The Comparison of Combination SSRI and PDE-5 Inhibitor Therapy to SSRI Monotherapy in Men with Premature Ejaculation

OBJECTIVE: To evaluate whether combination therapy with a selective serotonin reuptake inhibitor (SSRI) and phosphodiesterase-5 (PDE-5) inhibitor is superior to SSRI monotherapy in the treatment of premature ejaculation. DATA SOURCES: A literature search of MEDLINE (January 1980-April 2011) and International Pharmaceutical Abstracts (January 1970-April 2011) was conducted using the search terms premature ejaculation, phosphodiesterase-5 inhibitor, and selective serotonin reuptake inhibitor. STUDY SELECTION AND DATA EXTRACTION: All English-language human studies assessing the use of a PDE-5 inhibitor and SSRI in the treatment of premature ejaculation were evaluated. Additional references were retrieved from reference citations. DATA SYNTHESIS: Premature ejaculation is a multi-component disorder with several treatment options. Studies have demonstrated that both SSRIs and PDE-5 inhibitors used as monotherapy can delay time to ejaculation. Four clinical trials have been conducted to compare the efficacy of SSRI monotherapy versus combination SSRI-PDE-5 inhibitor therapy for the treatment of premature ejaculation. All studies focused on the treatments' ability to delay time to ejaculation. A statistically significant delay in time to ejaculation was found in patients using both an SSRI and PDE-5 inhibitor when compared to those on an SSRI alone. Average time to ejaculation was increased by approximately 50-78 seconds in patients using combination therapy when compared to monotherapy. The data also show greater delay in ejaculation with combination therapy in patients previously using SSRI monotherapy but dissatisfied with its effects. Adverse drug reactions including headache and flushing were higher in the combination group. CONCLUSIONS: Although a modest delay in ejaculation is seen when using an SSRI and PDE-5 inhibitor together, the combination also comes with increased risks for adverse drug reactions and is more expensive. SSRI monotherapy should continue to be first-line treatment for premature ejaculation due to a better adverse drug reaction profile, lower cost, and high efficacy. Combination therapy may be prescribed for those who fail SSRI monotherapy or have concomitant erectile dysfunction.