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Overall10of the men continued taking dapoxetine for the entire two yearsDiscontinuation rates increased over timeJust over a quarter of the men stopped therapy during the first monthIn 6 months79had stopped taking dapoxetineand by 24 monthsthe rate was 90
Although SSRIs are intended for chronic use in the treatment of depression and are designed to have pharmacokinetic profiles that would allow them to provide constant systemic concentration with long-term administrationthey may need days to weeks to reach a maximum steady-state concentration in order to exhibit efficacyHiemke and Hartter 2000ThereforeSSRIs are commonly used in a daily dosing schedule for the treatment of PEMontague et al 2004In addition to the potentially desirable side-effect of delaying ejaculationthis dosing regimen for long-acting SSRIs is associated with a number of undesirable side-effectssuch as decreased libido and EDMontague et al 2004With the success of daily SSRI use in delaying ejaculationit has been suggested that on-demand treatment with SSRIs possessing a short half-life and short T max would be equally effectivemore convenientand exhibit fewer serotonergic side-effects than observed with daily treatmentWaldinger 2005Thereforean ideal compound for the treatment of PE should exhibit pharmacokinetic profiles having rapid absorptionadequate availability to establish therapeutic exposure at the target siteand rapid elimination to reduce total drug exposure and minimize the incidence of side-effectsModi et al 2006
Althoughmany studies have been published on the use SSRIs in the treatment of PEWaldinger et al were the first to evaluate these studies methodologically in light of evidence-based criteriaWaldinger 2003Waldinger et al 2004bThe results revealed that from 79 publications on drug treatment of PE35 studies involved serotonergic antidepressantsHe clearly documented that in both single-blind and open-design studiesas well as studies using a questionnaire or subjective report on ejaculation timethere was a high variabilityand that there was over-estimated responses in the degree of ejaculatory delayOnly 8 studies18.5fulfilled all criteria of evidence-based medicineegdouble-blind studies prospectively using real-time stopwatch assessments at each intercourse both at baseline and during the drug trialWaldinger 20032005Waldinger et al 2004bFor daily treatmenta rank order of efficacy of the SSRIs was establishedwith clomipramine being the bestfollowed by paroxetinesertralineand fluoxetine.
The stop-start technique has since been popularized by Kaplan in 1983In this technique the man is asked to pause during sexual stimulationjust prior to impending ejaculationThis pause allows the patient to acclimatize to the sensation and to condition himself to increased ejaculatory controlThis technique helps the patient to heighten his awareness of sexual sensationsUnfortunatelymany others have found that any initial success achieved by behavioral therapy was not maintained at 3-year follow-upSharlip 2005Non-pharmacological treatment options for PE are provided in Figure 1
In a recent Sexual Medicine studyalmost 80of men stopped using dapoxetine within the first six monthsCost was the most commonly-cited reason.
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