SSRI Treatment for Premature Ejaculation: Dapoxetine 30mg PRN

Introduction to Dapoxetine

The European Association of Urology recommends dapoxetine 30 mg taken on-demand 1-3 hours before sexual activity as an appropriate and effective first-line treatment for premature ejaculation, though the 60 mg dose provides superior efficacy if the 30 mg dose proves insufficient 1, 2

Dapoxetine is the only SSRI specifically approved for on-demand treatment of premature ejaculation, although it is not FDA-approved in the USA, it is approved by the EMA and in many other countries 1
In patients with baseline intravaginal ejaculatory latency time (IELT) <30 seconds, dapoxetine 30 mg improves IELT by 3.4-fold 1
Dapoxetine 30 mg should be taken 1-3 hours before anticipated sexual activity for optimal plasma concentrations 2

Diarrhea is a common adverse event, occurring in 3.9% of patients taking 30 mg of dapoxetine and 6.8% of patients taking 60 mg 1
Dizziness is a dose-dependent side effect, occurring in 3.0% of patients taking 30 mg of dapoxetine and 6.2% of patients taking 60 mg 1

The European Urology Association warns against using dapoxetine in patients with bipolar depression due to the risk of mania 2, 3
The American Urological Association advises against combining dapoxetine with MAOIs due to the risk of serotonin syndrome 2, 3
The European Association of Urology recommends monitoring patients under age 24 or those with comorbid depression for suicidal ideation 2, 3

The American Urological Association recommends paroxetine 20 mg daily as the preferred off-label SSRI for premature ejaculation, providing an 8.8-fold increase in IELT 4, 2, 3
The European Association of Urology suggests that on-demand administration of off-label SSRIs is modestly efficacious but provides substantially less ejaculatory delay than daily treatment in most studies 2, 3

The European Urology Association notes that therapy with dapoxetine will likely be needed on a continuing basis, as premature ejaculation typically returns upon discontinuing treatment 7, 4
The American Urological Association states that patient satisfaction and quality of life are the primary outcome targets, not just IELT improvement 8
The European Association of Urology reports that discontinuation rates with dapoxetine reach 90% at 2 years, mainly due to cost and disappointment with the on-demand nature 1

The American Urological Association advises against abruptly discontinuing daily-dosed SSRIs, as this can precipitate SSRI withdrawal syndrome 2, 3
The European Association of Urology warns that 40% of patients refuse or discontinue off-label SSRIs within 12 months due to concerns about taking an antidepressant, suboptimal effects, or cost 2, 3