Safety and efficacy of “on-demand” tramadol in patients with premature ejaculation: an updated meta-analysis

Abstract

Introduction: Tramadol has been used for the treatment of premature ejaculation, however, the studies published for the same are not well designed. The primary objective of this study was to explore the literature pertaining to the use of tramadol in patients with PE to determine its safety and effi cacy in this population. Materials ande methods: Systematic literature search of various electronic databases was conducted to include all the randomized studies and quasi-randomized studies. Standard PRISMA (Preferred reporting Items for Systematic reviews and Metaanalysis) guidelines were pursued for this review and study protocol was registered with PROSPERO (CRD42019123381). Results: Out of 9 studies included in this review, 5 were randomized controlled trials, and rests of the 4 studies were quasi-randomized studies. Tramadol resulted in signifi cantly higher improvement of IELT with the mean difference (MD) of 139.6 seconds and confi dence interval (CI) 106.5-172.6 seconds with a p-value of p <0.00001. All dosages except 25mg fared well as compared to placebo. Tramadol fared better than placebo at 1 month, 2 months, and 3 months after initiation of therapy as compared to the placebo. Tramadol group had reported a signifi cantly higher number of adverse events with treatment as compared to placebo but none of them were serious. Conclusion: Tramadol appears to be an effective drug for the management of PE with a low propensity for serious adverse events. However, evidence obtained from this study is of low to moderate quality. Furthermore, effective dose and duration of therapy remain elusive.

The safety profile of tramadol combined with nicotine on liver and testicles: Evidence from endoplasmic reticulum stress

“…Tramadol has been used to treat premature ejaculation [11,[22][23][24]. The current model supports the use of moderate doses to treat premature ejaculation.…”

“…Another study in which rats were administered tramadol at 40 mg/kg 3 times a week for 8 weeks found that the animals had marked testicular impairment [10]. Creating a model of chronic use of tramadol is important since it is used for premature ejaculation, and it is a candidate drug for addition [11].…”

European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction

“…Paroxetine was found to be superior to fluoxetine, clomipramine, and sertraline [3,[183][184][185][186]. Likewise, tramadol, a mild opioid receptor agonist that also promotes reuptake inhibition of serotonin and noradrenaline, has been demonstrated to be effective as an off-label on-demand oral therapy in men with a history of lifelong PE [3,187,188]. Side effects were reported at doses used for analgesic purposes (up to 400 mg daily) and include constipation, sedation, and dry mouth.…”

The Influence of Tramadol on Intravaginal Ejaculatory Latency Time and Sexual Satisfaction Score in Treating Patients With Premature Ejaculation: A Network Meta-Analysis

“…PE didn’t only affect the male partner, but it had also a major impact on quality of life of their sexual partners, including anxiety, anger, and loss of confidence ( McMahon, 2016 ; Sharma et al, 2021 ). It was necessary to explore an effective treatment for PE.…”