name | Active Ingredient | Usage Frequency | Typical Dose | Side Effects | Prescription Required | Cost ($) |
|---|---|---|---|---|---|---|
| Dapoxetine | Dapoxetine | As needed | 30 mg before sex | Nausea, dizziness | Yes | 1.5-2.5 |
| SSRIs (off-label) | Sertraline, Paroxetine | Daily | 50-100 mg daily | Fatigue, dry mouth | Yes | 1-2 per pill |
| Tramadol (off-label) | Tramadol | As needed | 50 mg | Drowsiness, nausea | Yes | 0.50-0.80 per pill |
with PE to maintain their erections and continue satisfactory sexual intercourse despite rapid ejaculation.
Medication Summary
More recently, in a single-blind, placebocontrolled, crossover, stop-watch study, these findings were confirmed using the 25-mg dose in 60 patients with lifelong PE [78]. The overall mean increase in IELT was from 0.79 to 6.20, as opposed to a minimal 0.84 in the crossed over placebo treatment arm (P = <0.0001). Mild side effects were experienced in eight patients (13.3%), consisting of mild dyspepsia and somnolence [78]. The association of erectile dysfunction (ED) with rapid ejaculation has been reported in important epidemiological studies, and PE may be seen in up to a third of patients with ED [80,81]. It is generally accepted that the association between PE and ED may be rooted in a compensatory mechanism where a man with PE develops ED simply as a result of the anxiety associated with the condition, and conversely, a patient suffering from ED may ejaculate early in the course of his erection before the failure-to-maintain phase of the erection sets in.
Paroxetine (Paxil, Pexeva)
An alternative, but related, view held by other investigators suggests that PE and ED share a vicious circle, where the level of excitation is instinctively reduced by a man with PE trying to control his ejaculation (thus leading to ED), and conversely, a man suffering from ED will try to increase his excitation to achieve an erection, thus leading to a rapid ejaculation [82]. In cases of PE associated with ED, treatment of ED by using PDE5 inhibitors may have a salutary effect on ejaculatory dysfunction [83]. Mancina and colleagues have demonstrated the expression of PDE5 in all the muscular layers of human and rabbit vas deferens [84]. Based on their findings documenting the presence of this enzyme in the ejaculatory tract, the authors postulated a potential direct effect of PDE5 inhibitors in mediating ejaculatory function. Experiments with knockout mice suggest that endothelial nitric oxide synthase (eNOS) gene deletion may adversely affect ejaculatory as well as erectile function.
2. Condoms
Kriegsfeld and colleagues set out to study lovegra 100 mg the effects of eNOS on sexual function, and discovered that male mice missing the gene for eNOS exhibited significant abnormalities in ejaculatory function. More specifically, the data from their animal study suggest that ejaculatory function may be inhibited by nitric oxide from eNOS in nongenetically altered mice, and that this effect is most likely achieved by decreasing sympathetic nervous system activity to prevent PE [85]. The authors hypothesized that administration of medications peripherally that can selectively increase eNOS may be effective in treating PE with minimal central nervous system adverse events. Patients with lifelong PE, as opposed to those with acquired or late-onset PE, are reported to have a 50% rate of concomitant ED. Nevertheless, the value of PDE5 inhibitors in the treatment of PE alone has not been established. In 1990, Fein reported on a small group (N = 8) of patients with PE who used vasoactive intracavernosal pharmacotherapy (mixture of phentolamine mesylate [1.0 mg/mL] and papaverine hydrochloride [30 mg/mL]) to address their PE [90].
What is Premature Ejaculation and How is it Treated?
The authors found that the ejaculatory control achieved with paroxetine as needed is significantly better when the patients were initially treated with a daily dose of the medication and later changed to an on-demand regimen [68]. Their findings were later corroborated in a study by Salonia et al who reported that paroxetine, when initially prescribed on a longterm basis, then later switched to an on-demand basis, proved safe and effective in prolonging the IELT (from 0.33 +/– 0.04 to 4.2 +/– 0.03), and 75% of the men reported an improved satisfaction with their sexual activity [69]. Enthusiasm for treatment of PE with SSRI has recently been dampened by the release of the FDA advisory in May 2007, which warned that suicidal ideation and attempts have been associated with the initiation of these antidepressant medications, especially in young adults aged 18–24 [70]. The risk of suicide seems to be highest during the first 1 or 2 months of therapy. While a report at the 2007 American Urological Association (AUA) annual convention found that there was no associated “suicidality,” when the SSRI dapoxetine was used in the treatment of PE, the FDA advisory indicates that there is as yet insufficient evidence to exculpate any single medication from this risk.
SSRIs for Premature Ejaculation
At a minimum, the circumspect clinician would carefully follow the patients for any signs of depression or suicidal ideation; it is also wise to document that the patient has been fully informed that there may be an increased risk of suicidal tendency, and also that SSRIs are not FDA approved for the treatment of PE [70–72]. Clomipramine is a tricyclic antidepressant used in the treatment of obsessive compulsive disorders. Although it is not an SSRI, clomipramine does inhibit 5-HT transport [55]. A 25-mg dose has effected delay in ejaculation, when taken as a onetime treatment 5 hours before intercourse by men with lifelong PE [1]. It has been shown to be effective in a placebo-controlled, double-blind trial, with a dose-dependent response rate.
Competing interests
Efficacy was established, using a 10-mg dose, but the IELT increased by 249% over controls when a 25-mg dose was used, and 517% with a 50-mg dose [73,74]. Clomipramine has been studied both as a chronic-care and as an on-demand medication. have recommended a two-tiered approach, initially using a single dose of up to 25 mg, taken from 4 to 24 hours prior to intercourse. If on-demand treatment proved unsatisfactory, a daily, long-term dose of 10–30 mg was instated [75]. Treatment with clomipramine, when compared with SSRIs and placebo, over a 4-week period, produced a sexual satisfaction rate that was significantly higher.