Use of Clomipramine In Treatment Of Premature Ejaculation

When you experience an orgasm before or within a minute of starting intercourse, this is known as premature ejaculation (PE). Although there is no specific time for a guy to ejaculate during sex, if you ejaculate and lose your erection thus quickly, you and your partner may feel rushed.

Premature ejaculation can be influenced by both psychological and biological reasons. Premature ejaculation is a common and treatable problem, although many men are reluctant to talk about it. Medications, counseling, and sexual techniques that postpone ejaculation (or a mix of these) can all help you and your partner have better sex. 

Early methods for treating PE were behavioral treatment, which included the start-stop and squeeze procedures. Recent investigations have documented the therapeutic effects of topical anesthetics, selective serotonin reuptake inhibitors, and tricyclic antidepressants. Clomipramine has been found to increase ejaculatory latency in men with PE. Let us see in detail how Clomipramine works for Premature Ejaculation.

Antidepressants For The Treatment Of Premature Ejaculation

Premature ejaculation was revolutionized when selective serotonin reuptake inhibitors (SSRIs) were introduced. In 1994, the first research on SSRIs in men with premature ejaculation found that paroxetine had a delaying effect (Paxil). Since then, SSRIs have been studied extensively for their ability to delay ejaculation. For premature ejaculation, SSRIs and the tricyclic antidepressant clomipramine (Anafranil) have been the drugs of choice.

Despite considerable differences in design and drug dosing, Clomipramine, Fluoxetine (Prozac), Paroxetine, and Sertraline (Zoloft) significantly delay ejaculation compared to placebo, according to a meta-analysis of 35 treatment studies with serotonergic antidepressants conducted between 1943 and 2003.

What Is Clomipramine?

Clomipramine is a tricyclic antidepressant used to treat obsessive-compulsive disorder. It is one of the more sedating tricyclic antidepressants used as a hydrochloride salt for treating phobias, OCD, and depression.

It functions as a trypanothione-disulfide reductase inhibitor, serotonergic drug, serotonin antagonist, antidepressant, and anti-coronavirus agent. It is similar to imipramine in terms of function.

Mechanism Of Clomipramine

Clomipramine is a tricyclic antidepressant with anti-obsessional effects. Clomipramine, like other tricyclics, prevents norepinephrine and serotonin from entering central nerve terminals, presumably by impeding the membrane pump of neurons.

Thus, clomipramine raises the level of transmitter monoamines at receptor locations. By altering serotonergic neurotransmission, clomipramine affects depression and compulsive and obsessive behavior. 

It appears that clomipramine has a modest sedative effect that could be useful in reducing the anxiety that frequently goes along with depression. The anticholinergic properties of clomipramine, like those of other tricyclic drugs, have some negative consequences.

Clomipramine demonstrates weak antihistamine and anti-serotonin actions. It lowers the threshold for convulsions and improves the effects of norepinephrine and other drugs on the central nervous system. The ability of clomipramine to prevent serotonin reuptake is significant.

How Does Clomipramine Work In Premature Ejaculation?

Tricyclic antidepressants and SSRIs likely cause delayed ejaculation by inhibiting some descending pathways connected to the ejaculatory reflex.

Several studies have demonstrated that clomipramine, a tricyclic antidepressant, can effectively manage PE at various doses. Clomipramine may work by inhibiting the ejaculatory reflex, reducing psychologic arousal, or exerting anxiolytic effects. 

Scientific Study On Clomipramine For Premature Ejaculation

Clomipramine was tested to see if it increased ejaculation delay in males with premature ejaculation and controls. The study comprised eight patients with primary premature ejaculation, six with primary premature ejaculation and erectile dysfunction, and eight controls. 

The study used a prospective, double-blind, placebo-controlled crossover design with two 3-week periods of Clomipramine and placebo. Individuals received either 25 mg of clomipramine or a placebo during the treatment period, 12 to 24 hours before the anticipated sexual activity.

In men with primary premature ejaculation, Clomipramine increased the latency to ejaculation during sexual activity (coitus or masturbation) from around 2 to 8 minutes. Controls and males with premature ejaculation and erectile dysfunction had no meaningful effects. 

According to laboratory findings, Clomipramine improved the regulation of ejaculatory response in men with primary premature ejaculation. Clomipramine also boosted these men's happiness with their sex lives and relationships.

In all of the individuals, Clomipramine prevented nocturnal penile tumescence. To summarise, Clomipramine increases ejaculatory latency efficiently in men with primary premature ejaculation, while it is ineffective in males with premature ejaculation plus erectile dysfunction.

You cannot get Clomipramine over the counter as it is a prescription-based drug. You can buy Clomipramine online from a legit online pharmacy but ask for a doctor's advice first. 

Dosage

When patients receive drugs in doses that fit their unique needs for an adequate amount of time at the lowest possible cost, this is considered the rational use of medicines. An improper dose regimen can cause health issues, especially in children and people with chronic illnesses. Therefore, it is necessary for designing the desired dosing regimen to achieve the intended therapeutic efficacy and prevent side effects.

Dosing In Premature Ejaculation

Men with premature ejaculation might initially be considered for treatment with Clomipramine 25 mg (or less) taken as needed 24 h before sexual intercourse. If this treatment is not successful, daily clomipramine with initially 10 mg and increasing to 30 mg may be required.

Side effects Of Clomipramine 

Side effects of medications are undesired effects that occur after the administration of the drug. Pay attention to any unwanted effects and take note of any changes.

To ensure that you remember to inform your physician, pharmacist, or other healthcare providers of the changes, note them down.

Know what to do and when to tell your doctor if you have adverse effects.

Precautions You Should Follow

These are necessary steps for preventing unusual events. Read all drug manuals and follow the instructions carefully. Call your doctor immediately if you note severe symptoms.

Before you take Clomipramine

1. Don’t take Clomipramine again if you have an allergic reaction to it.
2. Inform your doctor if you have any of the following
   
   • Heart attack 
   • Depression
   • Bipolar disorder
   • Glaucoma
   • Alcohol or substance abuse
   • Kidney or liver disease
3. Take Clomipramine as directed.
4. If you are pregnant or intend to become pregnant, consult your doctor. Only use this medication if the potential benefit outweighs the potential harm to the fetus.
5. This medication may enter the breast milk and cause adverse effects in nursing infants. If you breastfeed your child, speak with your doctor.
6. Avoid drinking alcohol while taking clomipramine.
7. If you miss a dose, skip it and take the next dose. Do not take two doses to make up for the missed one.

Drug Interactions Of Clomipramine

Interactions can sometimes result in reactions causing harm to the patient. Before starting any new drug, check for potential interactions with existing medications or dietary supplements.

Interactions

• The use of Clomipramine with anticholinergics or neuroleptics may cause hyperexcitation, delirium, or glaucoma.
• Comedication with diuretics may lead to hypokalemia.
• The activity and plasma concentrations of clomipramine may rise with using fluoxetine, fluvoxamine, and other selective serotonin reuptake inhibitors (SSRIs), with negative consequences.
• Use caution when taking  Clomipramine along with cimetidine or methylphenidate, as these medications interfere with the metabolism of several tricyclic antidepressants.
• Avoid Clomipramine use for at least 14 days after the termination of MAO-inhibitor therapy because of the risk of harmful interactions.

Bottom Line From Practical Anxiety Solutions

Premature Ejaculation is a sexual dysfunction affecting 30-40% of the male population. It is defined as any ejaculation that occurs between one and seven minutes (9-11). The primary symptom of PE is the inability to delay ejaculation for more than a minute after penetration.

Men with PE may be treated pharmaceutically using a variety of techniques. The lower risk, expense, and adverse effects related to clomipramine use are the main reasons for the choice of initial therapy as required. Clomipramine is effective, and its adverse effects are well tolerated. In addition to or in place of psychological treatment for PE, clomipramine is a safe treatment option.