Pooled evidence suggested that topical anaesthetic creams ( TAs ) , tramadol , selective serotonin reuptake inhibitors ( SSRIs ) , and phosphodiesterase type 5 inhibitors ( PDE5is ) are more effective at prolonging IELT comparing with placebo .
Conclusions We recommend the initial use of dapoxetine 30 mg OD for PE because it has been tested in largest and better design ed clinical trials rather than it is more effective than the other drugs studied .
TAs and tramadol 50 mg OD can be used as a viable alternative to oral treatment with SSRIs .
PDE5is combined with SSRIs are more effective than SSRIs monotherapy but are also associated with more side effects .
Purpose The purpose of the study was to conduct a systematic evaluation of the different general prescribed drugs for  premature ejaculation ( PE ) .
On-demand use of tramadol, sildenafil, paroxetine and local anaesthetics for the management of premature ejaculation: A randomised placebo-controlled clinical trial
Abstract Objectives : To compare the clinical efficacy of the on-dem and use of four drugs in the management of patients with premature ejaculation ( PE ) , as the off-label use of selective serotonin-reuptake inhibitors and topical penile anaesthetics is frequently indicated for the management of patients with PE , and tramadol HCl and sildenafil citrate were also tried for managing this disorder , but with recommendations based on weak evidence . Patients and methods : This was a single-centre , single-blind , placebo-controlled clinical trial conducted on 150 patients who had PE for > 1 year . Patients were r and omised equally into five groups .  On-dem and tramadol , sildenafil , paroxetine , local lidocaine gel or placebo was given for patients in groups 1–5 , respectively . During the month before treatment , the intravaginal ejaculation latency time ( IELT ) and sexual satisfaction scores ( on a 0–5-point scale ) were measured and compared to the mean IELT and sexual satisfaction scores recorded during 4 weeks of on-dem and drug administration , with monitoring of any possible side-effects . Results : Tramadol-treated patients had a significantly longer mean ( SD ) IELT , of 351 ( 119 ) s , than the other groups . Local anaesthetic was significantly better than paroxetine in prolonging the IELT , at 278 ( 111 ) vs. 186 ( 65 ) s , respectively . The improvement in sexual satisfaction was significantly better in the sildenafil group , with a mean ( SD ) improvement of 2.9 ( 1 ) points , than in the paroxetine and local anaesthetic groups , at 2.2 ( 0.9 ) and 1.9 ( 0.9 ) points , respectively . Conclusions : The four drugs significantly improved IELT values over placebo . Tramadol was associated with significantly longer IELT values , whilst sildenafil induced significantly better sexual satisfaction than the other drugs . The four drugs had tolerable side-effects
Pooled evidence suggested that topical anaesthetic creams ( TAs ) , tramadol , selective serotonin reuptake inhibitors ( SSRIs ) , and phosphodiesterase type 5 inhibitors ( PDE5is ) are more effective at prolonging IELT comparing with placebo .
Conclusions We recommend the initial use of dapoxetine 30 mg OD for PE because it has been tested in largest and better design ed clinical trials rather than it is more effective than the other drugs studied .
TAs and tramadol 50 mg OD can be used as a viable alternative to oral treatment with SSRIs .
PDE5is combined with SSRIs are more effective than SSRIs monotherapy but are also associated with more side effects .
Purpose The purpose of the study was to conduct a systematic evaluation of the different general prescribed drugs for  premature ejaculation ( PE ) .