Delayed Ejaculation Medication

Updated: Sep 20, 2018
  • Author: Adrian Preda, MD; Chief Editor: David Bienenfeld, MD  more...
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Medication

Medication Summary

The goal of pharmacotherapy is to achieve ejaculation delay.

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Antidepressants, Other

Class Summary

The mixed serotonergic and noradrenergic drugs have effects on serotonin, norepinephrine, and, in some cases, dopamine, as well as nicotinic acetylcholine systems. Because of the empirical nature of psychopharmacology, they may be used as first-line drugs or as alternative agents when other antidepressants cause undesired side effects.

Bupropion (Wellbutrin, Fortivo XL, Aplenzin)

Bupropion is used as an alternative in antidepressant-induced inhibited male orgasm. It inhibits neuronal dopamine reuptake, but it is also a weak blocker of serotonin and norepinephrine reuptake. A low incidence of sexual dysfunctions occurs with this medication.

Mirtazapine (Remeron)

Mirtazapine is used as an alternative in antidepressant-induced inhibited male orgasm. It is an antidepressant that is not chemically related to the tricyclics or to any other class of antidepressants. Its primary mechanism of action is antagonism at the central presynaptic alpha-2 receptors. The actions of the drug change as the dose is raised. Mirtazapine exhibits noradrenergic and serotonergic activity.

Imipramine (Tofranil)

Imipramine has an alpha-adrenergic effect and appears to be effective in psychotropic-induced male orgasmic disorder (MOD). It increases synaptic concentrations of serotonin and/or norepinephrine in the central nervous system by inhibiting their reuptake at the presynaptic neuronal membrane. It is also known to cause down-regulation of beta-adrenergic receptors, desensitization of adenyl cyclase, and down-regulation of serotonin receptors.

Vilazodone (Viibryd)

This agent is an antidepressant with serotoninergic effects. It is a partial agonist of the 5-HT1A presynaptic receptor.and it also blocks the serotonin reuptake via inhibition of CNS neuron serotonin uptake. Improved sexual functioning occurs with this medication.

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Phosphodiesterase (type 5) Enzyme Inhibitors

Class Summary

These agents increase the vasodilatory effects of nitric oxide by inhibiting the enzyme phosphodiesterase type 5, which, in turn, increases sensitivity for erections.

Sildenafil (Viagra)

Sildenafil is a phosphodiesterase type 5 (PDE5) selective inhibitor. It appears to be effective in psychotropic-induced male orgasmic disorder (MOD). Inhibition of PDE5 increases the activity of cyclic guanosine monophosphate (cGMP), which increases the vasodilatory effects of nitric oxide. This agent is effective in men with mild-to-moderate ED.

Take on an empty stomach about 1 hour before sexual activity. Sexual stimulation is necessary to activate response. The increased sensitivity for erections may last 24 hours. Sildenafil is available as 25-, 50-, and 100-mg tabs.

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Alpha/Beta Adrenergic Agonists

Class Summary

The effect of monoaminergic agents may involve modulation of the sympathetic system.

Ephedrine

Ephedrine stimulates the release of epinephrine stores, producing alpha- and beta-adrenergic receptors.

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Antihistamines, 1st Generation

Class Summary

H1 receptor antagonists act by competitive inhibition of histamine at the H1 receptor. Among other things, this inhibition mediates smooth muscle contractions.

Chlorpheniramine (Chlor-Trimeton, Chlorphen, Aller-Chlor, Pharbechlor)

This agent competes with histamine or H1-receptor sites on effector cells in blood vessels and the respiratory tract. It has been used successfully in patients with retrograde ejaculation.

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