Evaluation of Tramadol on Demand Vs. Daily Paroxetine as a Long-Term Treatment of Lifelong Premature Ejaculation

Abstract

Introduction 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. Aim To investigate the effectiveness of long-term daily paroxetine vs. on-demand tramadol HCl in treatment of PE. Main Outcome Measures Intravaginal ejaculatory latency time (IELT) and Arabic Index of PE (AIPE) were used to assess the efficacy of investigated drugs. Methods 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. Results 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). Conclusions 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.

Role of Tramadol in Premature Ejaculation: A Systematic Review and Meta-Analysis

“…However, other researchers concluded that tramadol does not make as distinct a contribution to PE improvement as some proponents have suggested. The dissenting researchers have even questioned the safety of tramadol for PE, noting concerns such as severe SEs and potential drug dependence [12]. …”

Safety and efficacy of tramadol hydrochloride on treatment of premature ejaculation

“…36,37 Other agents, including a-adrenoreceptor antagonists (terazosin and alfuzosin) 38 and an analgesic opioid receptor agonist and noradrenalin reuptake inhibitor (tramadol), have also been investigated for treating PE. 39 Psychotherapy and behavioural therapy also have a role, although well-designed, controlled trials that use such approaches are lacking. 40 PE management is dependent upon aetiology.…”

“…42 In an open-label crossover comparative study of daily paroxetine (20 mg) and on-demand tramadol (50 mg) in 35 subjects with lifelong PE, superior IELT fold increases and responses were demonstrated with paroxetine (22 fold vs. fivefold for tramadol) after 12 weeks of treatment. 39 Hellstrom 46 stated that tramadol for the treatment of PE showed promise, but the data available from small trials need to be corroborated. In addition, long-term studies are warranted to investigate the risk of opioid addiction.…”

“…This result is in agreement with previous studies. 39,42,[45][46][47][48][49] Tramadol has long been considered to have a low abuse potential. Although it is an opioid agonist, it has not been classified as a scheduled substance.…”

New Concepts in the Diagnosis and Treatment of Premature Ejaculation

“…In addition to stimulating the μ-receptor, tramadol acts as an inhibitor of norepinephrine and serotonin [30]. Though not as effective as paroxetine, researchers have reported beneficial results in head-to-head trials and have suggested tramadol as a possible on-demand treatment of PE [31].…”