Current and future pharmacotherapeutic strategies in treatment of premature ejaculation

"With tramadol, I ride like a Jaguar": a qualitative study of motivations for non-medical purpose tramadol use among commercial vehicle operators in Kumasi, Ghana

BACKGROUND

The misuse of tramadol has become a major aspect of the wider substance use challenge in recent years and is evolving into a health crisis at an alarming rate. However, literature on motivations for non-medical purpose tramadol use among commercial vehicle operators remains inadequate. The aim of this study was to document the motivations for non-medical purposes tramadol use in Kumasi. Such an understanding could inform policy direction to regulate non-medical purposes tramadol use in Ghana.

METHODS

We conducted this exploratory qualitative study with 23 purposively selected commercial vehicle drivers (15) and assistants (8) in Kumasi, Ghana. Data for the study were collected through in-depth face-to-face interviews between June 2018 and March 2019. Using a thematic analytical approach, the interviews were coded and analysed.

RESULTS

Multiple motivations for non-medical purposes tramadol use were found including those related to: (1) sexual; (2) psychological; (3) physical; and (4) economic factors. Participants also reported three main inter-linking categories of perceived tramadol adverse effects: (1) physical; (2) psychological; and (3) social effects. Although participants indicated no plans for stopping their non-medical use of tramadol any time soon, strong willingness was voiced for supporting officials in finding and dealing with non-medical purpose tramadol sellers.

CONCLUSION

Non-medical purposes tramadol use was associated with a confluence of factors, ranging from enhanced sexual performance to economic reasons. Based on the findings of the study and the dependence and addictive potentials of tramadol, there is the need for psychoeducational programmes for persons who misuse tramadol and enhancement of operational capacities of regulatory agencies.

Pharmacological interventions for premature ejaculation: a mixed-treatment comparison network meta-analysis of randomized clinical trials

Premature ejaculation (PE) is the most common sexual dysfunction in men. The present study is a network meta-analysis of drugs used for treating PE. Electronic databases were searched for randomized controlled trials comparing medical interventions with either placebo or with other active drugs in patients with PE. Inverse variance heterogeneity model was used for mixed-treatment comparisons. Intravaginal ejaculatory latency time (IELT) and adverse events were the main outcome measures. A total of 44 studies were included in the meta-analysis. Dapoxetine 30 and 60 mg, tadalafil, sildenafil, paroxetine with sildenafil, topical lidocaine, dapoxetine 30 mg with mirodenafil, vardenafil, fluoxetine, and tadalafil, pindolol with paroxetine, tramadol, topical lidocaine with tadalafil, paroxetine with tadalafil, and topical eutectic mixture of local anesthetics were associated with a significant increase in IELT. Similarly, dapoxetine 60 mg, venlafaxine, fluoxetine, tramadol at 25, 50, and 100 mg, and combined fluoxetine and tadalafil were associated with an increased risk of adverse events. Dapoxetine 30 mg has a high likelihood of being the "best" in the interventional pool. Dapoxetine at 30 mg could be used as the first-line agent in the management of PE.

Tramadol: Premature Ejaculation

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form, so the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments regarding “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .

Patients affected by premature ejaculation due to glans hypersensitivity refuse circumcision as a potential definite treatment for their problem

The diagnosis of premature ejaculation (PE) was based on a score > 8 at the PEDT five-item questionnaire. Local anaesthetic treatment (LAT) was the first-line therapy. Subjects who obtained a normalisation of EPDT score (≤8) were considered responders to LAT and even affected by lifelong PE due glans hypersensitivity. We proposed to patients not completely satisfied with LAT to undergo circumcision as a potential definitive treatment for PE. All patients received exhaustive information about potential benefits, limitations and complications. In case of refusal, each man was asked for the reasons of his choice. A total of 152 patients were recruited. Hundred and twenty-four patients among 152 (81.6%) positively responded to LAT. Among the 124 LAT responders, 21 (17%) were completely satisfied. The remaining 103 men experienced adverse reactions. It was proposed to such patients if they would be interested to a definitive form of treatment to resolve their problem. All the patients responded positively to this question. Only four patients among them (3.9%) accepted. The remaining 99 (96.1%) refused providing the following reasons of their choice: absence of guarantees 82.8%; irreversibility of the procedure creating a permanent body alteration 75.7%; costs of the procedure 12.1%; fear of potential complications 7%.

Safety and efficacy of tramadol hydrochloride on treatment of premature ejaculation

Premature ejaculation (PE) is the most common sexual disorder. It affects 20%-30% of adult men; the aetiology of this condition has not yet been elucidated. The aim of this study is to evaluate the efficacy, safety, tolerability, undesirable effects and improved satisfaction with sexual intercourse with tramadol hydrochloride at different dosages for the treatment of PE. A total of 300 patients who presented with lifelong (primary) PE were included in this study. The study was performed for 28 weeks, in which placebo (starch tablet) was given for 4 weeks, and active ingredient (tramadol hydrochloride) was administered at different therapeutic dosages for 24 weeks. Patients were divided into three equal groups, each consisting of 100 patients. The first group (A) was given tramadol hydrochloride capsule 25 mg. The second group (B) was given tramadol hydrochloride capsule 50 mg. The third group (C) was given tramadol hydrochloride capsule 100 mg. All of the 300 participants included completed the study voluntarily. The age of the patients varied from 25 to 50 years. After the treatment period, the recorded data were collected for each group and analysed. The results showed a highly significant increase in the mean intravaginal ejaculatory latency time (IELT) in all groups compared to baseline data (P<0.0001). We concluded that using tramadol hydrochloride at different doses on demand for the treatment of PE is effective, safe and tolerable, with minimal undesirable effects, and approval for this indication should be sought.

Update on treatments for premature ejaculation

Current and upcoming treatment options for premature ejaculation (PE) are of global clinical interest. In 2008, the International Society for Sexual Medicine published an evidence-based definition for PE. While there are no US Food and Drug Administration-approved therapies for PE, the American Urological Association 2004 guidelines state the serotonergic antidepressants paroxetine, sertraline, fluoxetine and clomipramine and the topical lidocaine-prilocaine cream are effective treatment options. However, there are limitations associated with their use, which may be overcome by PE-specific therapies currently in development. Two agents that are in advanced stages of clinical development include: (i) dapoxetine, an on-demand short-acting selective serotonin reuptake inhibitor, and (ii) PSD502, a metered-dose aerosol containing lidocaine and prilocaine, also for on-demand treatment. Another on-demand agent in development is tramadol, a weak opioid that is currently approved for treating pain. Coupled with efficient diagnosis, it is hoped that these newer agents will improve the quality of life for patients who suffer from PE.

Experimental evidence of the anaphrodisiac activity of Humulus lupulus L. in naïve male rats

ETHNOPHARMACOLOGICAL RELEVANCE

In the folk medicine Humulus lupulus L. (hops) is mainly recommended as a mild sedative with antispasmodic and digestive properties. It is also reputed to exert an anaphrodisiac effect but it is still lacking the experimental evidence of this activity.

AIM OF THE STUDY

To evaluate the influence of Humulus lupulus extract on sexual behavior of both naïve and sexually potent male rats; thereafter to investigate the role of 8-prenylnarigenin (8-PN) in the effect displayed by the hop extract.

MATERIALS AND METHODS

Sprague-Dawley male rats both naïve and sexually potent were acutely administered with the hop extract dosed at 5, 10, 25 and 50 mg/kg. In addition the extract was administered daily for 10 consecutive days at the dose of 0.25 mg/kg/day in sexually potent animals. The pure compound 8-PN was acutely administered in naïve rats at the dosages of 5, 12.5 and 25 microg/kg. All the animals were screened for their sexual behavior manifestation during the mating test.

RESULTS

In naïve rats the acute administration of Humulus lupulus extract at the doses of 25 and 50 mg/kg significantly reduced the percentage of mounting and ejaculating animals, in comparison to vehicle controls. The other parameters recorded during the mating test were not affected by the hop extract. In sexually potent rats nor the acute neither the repeated administration of the extract modified their copulatory behavior. The pure compound 8-PN failed to influence male sexual behavior of naïve rats.

CONCLUSION

Humulus lupulus extract exerted an anaphrodisiac effect only in naïve rats by inhibiting their mounting and ejaculating behavior. The presence of 8-PN in the extract could be only partially involved in the observed anaphrodisiac effect.

Oxytocin-induced contractions within rat and rabbit ejaculatory tissues are mediated by vasopressin V1A receptors and not oxytocin receptors

BACKGROUND AND PURPOSE

Oxytocin is believed to be involved in ejaculation by increasing sperm number and contracting ejaculatory tissues. However, oxytocin may mediate these effects via oxytocin or vasopressin (AVP) receptors. The aim of this study was to determine the effect of oxytocin and AVP on peripheral tissues involved in ejaculation and to identify the receptor subtype(s) involved.

EXPERIMENTAL APPROACH

Standard tissue bath techniques were used to measure isometric tension from tissues involved in ejaculation and erection.

KEY RESULTS

Oxytocin and AVP failed to elicit a tonic contractile response in rat and rabbit testes, vas deferens, epididymis, seminal vesicles and prostate. In contrast, oxytocin and AVP elicited large tonic contractions in erectile (corpus spongiosum and corpus cavernosum) and ejaculatory (prostatic urethra, bladder neck and ejaculatory duct) tissues in a concentration-dependent manner. The selective oxytocin agonist, [Thr4,Gly7]-oxytocin and the V2 agonist, [deamino-Cys1,Val4,D-Arg8]-vasopressin (dDAVP), failed to contract tissues. Oxytocin and AVP-induced contractions were weakly antagonized by the selective oxytocin antagonist, L-368899 but potently antagonized by the V1A antagonist, SR49059. The V1B antagonist SSR149415 failed to antagonize AVP contractions except in rabbit bladder neck. Neither L-368899 nor SR49059 antagonized endothelin-1-induced contractions.

CONCLUSIONS AND IMPLICATIONS

The contractile effect of oxytocin on rat and rabbit ejaculatory and erectile tissues is mediated via V1A receptors. Endothelin-1-induced contractions are not due to endogenous oxytocin or AVP release. V1A receptor antagonists may have a therapeutic role in both erectile dysfunction and premature ejaculation.

Long-term effects of glans penis augmentation using injectable hyaluronic acid gel for premature ejaculation

The authors created the glans penis augmentation by injectable hyaluronic acid gel and reported the 6-month result for premature ejaculation. In a total of 38 patients, long-term effects of 5 years were compared to those of 6 months in terms of residual volume of implants and efficacy on premature ejaculation. Maximal glandular circumference measured by tapeline significantly decreased by 15% (P<0.05) but mean patient's visual estimation (Gr 0-Gr 4) did not decrease (3.60 vs 3.56, P>0.05). Compared to 6-month follow-up, intravaginal ejaculatory latency time and vibratory threshold decreased at 5 years (P<0.05), but still well increased considering those of preaugmentation. Hence, 76% of patients and 63% of partners were still satisfied. There was no serious adverse reaction. In the 5-year long-term follow-up of glans penis augmentation by filler, the implants were well maintained and effective for glans penis hypersensitivity in premature ejaculation patients.

Premature ejaculation: current and future treatments

Premature ejaculation (PE) is recognized to be the most common male sexual disorder. PE provides difficulties for professionals who treat this condition because there is neither a universally accepted definition nor a medication approved by the Food and Drug Administration (FDA). Despite these shortcomings, physicians continue to diagnose their patients with PE according to major guidelines and treat them with either behavioral therapies or off-label medications. This review focuses on current and emerging treatment options and medications for PE. Advantages and limitations of each treatment option are discussed in the light of current published peer-reviewed literature.