Management of Bupropion-Associated Delayed Ejaculation

Pharmacological Interventions

Cabergoline (0.25-2 mg twice weekly) is one of the most commonly used medications for delayed ejaculation, though evidence quality is limited 1
Oxytocin (24 IU intranasal/sublingual during sexual activity) may help with delayed ejaculation based on limited evidence 1
Alpha-adrenergic agonists such as pseudoephedrine (60-120 mg, 120-150 minutes prior to sex) or ephedrine (15-60 mg, 1 hour prior to sex) may help facilitate ejaculation 1
Midodrine (5-40 mg daily, 30-120 minutes prior to sex) has been reported to improve ejaculatory function 1
Bethanechol (20 mg daily) may be considered based on limited evidence 1
Yohimbine (5.4 mg three times daily) has been suggested as a potential treatment 1

Referral to a mental health professional with expertise in sexual health should be considered for comprehensive management 1
Modification of sexual positions or practices to increase arousal may benefit men with delayed ejaculation 1

Consider checking testosterone levels in men with delayed ejaculation, as low testosterone may contribute to ejaculatory dysfunction 1

The first step in managing bupropion-associated delayed ejaculation is to evaluate if the bupropion dose can be reduced or the medication switched while maintaining depression control 1
The second step is to consider adding buspirone or cabergoline if medication change is not possible 1
The third step is to consider alpha-adrenergic agonists or other agents for refractory cases 1
A concurrent approach incorporating behavioral techniques and psychological counseling throughout treatment is recommended 1