Comparative study of on-demand and daily use of sertraline in treatment of premature ejaculation: A randomized clinical trial

Abstract

Objective The intravaginal ejaculatory latency time (IELT) may increase less in on-demand compared to daily intake, but may fulfill a suitable treatment for specific patients. We decided to compare the efficacy and safety of on-demand and daily use of sertraline in order to find the most effective and least complicated method in treatment of premature ejaculation (PE). Methods This study was parallel or concurrent control randomized clinical trial. Two hundred and forty patients with PE diagnosed by urologist in the two groups of 120 from July 2017 to February 2019 enrolled in the study. In the first group, it is prescribed 50 mg sertraline each 12 h daily and the second group received 50 mg 4 h before coitus for 4 and 8 weeks. The IELT before treatment and during all coitus after treatment were recorded by the patient's wife with a stopwatch. Results Mean IELT before, 4 and 8 weeks after treatment in two groups were: On-demand group 101.62±65.44 s, 208.75±128.02 s and 265.87±145.70 s; daily use group 102.50±81.22 s, 276.87±181.08 s and 353.75±176.45 s, respectively. The ejaculation time increased significantly in both groups ( p <0.05). However, increase in ejaculation time in daily use group was significantly higher than the on-demand group in 4 weeks ( p =0.036), especially in 8 weeks ( p =0.009). The percent of side effects in daily use group (26.7%) was higher than on-demand group (20%) ( p <0.05). Drowsiness, diarrhea and vertigo were significantly higher in the daily use than on-demand ( p <0.05). Conclusions On-demand and daily use of sertraline are effective and usually have no serious complications, but the on-demand method is considerably more tolerable. In patients who did not tolerate to daily use of this drug, on-demand could be used as a salvage therapy.

New approach to patients with premature ejaculation: Do social cognition and attachment profiles play a role in premature ejaculation?

“…Our findings may reveal new perspectives about the treatment options of PE. The anxiety-prone aspect of PE patients may explain the relatively consistent finding in literature that PE patients benefit from regular daily use of Selective Serotonin Re-Uptake Inhibitors (SSRI) compared to on-demand use of these medications (Siroosbakht et al, 2019). This hypothesis seems coherent with the studies on treatment of PE, as there are various studies showing reduced serotonergic neurotransmission accelerates ejaculation and SSRIs and tricyclic antidepressants are effective methods in the treatment of PE (Patel & Hellstrom, 2009).…”

Use of Topical Berberine to Manage Premature Ejaculation and/or Erectile Dysfunction: Restoration of Endothelial Homeostasis.

“…After encountering promising preliminary results coming from our observational studies, a double blind, placebo controlled, randomized clinical trial is under preparation and we wish to partner with respected international companies/institutions. The main outcomes and the exclusion criteria in the clinical trial would be adopted and/modified from a trial that tested sertraline effect on premature ejaculation (Siroosbakht et al 2019).…”

Expression of brain‐derived neurotrophic factor in rapid ejaculator rats: A further study

“…It is well known that serotonin (5‐hydroxytryptamine, 5‐HT) is the most widely studied neurotransmitter involved in the regulation of ejaculation (Olivier et al., 1998; Waldinger, 2002). However, the current situation is not satisfactory, as about 10%–20% of PE patients do not show remission after the treatment of different selective serotonin reuptake inhibitors (SSRIs) in different population (Siroosbakht et al., 2019; Soheila Siroosbakht et al., 2021). Variable responses to SSRIs elucidate that there are some other factors beyond 5‐HT system that could explain the pathogenesis of ejaculation.…”