Selective serotonin reuptake inhibitors for premature ejaculation

Selective serotonin reuptake inhibitors (SSRIs) may be used to treat premature ejaculation. Only dapoxetine is approved for this indication by the Australian Therapeutic Goods Administration (TGA); it has the highest quality data for efficacy (increases intravaginal ejaculatory latency time by a mean of 1.39 minutes).

Intermittent SSRI dosing before sexual activity is less likely to cause adverse effects (eg reduced libido, anejaculation) than continuous dosing. Review efficacy and adverse effects of SSRIs after 4 weeks or 6 doses. Use:

1 dapoxetine 30 mg orally, 1 to 3 hours before sexual activity. Maximum of one dose per 24 hours premature ejaculation, monotherapy dapoxetine

OR

1 paroxetine 20 mg orally, 3 to 5 hours before sexual activity. Maximum of one dose per 24 hours. premature ejaculation, monotherapy (intermittent dosing) paroxetine

If continuous daily SSRI dosing is preferred, use:

1 paroxetine 20 mg orally, once daily. Gradually increase the dose as needed, up to a maximum of 40 mg daily premature ejaculation, monotherapy (daily dosing) paroxetine

OR

2 fluoxetine 20 mg orally, once daily. Gradually increase the dose as needed, up to a maximum of 40 mg daily premature ejaculation fluoxetine

OR

2 sertraline 50 mg orally, once daily. Gradually increase the dose as needed, up to a maximum of 200 mg daily. premature ejaculation sertraline

In people with depression and in adolescents, consider discussion with a mental health specialist because of an association between SSRI use and risk of suicidal thoughts. Discontinuation symptoms can occur with the sudden cessation of daily dosed SSRIs.