Dapoxetine is a safe and effective treatment for premature ejaculation (PE), but it has a high discontinuation rate, according to new research.

In a recent Sexual Medicine study, almost 80% of men stopped using dapoxetine within the first six months. Cost was the most commonly-cited reason.

The International Society for Sexual Medicine (ISSM) classifies PE in two ways.

• Lifelong PE is ejaculation that occurs before or within one minute of penetration, starting with the man’s first sexual experience.
• Men with acquired PE ejaculate within approximately three minutes and had normal ejaculation at one time.

PE may be treated with sex therapy, medications, or a combination of these approaches. Dapoxetine, a selective serotonin reuptake inhibitor (SSRI), is the only oral medication developed to treat PE. It is approved in 60 countries.

Past studies have revealed high discontinuation rates among men taking dapoxetine for PE, even though trials have shown effectiveness. The current study reported on discontinuation rates and reasons during a 2-year period.

• One hundred eighty-two men with an average age of 38 years participated in the study. All of the men were seeking treatment for PE at the same medical center in South Korea. They began taking 30 mg of dapoxetine one to three hours before intercourse. If 30 mg were not effective, the dose was increased to 60 mg. At 1-, 3-, 6-, 12-, and 24-month follow-up periods, the men were evaluated. If they had stopped taking dapoxetine, they discussed the reasons why.
• Overall, 10% of the men continued taking dapoxetine for the entire two years. Discontinuation rates increased over time. Just over a quarter of the men stopped therapy during the first month. In 6 months, 79% had stopped taking dapoxetine, and by 24 months, the rate was 90%.
• Thirty-percent of the men who discontinued dapoxetine did so because of high cost. The study authors noted that dapoxetine, when prescribed for sexual disorders, is not covered by national health insurance in South Korea.
• A quarter of the men stopped taking dapoxetine because they were disappointed that PE was incurable and that dapoxetine had to be taken before sex.

“We suggest that physicians provide comprehensive counseling at the time of treatment commencement,” the authors wrote. “Patients must understand that dapoxetine helps them to control ejaculation only temporarily and that PE is controllable and not curable.”

Other cited reasons for discontinuation were side effects like nausea and dizziness (12%) and poor efficacy (10%). About 6% of the men sought other treatment options and for 18%, the reason for stopping dapoxetine was unknown.

The authors explained that while men estimated their intravaginal ejaculation latency time (IELT – the time it took for them to ejaculate after penetrating their partner), this measurement was not taken later, nor was it taken in men who discontinued treatment. This angle could be considered in future research, they said.

Resources

• Sexual Medicine - “Discontinuation of Dapoxetine Treatment in Patients With Premature Ejaculation: A 2-Year Prospective Observational Study”
  Park, Hyun Jun, MD, PhD, et al.
  (Full-text. Published online: April 5, 2017)
  http://www.smoa.jsexmed.org/article/S2050-1161(17)30019-3/fulltext