早 發 性 射 精 的 與 高 雄 長 庚 紀 念 醫 院 劑 科 師 許 博 淳 李 浩 銓 摘 要 SSRI fluoxetine paroxetine Dapoxetine SSRI SSRI dapoxetine SSRI off label use PE premature ejaculation 壹 前 言 (premature ejaculation, PE) (erectile dysfunction, ED) PE 18-65 44% 1 PE PE 20-40% 30% PE ED (anorgasmia) (vaginismus) 貳 定 義 PE 86 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.1 Mar. 31 2015
(International Society of Sexual Medicine, ISSM) PE 2 (intravaginal ejaculation latency time, IELT) (Premature Ejaculation Diagnostic Tool, PEDT) 3 8 PE (lifelong PE, LPE) (acquired PE, APE) 2 LPE PE APE PE (natural variable PE) 4 參 PE PE dapoxetine PE (off-label use) 一 Selective serotonin reuptake inhibitor, SSRI SSRI PE paroxetine sertraline fluoxetine citalopram paroxetine IELT 7.83 sertraline ( 3.13 ) fluoxetine ( 2.95 ) 5 SSRI SSRI 5-HT2 二 Tricyclic antidepressant, TCA SSRI clomipramine PE Clomipramine TCA α 1 α 1 MAOI 三 ED 類 品 Sildenafil PDE-5 ED PE PGE-1 (alprostadil) 臨 31 1 Mar. 31 2015 雜 誌 122 87
PE 四 其 他 Tramadol SSRI PE 6 Tramadol PE PE 表 一 早 發 性 射 精 品 分 類 / SSRI Paroxetine 10-40 mg ED Sertraline 50-200 mg SSRI Fluoxetine 20-40 mg Citalopram 20-40 mg Dapoxetine 30-60 mg TCA Clomipramine 12.5-50 mg SSRI PDE-5 Sildenafil 50-100 mg Tramadol 25 mg EMLA (lidocaine+prilocaine) PGE-1 Alprostadil 200-300 mcg ED PE 肆 新 上 市 品 Dapoxetine PE SSRI SSRI PE dapoxetine 99% 18.7 21.9 SSRI ED SSRI CYP2D6 CYP3A4 dapoxetine 7 ( 0.19%) 88 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.1 Mar. 31 2015
dapoxetine SSRI SNRI MAOI CYP2D6 fluoxetine terbenafine CYP3A4 ketoconazole rotonavir dapoxetine 30 60 24 Dapoxetine 2003 伍 結 論 ED PE ED PE off-label 臨 Treatment and Management of Premature Ejaculation in Adults Po-Chun Hsu, Haw-Chyuan Li Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital Abstract Premature ejaculation is a common, bothering male sexual disorder. It may be caused by penile hypersensitivity, the abnormality of cerebral neurotransmission, or the psychological panic. But the precise mechanism is still unclear. The recommend therapies of PE are combining medicine, psychological and educational training. The training is major to rebuild the patient's self-confidence and relieve the patient's feelings of annoyance and nervous. The aim of the training is that patient and partner can trust each other and recognize where the problem is. The goal is to solve premature ejaculation result from psychological factor. Firstline choice of medicine is SSRIs, such as fluoxetine or paroxetine. The delayed ejaculation 31 1 Mar. 31 2015 雜 誌 122 89
effects of SSRIs will appear after long-term daily dosing regimens about several weeks, but it may lose effectiveness after medicine discontinued. The adverse effects of SSRIs may worsen the sexual ability of patient. Other therapeutic options may be helpful, but the effects are still doubtful. Dapoxetine is the first, and only medicine that approved for PE treatment. It's taken as-needed, and has less side effect because of rapid metabolization. But we still need to pay attention on the drug-drug interaction between dapoxetine and others, especially other SSRIs or MAOIs. Although medicine may delay the time of ejaculation, time is not the absolute principle to determine someone's sexual life. On the other hand, the points we have to assess are psychological factors and interpersonal relationships, and after training and medication, does patient have a better quality of life or not. 參 考 資 料 : 1. McMahon CG, Lee G, Park JK, Adaikan PG. Premature ejaculation and erectile dysfunction prevalence and attitudes in the asia-pacific region. The journal of sexual medicine. 2012; 9: 454-465. 2. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, et al: An update of the international society of sexual medicine's guidelines for the diagnosis and treatment of premature ejaculation (pe). The journal of sexual medicine. 2014; 11: 1392-1422. 3. Symonds T, Perelman MA, Althof S, Giuliano F, Martin M, May K, et al: Development and validation of a premature ejaculation diagnostic tool. European urology. 2007; 52: 565-573. 4. Waldinger MD, Schweitzer DH. Changing paradigms from a historical dsm-iii and dsm-iv view toward an evidence-based definition of premature ejaculation. Part ii--proposals for dsm-v and icd-11. The journal of sexual medicine. 2006; 3: 693-705. 5. Waldinger MD, Zwinderman AH, Schweitzer DH, Olivier B. Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: A systematic review and meta-analysis. International journal of impotence research. 2004; 16: 369-381. 6. Safarinejad MR, Hosseini SY. Safety and efficacy of tramadol in the treatment of premature ejaculation: A doubleblind, placebo-controlled, fixed-dose, randomized study. Journal of clinical psychopharmacology. 2006; 26: 27-31. 7. McMahon C, Kim SW, Park NC, Chang CP, Rivas D, Tesfaye F, et al: Treatment of premature ejaculation in the asia-pacific region: Results from a phase iii double-blind, parallel-group study of dapoxetine. The journal of sexual medicine. 2010; 7: 256-268. 燦 爛 的 色 彩 90 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.1 Mar. 31 2015