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2016 ; 5
(4
): 487-501
Nephropedia Template TP
gab.com Text
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English Wikipedia
Emerging and investigational drugs for premature ejaculation
#MMPMID27652222
McMahon CG
Transl Androl Urol
2016[Aug]; 5
(4
): 487-501
PMID27652222
show ga
Over the past 20-30 years, the premature ejaculation (PE) treatment paradigm,
previously limited to behavioural psychotherapy, has expanded to include drug
treatment. Pharmacotherapy for PE predominantly targets the multiple
neurotransmitters and receptors involved in the control of ejaculation which
include serotonin, dopamine, oxytocin, norepinephrine, gamma amino-butyric acid
(GABA) and nitric oxide (NO). The objective of this article is to review emerging
PE interventions contemporary data on the treatment of PE was reviewed and
critiqued using the principles of evidence-based medicine. Multiple
well-controlled evidence-based studies have demonstrated the efficacy and safety
of selective serotonin reuptake inhibitors (SSRIs) in delaying ejaculation,
confirming their role as first-line agents for the medical treatment of lifelong
and acquired PE. Daily dosing of SSRIs is likely to be associated with superior
fold increases in IELT compared to on-demand SSRIs. On-demand SSRIs are less
effective but may fulfill the treatment goals of many patients. Integrated
pharmacotherapy and CBT may achieve superior treatment outcomes in some patients.
PDE-5 inhibitors alone or in combination with SSRIs should be limited to men with
acquired PE secondary to co-morbid ED. New on-demand rapid acting SSRIs, oxytocin
receptor antagonists, or single agents that target multiple receptors may form
the foundation of more effective future on-demand medication. Current evidence
confirms the efficacy and safety of dapoxetine, off-label SSRI drugs, tramadol
and topical anaesthetics drugs. Treatment with ?1-adrenoceptor antagonists cannot
be recommended until the results of large well-designed RCTs are published in
major international peer-reviewed medical journals. As our understanding of the
neurochemical control of ejaculation improves, new therapeutic targets and
candidate molecules will be identified which may increase our pharmacotherapeutic
armamentarium.