title: Evaluation of tramadol on demand vs. daily paroxetine as a long-term treatment of lifelong premature ejaculation.
abstract: BACKGROUND
  Premature ejaculation (PE) is the most common male sexual dysfunction with many lines of treatment that show conflicting results. Paroxetine and tramadol were both reported to be effective in treatment of PE.
  
  
  OBJECTIVE
  To investigate the effectiveness of long-term daily paroxetine vs. on-demand tramadol HCl in treatment of PE.
  
  
  METHODS
  Intravaginal ejaculatory latency time (IELT) and Arabic Index of PE (AIPE) were used to assess the efficacy of investigated drugs.
  
  
  METHODS
  Thirty-five cases with lifelong PE were enrolled in this study. Baseline recording of IELT using a stop watch and AIPE was done. Patients were randomized to take tramadol HCl on-demand or daily paroxetine. Reassessment was done after 6 and 12 weeks. A wash-out period for 2 weeks was given before cross-over to the other medication. Assessment of the effect of the second medication after 6 and 12 weeks was done.
  
  
  RESULTS
  Tramadol and paroxetine increased IELT significantly after 6 weeks by seven- and 11-folds, respectively, compared with baseline. After 12 weeks, a decline of IELT to fivefolds was recorded with tramadol whereas further increase of IELT to 22-folds was recorded with paroxetine compared with baseline (P < 0.05). Tramadol improved AIPE score significantly after 6 weeks but not after 12 weeks vs. baseline, whereas paroxetine increased the AIPE score after 6 and 12 weeks vs. baseline (P < 0.05).
  
  
  CONCLUSIONS
  Daily paroxetine is more effective than on-demand tramadol for treatment of lifelong PE. Tramadol is not recommended as a long-term treatment of lifelong PE.
authors.affiliation: Mansoura Faculty of Medicine, Andrology Unit, Mansoura, Egypt. moheiddin_alghobary@yahoo.com
authors.forename: Moheiddin
authors.initials: M
authors.lastname: Alghobary
authors.forename: Youssef
authors.initials: Y
authors.lastname: El-Bayoumy
authors.forename: Yosry
authors.initials: Y
authors.lastname: Mostafa
authors.forename: El-Hassanin Mohamed
authors.initials: el-HM
authors.lastname: Mahmoud
authors.forename: Mostafa
authors.initials: M
authors.lastname: Amr
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004534:Egypt; D004542:Ejaculation / Q000187:drug effects*; D005500:Follow-Up Studies; D006801:Humans; D007989:Libido / Q000187:drug effects; D008134:Long-Term Care; D008297:Male; D017374:Paroxetine / Q000008:administration & dosage* / Q000009:adverse effects; D010410:Penile Erection / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy*; D014147:Tramadol / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000701:Analgesics, Opioid; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D014147:Tramadol