Levosulpiride: a new solution for premature ejaculation?

Abstract

Premature ejaculation (PE) can be defined as a lack in the normal voluntary control over ejaculation and surely is the most common male sexual disorder. 1 It has been traditionally considered a psychological defect, but in recent years many organic causes have been found, 2 identified locally in the penis and in the central or peripheral nervous system. Consequently, a pharmacological way of relieving it has been researched 3 and some drugs, as fluoxetine, paroxetine, clomipramine, etc. have been used with various results. 4 We wish now to communicate the beneficial effects of another drug, levosulpiride, an anti-dopaminergic drug which is commonly used in some dyspeptic syndromes in anxious patients and to treat some types of hemicrania. We observed its effect on premature ejaculation accidentally, after prescribing the drug for its usual purpose to three patients. It was only by chance that all of them were suffering from premature ejaculation. During the following visit, after 20 -30 days, we were surprised to hear of a wonderful improvement in their sexual life. This observation led us to set up an appropriate double-blind study. Forty-nine patients were chosen, who had been suffering from PE for at least the past 5 years. After having obtained informed consent, we carefully examined their medical histories, in order to avoid epileptic subjects and any kind of psychiatric pathology. Patients suffering from erectile disorders were not included in the study. We did not research the patients' ejaculatory latency times, because we did not intend to discriminate among different types of ejaculatory pathologies, we only wished to test the improving capacity of the drug. The patients' ages ranged between 29 and 55 y, with a mean of 41.4. Fifteen subjects were chosen adequately, in order to maintain a comparable mean age with the other group and were treated with placebo only. The remaining 34 received 25 mg of the drug once a day for 60 days. They were taught to record their latency times with a stop-watch and to report any incidental side effect. In every patient an assay for prolactin was performed before starting the trial, as the hyperprolactinemic effect of the drug in many subjects is well known and we wanted to evaluate the size of it in everyone and the possible relationship with the therapeutic effect of the drug. 5 After 60 days the patients were followed-up. None of the patients were lost to follow-up. After collecting the results, the patients who had received the drug were divided in four groups, depending on the improvement rate they referred: A, B, C, D. In group A we put the subjects with a very good improvement, that was an improvement of more than 500% in the latency time (generally, these patients could last longer than 5 min, but we took care of the improvement rate only). Surprisingly, we had to note that this was the largest group, since 18 subjects were in it (52.94%). In the second group (B) we put the subjects who had some improvement, even though the latency time they achieved could not be...

Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis

“…We explain this phenomenon to be the result of the strong delaying actions of paroxetine, in particular on ejaculation. However, the meta-analysis also demonstrated that open and single-blind studies 49,27,35,42,57,60,65,[77][78][79][80][81] have been performed in this way. Based on this systematic review and meta-analysis, it is recommended that genuine evidence-based research on drug treatment of lifelong premature ejaculation should be performed by randomised, double-blind studies, with the prospective real time use of a stopwatch at each intercourse both during a baseline period and during the active drug-treatment trial.…”

“…These reports comprised the use of anesthetic ointments, 12,26,27,[29][30][31][32][33][34][35][36][37] neuroleptics, 20,22,[38][39][40][41][42] monoamine-oxidase inhibitors, 16,43 sympatholytic drugs, 18,19,[44][45][46] antibiotics, 47,48 and a group of miscellaneous agents 13,14,21,[49][50][51] (Table 1). Between 1973 and 2003, there have been 35 studies 15,17,23-25,60-79,80,81 on daily treatment with clomipramine, a tricyclic antidepressant, and on SSRIs (Table 2).…”

Low-Dose Amisulpride and Elevation in Serum Prolactin

“…Prolactin elevation has also been reported with low doses of sulpiride 9,12 and levosulpiride. 7 Finally, dose-dependent prolactin elevation and greater prolactin elevation in women than in men has been described with other antipsychotic drugs, such as paliperidone, as well.…”

Premature to early ejaculation: a sampling of manuscripts regarding the most common male sexual dysfunction published in the IJIR: The Journal of Sexual Medicine

“…Abdel-Hamid et al 4 observed that while SSRI treatments with clomipramine, sertraline and paroxetine increased median ejaculation latency from 1 min to 4, 3 and 4 min respectively, it was sildenafil that was superior, increasing latency values to 15 min. Other researchers 5,6 have examined the efficacy of other medications, including levosulpiride and citalopram in the treatment of early ejaculation. Paick et al 7 examined the pathophysiology of early ejaculation comparing penile sensitivity determinations of vibratory threshold values in 18 patients versus 15 controls.…”

“…Given the importance of the IJIR: The Journal of Sexual Medicine to the field of sexual medicine, several articles [1][2][3][4][5][6][7][8][9] concerning studies in early ejaculation have been published in this journal. McMahon 1 reported on the dose-dependent increase in mean ejaculatory interval, from an increase of around 7 min to around 16 min, with the use of the highest dose of the selective serotonin reuptake inhibitor sertraline hydrochloride.…”