A comparative study of the efficacy of levosulpiride versus paroxetine in premature ejaculation

Abstract

Background: Premature ejaculation (PME) can be defined as a lack in the normal voluntary control over ejaculation. It is the most common sexual dysfunction encountered by the male populace. In general, these patients presents with distress. Hence, a novel treatment to eliminate their problem is required. Although the role of SSRI has already been established, the high discontinuation rate and other types of sexual dysfunctions associated with SSRIs reduce their efficacy in controlling this menace. Levosulpiride is a new drug indicated in treatment of PE. Aims and Objectives: The objective is to study the efficacy of levosulpiride; paroxetine and their comparison in patients of PE. Methodology: Index of premature ejaculation (IPE) and intravaginal ejaculation latency time (IELT) were used. A total of 36 patients (18 in each group) were included. The patients were assessed at baseline; at 4 weeks’ and at 8 weeks’ interval. Results: On comparison the score of IPE in domains of ejaculation control, sexual satisfaction, and the total score of IPE were statistically significant on all the three visits. However, the distress score of IPE and the IELT score were statistically not significant between the two groups. Conclusion: No doubt both agents are efficacious in patients of PME but paroxetine is more efficacious than levosulpiride. At the same time, levosulpiride is a lesser studied and used drug hence more research should be done for it.

Levosulpiride for Premature Ejaculation: A Systematic Review and Meta-Analysis

“…The full texts of nine studies were then assessed. Finally, four studies were included in the qualitative analysis ( Bathla et al, 2020 ; Greco et al, 2002 ; Hussain et al, 2010 ; Mohan, 2019 ), and two were included in the meta-analysis ( Figure 1 ; Greco et al, 2002 ; Hussain et al, 2010 ).…”

“…Upon stimulation, the glans penis relays sensory information to three ejaculatory centers (medial preoptic area, paraventricular nucleus, and periaqueductal gray) in the brain, which integrate the peripheral events of the seminal emission, ejaculation, and orgasm. The nucleus paragigantocellular is then modulates the efferent output of dopamine (DA), which exerts inhibitory effects on the serotonergic neurons responsible for inhibiting ejaculation ( Bathla et al, 2020 ). In this way, the release of DA may inhibit the release of serotonin and ultimately cause ejaculation.…”

“…The central control of the ejaculatory pathway is primarily governed by serotonergic and dopaminergic neurons, whereas other chemical factors like acetylcholine, nitric oxide, neuropeptides, norepinephrine, gamma-aminobutyric acid, and oxytocin are secondarily involved ( Bathla et al, 2020 ; Peeters & Giuliano, 2008 ). The release of DA is followed by the stimulation of DA receptors ( Peeters & Giuliano, 2008 ).…”

“…Selective serotonin reuptake inhibitors (SSRIs) could be an effective treatment of PE, but they impose adverse side effects, such as fatigue, dry mouth, dizziness, nausea, headache, and sleep disturbances ( Liu et al, 2020 ). They can even cause other types of sexual dysfunction, such as anorgasmia and decreased sexual desire, leading to their discontinuation ( Bathla et al, 2020 ).…”

“…Some previous studies have reported improvements in intravaginal ejaculation latency time (IELT) in men with PE when they were treated with levosulpiride ( Greco et al, 2002 ; Hussain et al, 2010 ). However, a few studies have reported no significant improvement after levosulpiride treatment ( Bathla et al, 2020 ; Mohan, 2019 ). This review aims to report the efficacy of levosulpiride in the treatment of PE and improvement of IELT.…”