Comparing Over-the-Counter Supplements for PE

Expected duration
About this article
Over-the-Counter (OTC) Solutions and What to Avoid
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Pelvic physical therapy (PT)

Curr Opin Invest Drugs 2004;5:743–7. Safarinejad MR. Safety and efficacy of escitalopram in the treatment of premature ejaculation: A doubleblind, vardenafil vilitra 60 mg placebo-controlled, fixed-dose, randomized study. Giuliano F, Clement P. Serotonin and premature ejaculation: From physiology to patient management. Clomipramine and sexual function in men with premature ejaculation and controls. Giuliano F.

Delay pills might reduce sensation, extending intercourse time.
The safety profile of herbal pills is less documented than pharma drugs.
Patients should monitor for side effects and inform their doctor.
Psychological factors like anxiety can be addressed alongside pills.
Proper dosage and timing are key to maximizing benefits.

5-Hydroxytryptamine in premature ejaculation: Opportunities for therapeutic intervention. Giuliano F. Interview with Dr Francois Giuliano (by Christine McKillop). New avenues in the pharmacological treatment of premature ejaculation. Relevance of an evidence-based ejaculation time cutoff point for neurobiological research of premature ejaculation. Animal models of premature and retarded ejaculation. Waldinger MD, Schweitzer DH, Olivier B. On-demand SSRI treatment of premature ejaculation: Pharmacodynamic limitations for relevant ejaculation delay and consequent solutions.

Pill Type	Common Side Effects	Serious Risks	Population Caution	Duration of Side Effects
Local Anesthetics	Numbness, irritation	Allergic reactions	Men with allergies to anesthetics	Few hours to a day
Prescription Medications	Dizziness, nausea	Serotonin syndrome, depression	Men on SSRIs or antidepressants	Few hours to days
Natural Supplements	Gastrointestinal discomfort, headaches	No significant risks	Pregnant or nursing women	Varies

J Sex Med 2005;2:121–31. Peripheral and central neurochemical effects of the selective serotonin reuptake inhibitors (SSRIs) in humans and nonhuman primates: Assessing bioeffect and mechanisms of action. Sprouse J, Braselton J, Reynolds L, Clarke T, Rollema H. Activation of postsynaptic 5-HT(1A) receptors by fluoxetine despite the loss of firingdependent serotonergic input: Electrophysiologicaland neurochemical studies.

Topical gels can numb nerves and delay ejaculation temporarily.
Oral pills like dapoxetine are prescription medications for PE.
Herbal supplements claim to improve stamina and control.
SSRIs often prescribed off-label to help delay climax.
Some lifestyle changes, like stress reduction, may improve symptoms.

Sprouse J, Clarke T, Reynolds L, Heym J, Rollema H. Comparison of the effects of sertraline and its metabolite desmethylsertraline on blockade of central 5-HT reuptake in vivo. Anderson GM, Barr CS, Lindell S, Durham AC, Shifrovich I, Higley JD. Time course of the effects of the serotonin-selective reuptake inhibitor sertraline on central and peripheral serotonin neurochemistry in the rhesus monkey. Waldinger MD, Zwinderman AH, Olivier B. On-demand treatment of premature ejaculation with clomipramine and paroxetine: A randomized, double-blind fixed-dose study with stopwatch assessment. Eur Urol 2004;46:510–5; discussion 516. Modi NB, Dresser MJ, Simon M, Lin D, Desai D, Gupta S.

Expected duration

Sertraline as a treatment for premature ejaculation. Athanasios Z, Polyanthi P, George K. The efficacy of duloxetine in the treatment of premature ejaculation. Selective serotonin reuptake inhibitor-induced sexual dysfunction: clinical and research considerations. Utility of selective serotonin reuptake inhibitors in premature ejaculation. Single- and multiple-dose pharmacokinetics of dapoxetine hydrochloride, a novel agent for the treatment of premature ejaculation. Pryor JL, Althof SE, Steidle C, Rosen RC, Hellstrom WJ, Shabsigh R, Miloslavsky M, Kell S.

Product	Dosage	Quantity + Bonus	Price
Levitra Generic	60mg	20 Pills	81.30€ 77.43€
Viagra Original	100mg	64 + 4 Pills	264.15€ 251.57€
Levitra Original	20mg	34 + 2 Pills	188.51€ 179.53€
Viagra Super Active	100mg	30 + 6 Pills	64.09€ 61.04€
Kamagra Polo	100mg	84 + 4 Pills	244.49€ 232.85€
Levitra Generic	40mg	270 + 10 Pills	561.89€ 535.13€
Viagra Oral Jelly	100mg	63 + 7 Sachets	190.54€ 181.47€
Viagra Professional	100mg	30 Pills	88.92€ 84.69€
Viagra Super Active	100mg	270 + 30 Pills	390.61€ 372.01€
Cialis Generic	5mg	360 + 10 Pills	268.08€ 255.31€
Viagra Soft Tabs	100mg	120 + 8 Pills	232.21€ 221.15€
Cialis Generic	10mg	180 + 8 Pills	236.88€ 225.60€

Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: An integrated analysis of two double-blind, randomised controlled trials.

About this article

Arch Sex Behav 1984;13:69–83. Incidence and prevalence of the sexual dysfunctions: A critical review of the empirical literature. Arch Sex Behav 1990;19:389–408. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: Prevalence, comorbidities, and professional help-seeking. Eur Urol 2007;51:816–23; discussion 824.

Surgical treatments

Prevalence, characteristics and implications of premature ejaculation/rapid ejaculation. Etiology of ejaculation and pathophysiology of premature ejaculation. Prevalence of chronic prostatitis in men with premature ejaculation. Effects of a new type of 5-HT receptor agonist on male rat sexual behavior. Pharmacol Biochem Behav 1981; 15:785–92.

What you can do in the meantime

The role of the 5-HT2 receptor in the regulation of sexual performance of male rats. Waldinger MD, Berendsen HH, Blok BF, Olivier B, Holstege G. Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: The involvement of the serotonergic system. Behav Brain Res 1998;92:111–8. Effect of SSRI antidepressants on ejaculation: A double-blind, randomized, placebocontrolled study with fluoxetine, fluvoxamine, paroxetine, and sertraline. McMahon CG, Touma K. Treatment of premature ejaculation with paroxetine hydrochloride as needed: 2 single-blind placebo controlled crossover studies. Salonia A, Maga T, Colombo R, Scattoni V, Briganti A, Cestari A, Guazzoni G, Rigatti P, Montorsi F. A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation. FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. Available at NEW01624.html (accessed March 24, 2008). Rosen RC, Casey R, Levine SB, Mudumbi R, Tesfaye F, Hasmonay R. Treatment of premature ejaculation (PE) with dapoxetine (DPX) is not associated with suicidality. Healy D, Whitaker C. Antidepressants and suicide: Risk-benefit conundrums. Girgis SM, El-Haggar S, El-Hermouzy S.

Medication Name	Active Ingredient	Usage Frequency	Typical Dose	Side Effects	Prescription Required	Cost ($)
Dapoxetine	Dapoxetine	As needed	30 mg before sex	Nausea, dizziness	Yes	1.5-2.5
SSRIs (off-label)	Sertraline, Paroxetine	Daily	50-100 mg daily	Fatigue, dry mouth	Yes	1-2 per pill
Tramadol (off-label)	Tramadol	As needed	50 mg	Drowsiness, nausea	Yes	0.50-0.80 per pill

A double-blind trial of clomipramine in premature ejaculation. Clomipramine as a treatment for rapid ejaculation: A double-blind crossover trial of fifteen couples. Effective daily treatment with clomipramine in men with premature ejaculation when 25 mg (as required) is ineffective. Maier U, Koinig G. Andrological findings in young patients under long-term antidepressive therapy with clomipramine. Mousavizadeh K, Ghafourifar P, Sadeghi-Nejad H.

Over-the-Counter (OTC) Solutions and What to Avoid

The selective serotonin re-uptake inhibitors fluvoxamine and paroxetine differ in sexual inhibitory effects after chronic treatment. Waldinger MD, Zwinderman AH, Olivier B. SSRIs and ejaculation: A double-blind, randomized, fixeddose study with paroxetine and citalopram. Waldinger MD, Zwinderman AH, Olivier B. Antidepressants and ejaculation: A double-blind, randomized, placebo-controlled, fixed-dose study with paroxetine, sertraline, and nefazodone.

RedBox Rx Reviews

Jern P, Santtila P,Witting K, Alanko K, Harlaar N, Johansson A, von der Pahlen B, Varjonen M, Vikstrom N, Algars M, Sandnabba K. Premature and delayed ejaculation: Genetic and environmental effects in a population-based sample of Finnish twins. Penile sensitivity in patients with primary premature ejaculation. Somatosensory evoked potentials in patients with primary premature ejaculation. Guidelines for the diagnosis and management of premature ejaculation.

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Developmental status of topical therapies for erectile and ejaculatory dysfunction. Optimum usage of prilocaine-lidocaine cream in premature ejaculation. Topical anaesthetic use for treating premature ejaculation: A double-blind, randomized, placebo-controlled study. Clinical study of SS-cream in patients with lifelong premature ejaculation. Althof S.

Behavioral Techniques for Ejaculatory Control

The psychology of premature ejaculation: Therapies and consequences. Premature ejaculation: A review of 1130 cases. Aycock L. The medical management of premature ejaculation. The use of phenoxybenzamine treatment in premature ejaculation.

Authors and Affiliations

Effect of an alpha-blocking agent (phenoxybenzamine) in the management of premature ejaculation. Eaton H. Clomipramine in the treatment of premature ejaculation. Ejaculation-retarding properties of paroxetine in patients with primary premature ejaculation: A double-blind, randomized, dose-response study. Br J Urol 1997;79:592–5. Intracavernous medication for treatment of premature ejaculation. Chen J, Mabjeesh NJ, Matzkin H, Greenstein A. Efficacy of sildenafil as adjuvant therapy to selective serotonin reuptake inhibitor in alleviating premature ejaculation. A new combination treatment for premature ejaculation: A sex therapist’s perspective. Symonds T, Perelman MA, Althof S, Giuliano F, Martin M, May K, Abraham L, Crossland A, Morris M. Development and validation of a premature ejaculation diagnostic tool. Azam U. Late-stage clinical development in lower urogenital targets: Sexual dysfunction. Taber MT, Wright RN, Molski TF, Clarke WJ, Brassil PJ, Denhart DJ, Mattson RJ, Lodge NJ. Neurochemical, pharmacokinetic, and behavioral effects of the novel selective serotonin reuptake inhibitor BMS-505130. Pharmacol Biochem Behav 2005;80:521–8.

Pelvic physical therapy (PT)

Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: A double-blind, placebo controlled study. Disorders of orgasm and ejaculation in men. J Sex Med 2004;1:58–65. Biri H, Isen K, Sinik Z, Onaran M, Kupeli B, Bozkirli I. Sertraline in the treatment of premature ejaculation: A double-blind placebo controlled study. Aloosh M, Hassani M, Nikoobakht M. Seminal plasma magnesium and premature ejaculation: A case-control study. Premature ejaculation (PE) is a male sexual dysfunction that occurs when a male expels semen (and most likely experiences orgasm) soon after beginning sexual activity, and with minimal penile stimulation.

Topical anesthetic creams and sprays are alternative options.
Lifestyle modifications, like reducing stress, are helpful adjuncts.
Natural pills should be scrutinized for scientific validation.
Contraceptive pills do not treat PE but are often confused with treatments.
Medications may have different durations of action depending on formulation.

Mechanism	Description	Example Drugs/Ingredients	Effect Duration	Notes
Local Anesthetic Effect	Numbs the penis to temporarily reduce sensitivity	Lidocaine, Prilocaine	30-60 minutes	Used in creams/spays
Serotonin Reuptake Inhibition	Alters neurotransmitter levels to delay ejaculation	Dapoxetine, SSRIs	1-3 hours	Prescription medications
Central Nervous System Modulation	Influences brain pathways controlling ejaculation	Tramadol, certain antidepressants	2-4 hours	Off-label use