Ejaculation delayed

Since the introduction of the first approved SSRI, fluoxetine (1) in 1987 [9], a number of SSRIs have been developed for the treatment of depression [2], Currently, the five most commonly prescribed SSRIs are fluoxetine, escitalopram (2, S-enantiomer of citalopram), sertraline (3), paroxetine (4) and fluvoxamine (5). Recent effort in the clinical development of new SSRIs has focused on the treatment of premature ejaculation (PE) by taking advantage of the ejaculation-delaying side effects of SSRIs [10]. Although SSRIs have been prescribed off-label to treat this condition, an SSRI with rapid onset of action and rapid clearance could be preferred for on-demand treatment of PE [11,12]. Dapoxetine (LY210448, 6), an... 

Loss of Interest in Sex. One of the prominent symptoms of depression is anhe-donia, a lack of interest or pleasure in life. Anhedonia is commonly manifested by a decreased libido or a lack of interest in sex. This is different from the sexual dysfunction of delayed ejaculation, delayed orgasm, or anorgasmia seen with all antidepressants that block serotonin reuptake. The problem, however, is that loss of... 

Drugs that potentiate serotonin function can cause ejaculatory delay in men, and this has led to the use of SSRIs to treat premature ejaculation (SEDA-26, 13). Venlafaxine is also reported to cause problems with ejaculation during routine use and its efficacy has been studied in a placebo-controlled, crossover study in 31 men with ejaculation latencies of less than 2 minutes (25). Both placebo and venlafaxine (75 mg/day of the XL formulation) significantly increased latency to ejaculation over baseline, placebo by 2 minutes and venlafaxine by 3 minutes there was no difference between the two treatments. The authors concluded that venlafaxine is not effective for the management of premature ejaculation. However, the small number of subjects studied and the large placebo effect makes this conclusion tentative. It does appear, however, that the effect of venlafaxine on ejaculation delay is probably less striking than, for example, that of paroxetine. 

Impotence painful ejaculation Impotence priapism Decreased libido impotence painful, delayed ejaculation delayed orgasm in women... 

Decreased or no ejaculation Impotence retarded or no ejaculation delayed or no orgasm priapism Decreased libido impotence priapism Impotence no ejaculation decreased libido Impotence priapism Decreased libido impotence Impotence... 

Ejaculation disorders, including delayed and retrograde ejaculation, occur with all adrenergic antagonists and are an... 

BMS-505130 (7) is a potent and selective serotonin transporter inhibitor (SERT K< = 0.18 nM, NET K< — 4.6 gM, DAT K< — 2.1 (tM). In brain microdialysis studies, 7 demonstrated a dose-dependent increase in cortical serotonin levels. Compound 7 was also active in the mouse tail suspension model [15]. Following oral administration, peak plasma concentration of 7 was reached at 1.6 h and then declined to a concentration less than 10% of Cmax within 6 h. The short half-life of 7 might be advantageous for the treatment of PE where an acute effect to delay ejaculation followed by a relatively rapid fall in SSRI plasma concentration might be desirable. 

One additional medication that has recently been studied is sildenafil, which is more commonly known by its trade name Viagra. Sildenafil is taken at doses from 50 to 100 mg per dose about 1-2 hours before sex. Sildenafil is sometimes effective but its expense and potential complications in patients with heart disease limit its usefulness. It can be quite useful in males who experience erectile dysfunction, though it does not improve delayed ejaculation. 

Reactions associated with treatment of narcotic addiction include difficulty sleeping, anxiety, nervousness, headache, low energy, irritability, increased energy, dizziness, abdominal cramps/pain, nausea, vomiting, loss of appetite, diarrhea, constipation, joint/muscle pain, delayed ejaculation, decreased potency, skin rash, chills, and increased thirst. 

MDD. Adverse reactions occurring in at least 3% of patients include the following abnormal orgasm, anxiety, blurred vision, constipation, decreased appetite/anorexia, decreased libido, delayed ejaculation, diarrhea, dizziness, dry mouth, ejaculatory dysfunction, erectile dysfunction, fatigue, increased sweating, insomnia, nausea, somnolence, tremor, vomiting. 

Naltrexone can induce hepatotoxicity at doses only five times the therapeutic dose and should be used with care in patients with poor hepatic function or liver damage. Side effects of the use of naltrexone are more frequently observed than following naloxone administration. Such side effects include headache, difficulty sleeping, lethargy, increased blood pressure, nausea, sneezing, delayed ejaculation, blurred vision, and increased appetite. 

Blurred vision, erectile dysfunction, delayed or failed ejaculation, anorgasmia, anxiety, decreased libido, hot flashes... 

Decreased libido, anorgasmia, and delayed ejaculation are common side effects of SSRIs. When possible, management of sexual side effects should be postponed until the patient has completed an adequate trial of the antidepressant. 

Side effects such as postural light-headedness, constipation, delay in urination, delay in ejaculation and orgasm, muscle twitehing, sedation, fluid retention, insomnia, and excessive sweating are quite common. Many of these side effects lessen after the third week. 

MAOIs are commonly associated with treatment-emergent sexual dysfunction, including decreased libido, delayed ejaculation, anor-gasmia, and impotence. Some patients become tolerant to this side effect over time, but more often the problem persists unless the dose is reduced or another medication is used to counter the sexual side effects. The treatment of sexual side effects is discussed in the Selective Serotonin Reuptake Inhibitors section earlier in this chapter. 

Delayed ejaculation has been reported with agents such as thioridazine, perhaps due to its greater autonomic effects. Clinicians must be sensitive to these issues because many patients are embarrassed to talk about them. 

SSRIs and venlafaxine can cause of variety of sexual dysfunctions including delayed ejaculation, anorgasmia, and decreased libido ( Table 7-24). For two reasons, the adverse effect of these medications on sexual function was underestimated during the early clinical trials. First, such trials rely on spontaneous reporting by participants. Second, these adverse effects appear to take several weeks to develop. These adverse effects develop in approximately 30% to 40% of patients on adequate doses of SSRIs and venlafaxine. Although all manufacturers of these medications endeavor to suggest that their product is less likely to cause these effects, there is no compelling evidence to indicate that is true. Comparisons of rates across studies are not fair comparisons because they may differ based on how these problems were assessed. 

Sedation is uncommon and instead many patients will find that these drugs may impair sleep, which is why the dose is best taken in the morning. There is also little effect on psychomotor function. Occasional patients have a small reduction in heart rate but otherwise effects on the cardiovascular system are rare. Epileptic convulsions can occur but are rare and much less common than with tricyclic antidepressants. There is some evidence for potentiation of electroconvulsive therapy (ECT)-induced seizures. Sexual dysfunction is reported, principally delayed ejaculation and anorgasmia. 

Anabolic steroids, antidepressants and drugs of abuse affect libido, potency, and ejaculatory function. Anabolic steroids are derivatives of testosterone, and have strong genitotropic effects. There is published evidence indicating that anabolic steroids increases sexual desire however, the frequency of erectile dysfunction is also increased. Treatment with the antidepressant fluoxetine has been associated with sexual side effects including delayed or nonexistent ejaculation and hyposexuality. Mice treated in utero with the anideukemic agent 5-aza-2/-deoxycytidine exhibit abnormal reproductive behavior and low reproductive capacity. 

SSR1 drugs are associated with sexual problems such as anorgasmia and delayed ejaculation. 

Adverse affects Commonly observed adverse effects of fluoxetine are summarized in Figure 12.7. Loss of libido, delayed ejaculation and anorgasmia are probably under-reported side effects often noted by clinicians but are not prominently featured in the list of standard side effects. Overdoses of fluoxetine do not cause cardiac arrhythmias but can cause seizures. For example, in a report of patients who took an overdose of fluoxetine (up to 1200 mg compared with 20 mg/day as a therapeutic dose) about half of the patients had no symptoms. 

Delayed or complete abolition of ejaculation is attributed to strong 5-HT re-uptake blockade but perhaps with additional alpha-adrenoceptor-blocking activity (16). Impotence may be due to a ganglionic blocking... 

The adverse sexual effects of SSRIs have been reviewed (58). The use of SSRIs is most often associated with delayed ejaculation and absent or delayed orgasm, but reduced desire and arousal have also been reported. Estimates of the prevalence of sexual dysfunction with SSRIs vary from a small percentage to over 80%. Prospective studies that enquire specifically about sexual function have reported the highest figures. Similar sexual disturbances are seen in patients taking SSRIs for the treatment of anxiety disorders (59), showing that SSRI-induced sexual dysfunction is not limited to patients with depression. It is not clear whether the relative incidence of sexual dysfunction differs between the SSRIs, but it is possible that paroxetine carries the highest risk (58). 

The ability of SSRIs to cause delayed ejaculation has been used in controlled trials of men with premature ejaculation (61,62). Of the SSRIs, paroxetine and sertraline produced the most benefit in terms of increase in time to ejaculation, but fluvoxamine did not differ from placebo. Clomipramine was more effective than the SSRIs but caused most adverse effects. From a practical point of view many patients might prefer to take medication for sexual dysfunction when needed rather than on a regular daily basis, and it would be of interest to study the beneficial effects of SSRIs on premature ejaculation when used in this way. 

Laboratory studies have shown that fluvoxamine differs from paroxetine, sertraline, and fluoxetine in not delaying the time to ejaculation. The effect of citalopram to delay ejaculation is also relatively modest (63). There are,... 

Citalopram has a relatively modest effect in delaying ejaculation (21). 

Delayed ejaculation associated with paroxetine has been reported (SEDA-18, 21). 

Impotence and delayed ejaculation in men and difficulty in achieving orgasm in two women have been reported with a variety of MAO inhibitors used to treat narcolepsy (28), phobic anxiety (29), and depression (30-32). Sexual symptoms are often dose-related and there is a delicate interplay between psychic and pathophysiological influences. In men with premature ejaculation this effect may even be considered therapeutic. 

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