IRFANA PARVEEN
By Irfana Parveen

B.Sc (Psychiatry Ward)

06 December 2021
Medically reviewed by
Sumayya Salam
Pharm D
Paxil For Premature Ejaculation
Table of Contents

One of the most prevalent sexual dysfunctional disorders, premature ejaculation (PE), affects 20–30% of males. PE has an impact on the nature of intercourse, causing distress and anxiety as well as affecting relationships between partners.

Numerous effective treatments have been investigated by andrologists over the past few decades, including surgery, topical anesthetics, tricyclic antidepressants, PDE5Is, and selective serotonin reuptake inhibitors (SSRIs). Paroxetine is one of the SSRIs that increases the amount of 5-hydroxytryptamine (5-HT) in postsynaptic membrane receptors, thus delaying ejaculation. 

Despite not being FDA-approved, Paroxetine has the advantages of lower costs and dropout rates. They are the most widely prescribed drugs for compulsive, panic, anxiety, and depressive disorders. Let's take a closer look at Paxil and how it affects premature ejaculation.

What Is Paxil (Paroxetine)?

Paxil (paroxetine) is a selective serotonin reuptake inhibitor (SSRI). Paroxetine is used to treat anxiety disorders, panic attacks, obsessive-compulsive disorder (OCD), depression, and post-traumatic stress disorder. 

It works by aiding in the brain's natural chemical (serotonin) balance restoration. It is occasionally recommended for Premature Ejaculation in addition to treating mood problems.

Indications

FDA approved indication

Paxil has been given FDA approval for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), panic disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), premenstrual dysphoric disorder (PMDD), and vasomotor associated symptoms with menopause. Although paroxetine is not FDA-approved for usage in children or adolescents under 18, doctors do so off-label in this population.

Off-label indications

  • Diabetic neuropathy
  • Vasovagal syncope
  • Stuttering
  • Separation anxiety 
  • Dysthymia
  • Body dysmorphic disorder
  • Postpartum depression
  • Premature ejaculation
  • Malignancy-related pruritus unresponsive to standard treatment

Mechanism of Paroxetine

The primary mechanism of action of paroxetine is to block the serotonin reuptake transporter (SERT), hence increasing the concentration of synaptic serotonin. 

According to current thinking, depression causes an increase in serotonergic receptors by lowering serotonin levels in the brain. Paroxetine stimulates the downregulation of the previously elevated serotonin receptors by raising the synaptic concentration of serotonin, which normalizes the receptor concentration. 

How does Paroxetine work in premature ejaculation?

Paroxetine has been demonstrated to be the most effective, with an 8.8-fold increase in IELT (intravaginal ejaculatory latency time) compared to other SSRIs. The effects of these medications typically take time to become apparent.

Paroxetine blocks serotonin from reabsorbing from the synaptic cleft's axonal end. Serotonin levels in the microneuronal milieu rise as a result, as does the activation of post-synaptic receptors by serotonin. The delay of ejaculation follows an increase in serotonin levels. 

SSRIs useful in treating premature ejaculation include Sertraline, Paroxetine, Fluoxetine, Citalopram, and Dapoxetine.
Paxil is the most potent inhibitor of the reuptake of serotonin among the available SSRIs.
Paroxetine appears to induce the most drowsiness among the other SSRIs. However, this resolves a few weeks after starting the drug. Until you know how paroxetine affects you, avoid operating machinery or performing other tasks that call for alertness.

Study On The Use Of Paxil For Premature Ejaculation

The Australian Centre conducted this study for Sexual Health, St. Luke's Hospital, Sydney, to determine the efficiency of chronic and 'on demand' paroxetine hydrochloride administration in treating premature ejaculation (PE).

Ninety-four average men, ages 18 to 61 (mean 39), were treated with oral paroxetine as Paxil for premature ejaculation hydrochloride, a selective serotonin reuptake inhibitor, for premature ejaculation. All of the males were married or in committed relationships. 

Sixty-four out of ninety-four males (Group A) were given paroxetine hydrochloride 20 mg once daily as an initial treatment. After four weeks, those men who improved their ejaculatory control were given 'on-demand paroxetine hydrochloride (20 mg) three to four hours before their intended intercourse. The remaining 33 of the 94 males (Group B) were given 20 mg of 'on-demand paroxetine hydrochloride 3-4 hours before their intended intercourse.

The pre-mean ejaculatory latency time (ELT) of both groups A and B was 0.4 min (range 0-1 min). The mean ELT in group A was 4.5 minutes in 761 intercourses at a frequency of 2.4 intercourse per week following four weeks of daily Paxil medication. After four weeks of daily Paxil medication, the mean ELT in group A improved to 3.9 minutes (range 0-10), and 36 men felt they maintained improved ejaculatory control. 

How To Use Paxil For Premature Ejaculation?

Paroxetine is taken orally. The dose is titrated based on the patient's symptoms and tolerance to the dosage. There are normal and controlled-release tablets and liquid forms. Depending on tolerance, paroxetine can be taken at any hour of the day. 

You can take the medication with or without food. The doses of Paroxetine that are effective in increasing IELT are 10–40 mg. 

Dosage For Paxil 

The dosage is a list of directions for how to take the medication. It covers the appropriate dose, timing, and duration of administration. The ideal dosage yields the desired result with the fewest adverse effects.

Dosage for Premature Ejaculation

For primary PE, paroxetine in a dose of 20 mg is sufficient, and increasing the dose can result in an even longer ejaculation latency.The doses of Paroxetine that are effective in increasing IELT are 10–40 mg. 

Other Drugs For Premature Ejaculation

The US Food and Drug Administration (FDA) has not given any specific drugs approval to treat premature (early) ejaculation. However, a number of drugs have been utilized for this purpose safely and successfully. 

SSRIs

The most effective treatments  have been selective serotonin reuptake inhibitors (SSRIs) and antidepressants with SSRI-like effects.

Escitalopram

Escitalopram is an antidepressant and anxiety medication. It works by assisting in the restoration of a natural substance (serotonin) equilibrium in the brain. Escitalopram belongs to the selective serotonin reuptake inhibitors class of medicines (SSRI). It may increase your energy and emotions of well-being while also reducing anxiousness resulting in a delayed orgasm.

Fluoxetine

The active element of Prozac, fluoxetine, is effective in treating PE in studies. Prozac's efficacy as a treatment for premature ejaculation is linked to the relationship between serotonin levels and ejaculation.

Sertraline

Research has proven Sertraline to be both safe and effective for the use of premature ejaculation. It can be more effective if it is consumed alongside behavioral and psychological treatments.

Topical anesthetic agents

It might reduce penile excitability and sensitivity while delaying ejaculation. The lowest-risk treatment option for premature ejaculation is likely topical anesthetic cream. For instance, Lidocaine 2.5% and prilocaine 2.5% (EMLA).

Phosphodiesterase Type 5 Inhibitors

PDE5 inhibitors are a safe and efficient therapeutic adjunct for early ejaculation if not contraindicated. E.g.,Tadalafil, Sildenafil 

Side Effects Of Paxil

Paxil (paroxetine hydrochloride) is a selective serotonin reuptake inhibitor (SSRI). Some side effects are insignificant and of little concern, while others could be serious and necessitate medical treatment.

Although many side affects are mild and not dangerous, it is still crucial to notify your doctor since the side effect could be a warning of danger or that the drug is not working as it should.
Here are some common and serious side effects:

Common

Serious

Anxiety

Suicidal thoughts or actions

Impotence

Severe allergic reactions

Headache

Serotonin syndrome

Nausea

Abnormal bleeding

Weakness

seizures

Abdominal pain

Change in appetite or weight

Diarrhea

Episodes of mania

Constipation

A decrease in sodium levels

Agitation

Decreased need for sleep

Dry mouth

Bone pain or tenderness, swelling, bruising

Precautions you should take before having Paxil

Precautions are cautionary steps that you or others need to take when using medications.

When using a prescription drug, it is essential to take the advised safety measures in order to prevent drug misuse.

Before taking Paroxetine, tell your doctor about all the medications you take. Discuss if you have any allergies or any queries regarding the drug.

  • Take Paxil as directed by your doctor. The dose may need to be modified by your doctor until it is suitable for you. 
  • You can take Paxil either with or without food.
  • For Paxil Oral Suspension, shake it thoroughly before using. 
  • Inform your healthcare practitioner of all the drugs you use, including vitamins, herbal supplements, prescription drugs, and over-the-counter medications, as some medications, including Paxil, may interact with one another.
  • Inform your doctor if you are pregnant or plan to become pregnant before beginning Paxil. Paxil can harm your unborn child, including a raised chance of birth abnormalities, specifically heart disorders.
  • If you're nursing, let your doctor know as Paxil passes into milk.
  • Take the missing Paxil dose as soon as you remember if you forget to take it. Skip the missed dose if it is almost time for the next one, and take your next pill as scheduled. Never take two Paxil doses at the same time.
  •  If you take too much Paxil, contact your doctor or seek emergency medical attention.
  • Avoid stopping Paxil abruptly without first consulting your doctor.
  • Avoid driving, using heavy machinery, or engaging in other unsafe actions until you understand how Paxil will affect you.
  • Avoid consuming alcohol while taking Paxil.

Drug Interactions

Drug interactions could alter how your medications work or raise the possibility of side effects. Without your doctor's approval, never start, stop, or change the dosage of any drugs. When modifying a regimen, check to see if any of the patient's prescriptions have known interactions, and give the patient advice on what to do to reduce the likelihood of a drug interaction.

Common drug interactions of Paxil include

  • Concomitant use of paroxetine with tryptophan may cause unpleasant effects are possible, most commonly headache, nausea, sweating, and dizziness.
  • Co-administration of Paroxetine with blood thinners like warfarin, NSAIDs, and antiplatelet medications can raise the risk of bleeding.
  • Combining this medication w ith MAO inhibitors may result in a dangerous (potentially deadly) drug interaction. Avoid  MAO inhibitors for two weeks before treatment with this drug. If you are also taking other medications that elevate serotonin, your chance of developing serotonin syndrome poisoning rises.
  • Avoid using this medication concurrently with pimozide or thioridazine. Combining these medications can result in potentially significant heart problems.

Bottom Line From Practical Anxiety Solutions

Premature ejaculation is one of the most prevalent sexual dysfunctions impacting men today. The number of research on PE has increased over the last few years, which has changed how people view this condition. Premature ejaculation is nothing to be ashamed of; almost everyone has experienced it. Treating it requires you and your doctor's attention.

When compared to alternative medications, paroxetine has the benefit of improving PE with minimal side effects. It seems to be an effective drug for treating premature ejaculation. Do not stop taking this medication without consulting your doctor. In case of overdose or serious adverse effects, seek emergency medical care.

  • Davis, B., Nagarajan, A., Forrest, L. et al. Mechanism of Paroxetine (Paxil) Inhibition of the Serotonin Transporter. Sci Rep 6, 23789 (2016). From https://doi.org/10.1038/srep23789 Obtain on 02/11/2022

  • Bazzano, A. T., Mangione-Smith, R., Schonlau, M., Suttorp, M. J., & Brook, R. H. (2009). Off-Label Prescribing to Children in the United States Outpatient Setting. Academic Pediatrics, 9(2), 81-88. From https://doi.org/10.1016/j.acap.2008.11.010 Obtain on 02/11/2022
  • Mercado, Michael G., et al. "What's the best drug treatment for premature ejaculation?." (2008). From http://hdl.handle.net/10355/3821 Obtain on 02/11/2022
  • McMahon CG, Touma K. Treatment of premature ejaculation with paroxetine hydrochloride. Int J Impot Res. 1999 Oct;11(5):241-245; discussion 246. From  https://doi.org/10.1038/sj.ijir.3900415  PMID: 10553802. Obtain on 02/11/2022
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