Understanding Dapoxetine 60mg for Premature Ejaculation
Bailey, G.
What is premature ejaculation and is it common?
In Figure 7, the total number of AEs occurred in 49.1% (2601/5293) and 20.7% (1040/5017) of subjects treated with dapoxetine and placebo, respectively. In Figure 8, the total number of AEs occurring with dapoxetine 60 mg or 30 mg were 58.2% (1421/2441) and 36.6% (907/2476), respectively. The most frequently reported AEs were nausea, dizziness, headache, diarrhea and insomnia22,23. Fortunately, the most common AEs with dapoxetine were mild or moderate in nature and were transient symptoms9,10,11,12,13,15,16,17,18,19,20,21,24,25. The present findings agree with the results of previous clinical trials that reported similar low incidence rates of side effects.
Dapoxetine: Different Dose Strengths/Powers Available
Dapoxetine is a short-acting SSRI and doses of 30 mg and 60 mg have been evaluated through our meta-analysis. Peak plasma concentrations of dapoxetine were observed within 1.01–1.27 hours after oral administration24. The elimination half-life time is 1.3–1.4 hours and there appears to be very little accumulation24. Dapoxetine undergoes rapid absorption, elimination and dose-dependent pharmacokinetics, which are unaffected by multiple dosing. The unique pharmacokinetic characteristics might be the reason why dapoxetine is the on-demand treatment of choice for PE. C.
- Dapoxetine is not recommended for men with severe renal impairment (CrCl <30 mL/min).
- Mild to moderate renal impairment (CrCl 30-59 mL/min) may use with caution at 30 mg max.
- No data for end-stage renal disease; use contraindicated.
& Trost, L.
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Safety and efficacy data have demonstrated that dapoxetine use produces acceptable improvement in the IELT and PGIC with on-demand use. Thus, we also believe it is probably better suited as an on-demand treatment option for PE26. Our systematic review and meta-analysis has many drawbacks, the primary one being that this was a heterogeneous trial. In an attempt to reduce the high heterogeneity, we carried out a subgroup analysis among studies involving the drug dosage used (30 mg versus 60 mg groups). The heterogeneity was significantly decreased when comparing dapoxetine with placebo in the IELT by subgroup analysis.
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However, this heterogeneity of data still exists in the PGIC and AEs analyses, which we were unable to improve. We believe this heterogeneity might have resulted in the evaluation of the PGIC value using a 7-point scale (from −3 = much worse to 3 = much better) and AEs that were assessed using a subjective evaluation by individual patients. Additional factors might have been potentially amplified heterogeneity; these include differences in treatment duration, individual differences and mental or physical conditions. Secondly, some of the included studies did not report the outcome measures; hence, the statistical results might be influenced by the statistical parameters used for calculations. Additionally, nearly all trials included in this study lacked a clear description of the allocation concealment, but all trials included in this meta-analysis were RCTs, the methods were designed well. Current diagnosis and management of premature ejaculation.
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Thus, the data from the studies included in our meta-analysis were reliable. In summary, our meta-analysis has shown that either 30 mg or 60 mg dapoxetine on-demand orally was associated with a significantly greater increase in mean IELT and PGIC compared placebo. Additionally, 60 mg had a better efficacy than 30 mg dapoxetine on-demand orally. However, the meta-analysis also demonstrated that those treated with dapoxetine (especially 60 mg on-demand orally) reported more AEs than placebo or the dapoxetine 30 mg group. Nonetheless, the most commonly reported AEs were mild and tolerated.
Exclusion Criteria
We searched the following databases dapoxetine order online up to and including June 2014: MEDLINE by PubMed, EMBASE, Cochrane Central Register of Controlled Trials (Cochrane Library). We did not restrict our search to articles published in English and the following search terms were used in conjunction with: dapoxetine, SSRIs and premature ejaculation, sexual dysfunction. We also searched the relevant references of all studies included in the analysis. All retrieval literatures were independently performed by Cao D and HY. Included in the study were all published or unpublished RCTs evaluating dapoxetine interventions for PE. Curr Sex Health Rep 6, 65–80 (2014).
8. Special Populations and Considerations
Disagreements were discussed and resolved by using a third person-evaluation. These assessments were reported for each individual study in the “risk of bias in included studies” in Figure 2. All statistical analyses were conducted using Review Manager, version 5.1.0 (Cochrane Collaboration, Oxford, UK). Statistical analysis of dichotomous variables (PGIC and AEs) were performed using the RR as the summary analysis, while continuous variable (IELT) was analyzed using the MD; accompanying 95% CIs and P-values were reported. For all statistical results, P < 0.05 was considered statistically significant.
Cite this article
The Mantel-Haenszel χ2 test and I2 statistic for heterogeneity were conducted. I2 values of <50% were defined as acceptable; those >50% indicated high levels of heterogeneity. When there was a lack of heterogeneity, a fixed-effects models was used, otherwise random-effects model was applied for the meta-analysis. Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the global study of sexual attitudes and behaviors. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities and professional help-seeking. Guidelines on male sexual dysfunction:
See also
The integrated analysis from five trials by McMahon et al19 also showed dapoxetine 30 and 60 mg on-demand significantly increased mean IELT compared with placebo (1.9 minutes for placebo, 3.1 and 3.6 minutes for dapoxetine 30 mg and 60 mg, respectively). Our statistical results and subgroup analysis of PGIC demonstrated that dapoxetine was associated with a major improvement in PGIC. As shown in Figure 5, the overall RR was 2.14 (95% CI = 1.90–2.24) between dapoxetine and placebo, 2.01(95% CI = 1.69–2.38) between the dapoxetine 30 mg subgroup and placebo and 2.26 (95% CI = 1.91–2.67) between the dapoxetine 60 mg subgroup and placebo, respectively. Additionally, the present meta-analysis also demonstrated significant improvement in PGIC with 60 mg over 30 mg dapoxetine on-demand alone. Pryor et al9 thought that the PGIC condition as a study endpoint is informative with respect to men's perception to minor detectable changes in IELT.
Data extraction
In other words, there is a positive relationship between the participants' PGIC ratings and mean change in IELT values. The present findings agree with the results of previous clinical trials that reported a similar improvement in PGIC with dapoxetine versus placebo or comparing 60 mg versus 30 mg dapoxetine9,10,11,12,13,16,17,18,19,20,21. This analysis revealed the incidence of total AEs was more frequent with dapoxetine than with placebo and more common with dapoxetine 60 mg than 30 mg. However, from a review of all the studies reported in the literature, AEs of dapoxetine are generally tolerable. In the integrated analysis of the McMahon et al16 study, total AEs occurred in 35.1%, 47.0%, 60.3% subjects with placebo, dapoxetine 30 mg and dapoxetine 60 mg on-demand orally, respectively. erectile dysfunction and premature ejaculation.
| Pharmacokinetic Parameter | Typical Value | Notes | Reference Source |
|---|---|---|---|
| Absorption | Rapid (Tmax ~ 1-2 hours) | Peak plasma concentration | Clinical studies |
| Bioavailability | ~56% | Varies among individuals | Pharmacology review |
| Half-life | ~19 hours | For therapeutic levels | Pharmacokinetic data |
| Metabolism | Liver (mainly CYP3A4) | Hepatic metabolism | Scientific literature |