title: Randomized Crossover Trial of Amoxapine Versus Vitamin B12 for Retrograde Ejaculation.
abstract: OBJECTIVE
  To compare the efficacy and safety of amoxapine and vitamin B12 for treating retrograde ejaculation (RE).
  
  
  METHODS
  Between May 2009 and November 2012, this open-label, randomized, crossover study enrolled 26 men suffering with RE at Department of Reproductive Medicine, Omori Hospital. Patients were randomly allocated into two groups (n=13 each). The amoxapine-B12 group received amoxapine (50 mg daily for 4 weeks, orally) followed (after a 1-week washout period) by vitamin B12 (500 μg three-times daily for 4 weeks). The B12-amoxapine group received the opposite regimen. All pa-tients masturbated to ejaculation at least twice during each treatment period. The primary outcome was antegrade ejaculation of semen, as reported by the patient, on more than one occasion during either treatment period (defined as treatment success). Any adverse events were noted. Success rates were compared between treatments using Fisher's exact test.
  
  
  RESULTS
  One patient (B12-amoxapine group) withdrew for personal reasons (breakdown of marital relations); all other patients completed the study. Overall success rate was 88% (22/25). Success rate was higher for amoxapine than for vitamin B12 (80%, 20/25 vs 16%, 4/25; P<0.0001). 18 patients were responsive to amoxapine but not to vitamin B12, 2 patients were responsive to vitamin B12 but not amoxapine, 2 patients were responsive to both drugs, and 3 patients had no response to either drug. One patient (4%) reported sleepiness and 2 (8%) reported constipation while receiving amoxapine. No adverse events were reported during vitamin B12 treatment.
  
  
  CONCLUSIONS
  Amoxapine may be an effective, safe and well-tolerated therapy for RE.
authors.affiliation: Department of Urology, Reproduction Center, Toho University School of Medicine, Omori Hospital, Tokyo, Japan.|Department of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Jianlin
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Urology, Reproduction Center, Toho University School of Medicine, Omori Hospital, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nagao
authors.affiliation: Department of Urology, Reproduction Center, Toho University School of Medicine, Omori Hospital, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Tai
authors.affiliation: Department of Urology, Reproduction Center, Toho University School of Medicine, Omori Hospital, Tokyo, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Department of Urology, Reproduction Center, Toho University School of Medicine, Omori Hospital, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakajima
mesh_terms: D000328:Adult; D000657:Amoxapine / Q000009:adverse effects / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004542:Ejaculation; D006801:Humans; D008297:Male; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy*; D016896:Treatment Outcome; D014805:Vitamin B 12 / Q000009:adverse effects / Q000627:therapeutic use*; D014806:Vitamin B 12 Deficiency; D014803:Vitamin B Complex / Q000627:therapeutic use*
chemical_list: D000657:Amoxapine; D017367:Selective Serotonin Reuptake Inhibitors; D014805:Vitamin B 12; D014803:Vitamin B Complex
keywords: Drug Therapy; Ejaculation; Infertility, Male