Treatment of patients with Premature Ejaculation using fluoxetine and Cialis (Tadalafil)
According to statistics, today about 50% of men aged 40 to 70 have erectile dysfunction of varying severity and more than a quarter in the age of 18-59 years is complaining about the violation of ejaculation. As often found, though incalculable, the cases of decreased libido are quite frequent as well. Moreover, in practice, these violations are often combined, and in these combinations, they can strengthen and mask each other making it difficult to assess the overall condition of the patient’s sexual function. Psychological disorders are usually associated with sexual dysfunction, making it difficult to make a timely diagnosis and assign the proper treatment. At the same time, more and more people prefer to have full sexual relations until old age that forces doctors to seek for new effective approaches to correction of associated sexual dysfunction symptoms.
The latest achievements of pharmacology were marked by the introduction of inhibitors of phosphodiesterase type 5 (PDE-5), designed for erectile dysfunction treatment, capable of returning active sex life to a way wider male audience. With respect to premature ejaculation (PE) in particular such a breakthrough in the development of therapeutic agents is not there so far. However, in 1990, an ability of some psychotropic drugs to delay ejaculation was discovered, which is a side effect of these drugs, gives grounds for some optimism. It is about a group of drugs originally developed for the correction of psychological disorders: tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).
Among the TCAs, according to the medical literature, to correct Premature Ejaculation (view more info) clomipramine is used more frequently. SSRIs ability to inhibit ejaculation is supported by only three drugs – fluoxetine, paroxetine and sertraline. It is proved that the inhibitory effect on ejaculation in TCA is expressed significantly stronger than that of SSRIs, but the high frequency and nature of side effects of tricyclic antidepressants, particularly marked by several researchers painful ejaculation limits their use for this purpose.
The mechanism of inhibitory effect of SSRIs on ejaculation is established in animal studies in which a part of the brain taking part in the development of the ejaculatory reflex was defined. In particular, it turned out that in the brain there are centers, stimulating and inhibiting ejaculation. Stimulating effect comes from the hypothalamus, and moderating – from groups of neurons located in the brain stem (nucleus paragigantocellularis). The primary mediator in these cells is serotonin. Its accumulation under the action of SSRIs is responsible for their inhibitory effect on ejaculation.
Effective Medication for treatment Premature Ejaculation – Priligy (Dapoxetine) – Read here now.
An additional mechanism of inhibitory effect of SSRIs on ejaculation may be their peripheral blocking effect on calcium channels of membranes of muscle fibers located in the vas deferens and seminal vesicles, found a number of investigators in animal experiments .
Comparative evaluation of SSRIs showed approximately the same efficacy in their correct PE. According to some authors, depending on the dose of the SSRI the latency period to ejaculation could be increased by 2 to 10 minutes.
However, the use of SSRIs, which allows to adjust the PE, has a negative impact on other aspects of the sexual function of men, namely suppresses libido and weakens erection. In order to correct this undesirable effect simultaneously requested use stimulators of erection, in particular PDE5 inhibitors. A number of publications on the successful use of sildenafil in combination with fluoxetine or paroxetine. Thus it is possible to completely eliminate the negative impact of antidepressants on erectile function (unexpectedly additive effect of these drugs against braking ejaculation); thus, it was shown that the combined use of paroxetine and sildenafil has ejaculation significantly stronger effect than monotherapy with paroxetine.
Material and methods
For the study a group of 53 men aged 19 to 51 years (average age – 32.4 years) was selected with a constant absolute form PE. Among them 9 men have PE V degree (ejaculation occurs before introjection of the penis into the vagina), and were unable to carry out retry due to lack of an erection after the first ejaculation, 44 males had PE IV degree (ejaculation occurs after several frictions). All the patients had a regular sexual partner were mentally healthy and not suffering from inflammation of the lower parts of urogenital system, as well as severe comorbidities. Patients were instructed to attempt intercourse at least 1 time in 3 days. The control group was represented by 12 men, the others were a part of the core group. The ratio of males to PE IV and V degrees in the main (41 males) and control (12) groups was approximately the same (in the main group 35 – PE grade IV and 6 – PE V extent in the control group: 9 and 3, respectively).
The study group reps were appointed 40 mg of fluoxetine once per day in the evening and 20 mg of Cialis (Tadalafil, watch full guide about Cialis) 2 times a week. Patients in the control group received only fluoxetine 40 mg 1 time per day in the evening. The treatment course lasted for 3 months and then followed up for 18 months. The results of treatment were evaluated at 3, 6 and 18 months. To evaluate the results of treatment the scale of the international index of erectile function (IIEF-5) and the definition of ejaculation latency time (ELT) were used.
Canadian Pharmacy: Results and Conclusions
By the end of the third month of treatment, three of the six patients with premature ejaculation V degree of the core group were capable of ejaculating into the vagina. During the observation period, the number of such patients has increased, reaching a peak (5 people) to the 6th month. By this time of ejaculation latency time, they ranged from 3.2 to 5.3 minutes (average – 3.8 minutes). By the end of the observation period (18 months), the number of men capable of carrying out the ejaculation into the vagina, in this subgroup was at the same level, and ejaculation latency time practically unchanged. The average value of the index IIEF-5 in the same subgroup of patients has increased at 6 months of follow-up 11, down to 10 by the end of treatment.
Among the study group of patients with grade IV PE a substantial increase in the length of the friction period lasted until the 6th month of the study, followed by a slight setback to the 18th month.
Within 3 months of the treatment course in 6 patients of the group marked nausea, from 5 – sleep disturbance, coupled with a headache. However, these phenomena in all cases were moderate, did not require discontinuation of treatment and disappear on their own after receiving the drug.
In the control group by the end of 3 months of fluoxetine course 2 out of 3 men with PE V degree were able to carry out the ejaculation into the vagina. Latent ejaculation time they have managed to reach varied between 2.5 and 2.9 minutes (average – 2.7 minutes). In the future, these men retained the ability to carry out the ejaculation into the vagina, but the time period of the friction has progressively reduced. In the subgroup of patients with grade IV PE ejaculation latency time has also increased, but to a lesser extent than men of the main group. Average on a scale IIEF-5 in the control group during the observation has changed slightly (with PE grade IV remained unchanged). It should be noted that by 6 month observation the number of males in the control group was capable of engaging in ejaculation into the vagina 39% more frequently.
