Premature ejaculation (PE) is the most common sexual disorder affecting 20-24% of men. Dapoxetine is the first drug to obtain Marketing Authorization in France. Its interest in the management of premature ejaculation is proven and seems to be improved when it is combined with another cognitive-behavioral therapy with an improvement in the duration of sexual intercourse and a gradual reduction in the number of tablets required.
Premature ejaculation can be primary or acquired and corresponds to ejaculation always or almost always occurring before vaginal penetration, or less than a minute after it, with the impossibility of delaying ejaculation and having negative personal consequences.
It is the most common sexual disorder although still too often underestimated.
The management of PE should be multidisciplinary including behavioral methods as well as pharmacological treatment.
Many therapies have been described for the treatment of PE, such as antidepressants taken daily (selective serotonin reuptake inhibitor: SSRI), tramadol, or local anesthetics such as xylocaine; however, only dapoxetine has had Marketing Authorization since 2013 for the treatment of primary or acquired premature ejaculations.
Action Mechanism of Dapoxetine
Dapoxetine is a selective serotonin reuptake inhibitor (SSRI), The mechanism of action of dapoxetine is linked to the inhibition of neuronal serotonin reuptake and the subsequent potentiation of the action of the neurotransmitter at the level of pre- and postsynaptic receptors.
How to Use Dapoxetine
Dapoxetine tablets are available in a dosage of 30 or 60 mg.
Its price varies between 8 and 9 euros per unit.
The recommended starting dose is 30 mg taken between 1h and 3h before intercourse. This is taken on demand and should not exceed 1 tablet every 24h.
The tablet should be swallowed whole to avoid the bitter taste with a glass of water, it can be taken with or without food.
In case of insufficient response to the 30 mg dose, it is recommended to prescribe only 60 mg in the absence of adverse effects at the 30 mg dose.
A clinical evaluation must be carried out 4 weeks after initiation of treatment, in the event of efficacy and good tolerance, the treatment will be re-evaluated at least every 6 months.
Efficiency of Dapoxetine
Dapoxetine (Priligy®) is the first specially marketed treatment for PE to take on demand before sex.
In the various studies carried out, the delay in intravaginal ejaculation is increased by 2.5 to 3 times.
The Marketing Authorization concerns men aged 18 to 65 years, the efficacy and safety of the treatment have not been established for patients over 65 years of age.
This treatment is contraindicated for patients with severe renal impairment, moderate and severe hepatic impairment (Child B and C), as well as for patients treated with moderate or strong CYP3A4 inhibitors such as ketoconazole, ritonavir, saquinavir. ..
This treatment is also contraindicated for patients with erectile dysfunction using PDE5 inhibitors due to the increased risk of orthostatic hypotension.
Patients should be informed that the concomitant intake of alcohol increases the risk of syncope due to its neurocardiogenic action.
Currently, no studies have identified serious side effects associated with taking dapoxetine treatment.
The main side effects are: nausea (20%), dizziness and headache (10%), insomnia and asthenia (2%).
Despite its effectiveness, the side effects associated with prolonged use of SSRIs hamper the prescription of dapoxetine, however no serious side effects have been described. Dapoxetine is a recognized treatment for premature ejaculation, a combination therapy combining pharmacological treatment and behavioral therapy should be offered for this very common and yet still underestimated disorder.