Evaluation of tramadol on demand vs. daily paroxetine as a long-term treatment of lifelong premature ejaculation.

Premature ejaculation (PE) is the most common male sexual dysfunction with many lines of treatment that show conflicting results. Paroxetine and tramadol were both reported to be effective in treatment of PE. To investigate the effectiveness of long-term daily paroxetine vs. on-demand tramadol HCl in treatment of PE. Intravaginal ejaculatory latency time (IELT) and Arabic Index of PE (AIPE) were used to assess the efficacy of investigated drugs. Thirty-five cases with lifelong PE were enrolled in this study. Baseline recording of IELT using a stop watch and AIPE was done. Patients were randomized to take tramadol HCl on-demand or daily paroxetine. Reassessment was done after 6 and 12 weeks. A wash-out period for 2 weeks was given before cross-over to the other medication. Assessment of the effect of the second medication after 6 and 12 weeks was done. Tramadol and paroxetine increased IELT significantly after 6 weeks by seven- and 11-folds, respectively, compared with baseline. After 12 weeks, a decline of IELT to fivefolds was recorded with tramadol whereas further increase of IELT to 22-folds was recorded with paroxetine compared with baseline (P < 0.05). Tramadol improved AIPE score significantly after 6 weeks but not after 12 weeks vs. baseline, whereas paroxetine increased the AIPE score after 6 and 12 weeks vs. baseline (P < 0.05). Daily paroxetine is more effective than on-demand tramadol for treatment of lifelong PE. Tramadol is not recommended as a long-term treatment of lifelong PE.

Alghobary M ，El-Bayoumy Y ，Mostafa Y ，Mahmoud el-HM ，Amr M ... -  《-》

[Use of paroxetine on-demand in premature ejaculation].

Rivera P ，González R ，González F ，Storme O ... -  《Actas Urologicas Espanolas》

Tramadol HCL has promise in on-demand use to treat premature ejaculation.

Salem EA ，Wilson SK ，Bissada NK ，Delk JR ，Hellstrom WJ ，Cleves MA ... -  《Journal of Sexual Medicine》

On-demand use of tramadol, sildenafil, paroxetine and local anaesthetics for the management of premature ejaculation: A randomised placebo-controlled clinical trial.

Gameel TA ，Tawfik AM ，Abou-Farha MO ，Bastawisy MG ，El-Bendary MA ，El-Gamasy Ael-N ... -  《-》

The network meta-analysis of "on-demand" and "daily" use of paroxetine in treating men with premature ejaculation from randomized controlled trials.

This network meta-analysis aimed to assess the efficacy and safety of "on-demand" and "daily" use of paroxetine for patients with premature ejaculation (PE). We searched PubMed, Embase and Cochrane Library from inception to October 2021 to collect randomized controlled trials, and 24 articles including 2, 308 patients were finally involved. The results indicated that paroxetine (daily or on-demand) was superior to placebo at increasing intravaginal ejaculatory latency time (IELT), and 20 mg paroxetine daily was significantly better than fluoxetine and tramadol in improving IELT. Besides, 20 mg paroxetine on-demand was less effective than 20 mg paroxetine on-demand plus phosphodiesterase-5 inhibitors (PDEI5) and tramadol monotherapy in increasing IELT. Tramadol monotherapy was more effective than paroxetine monotherapy in improving sexual satisfaction score. Although patients treated with paroxetine had more coitus/week than patients treated with placebo, it was less than patients treated with PDEI5. These findings were robust to sensitivity analyses. The common adverse events related with paroxetine were fatigue, yawning and abnormal sleep (10.96%), gastrointestinal upset (10.80%). The "on-demand" and "daily" use of paroxetine can significantly improve the clinical symptoms of patients with PE and were well tolerated. Combination therapy and tramadol monotherapy can also be used as alternative treatments.

Zhou Z ，Yang Z ，Cui Y ，Zhang X ，Wang Y ，Zhang Y ... -  《-》