Table 3. Medications that may delay ejaculation.
| Drug | Possible mechanism | |
|---|---|---|
| 1 | SSRIs | - Activation of a particular serotonin receptor subtype: 5HT2 receptors |
| Citalopram | - Anticholinergic actions | |
| Escitalopram | - Blockade of α-1 noradrenergic receptors | |
| Fluvoxamine | - Antihistaminergic actions | |
| Fluoxetine | - Antidopaminergic actions | |
| Paroxetine | - Elevated prolactin | |
| Sertraline | - Inhibitory effects on nitric oxide synthase | |
| 2 | Other antidepressants | - Activation of a particular serotonin receptor subtype: 5HT2 receptors |
| Amitriptyline | - Anticholinergic actions | |
| Amoxapine | - Blockade of α-1 noradrenergic receptors | |
| Clomipramine | - Antihistaminergic actions | |
| Desipramine | - Antidopaminergic actions | |
| Desmethylimipramine | - Elevated prolactin | |
| Duloxetine | - Inhibitory action on nitric oxide synthase | |
| Imipramine | ||
| Mirtazapine | ||
| Nortriptyline | ||
| Protriptyline | ||
| Trazodone | ||
| Venlafaxine | ||
| 3 | Monoamine oxidase inhibitors | - Activation of serotonergic neurotransmission |
| Isocarboxazid | - Blockade of α-1 noradrenergic receptors | |
| Pargyline | - Decreased dopamine activity | |
| Phenelzine | ||
| Tranylcypromine | ||
| 4 | Anxiolytics | - Increased central serotonergic activity |
| Alprazolam | - Stimulate muscle relaxation | |
| Chlordiazepoxide | - Sedative effect | |
| 5 | Neuroleptics | - Inhibits dopamine activity |
| Mesoridazine | - Increases the level of prolactin | |
| - Blocks peripheral cholinergic and alpha-adrenergic receptors | ||
| 6 | Diuretics | - Direct effects on vascular smooth muscle cells |
| Thiazide | - Reduces the response to catecholamines | |
| 7 | Anti-inflammatory drug | - Blocks the enzyme cyclooxygenase, leading to inhibition of smooth muscle contraction in the vas deferens and seminal vesicles |
| Naproxen | ||
| 8 | α1-blockers | - Inhibition of α1-adrenergic receptor subtypes |
| Alfuzosin | - Inhibition of smooth muscle contraction in the vas deferens and seminal vesicles. | |
| Doxazosin | ||
| Silodosin | ||
| Tamsulosin | ||
| Terazosin | ||
| 9 | GABA transaminase inhibitors | - Inhibition of GABA transaminase, leading to increased brain concentrations of GABA (inhibitory) |
| Aminocaproic acid | ||
| 10 | Antihypertensives | - Reduction of central sympathetic outflow |
| Bethanidine | - α-1 and β-adrenergic blocking properties | |
| Guanadrel | - Produce sedation or depression | |
| Guanethidine | - Interfere with corporal smooth muscle constriction | |
| Labetalol | - Increased levels of prolactin | |
| Methyldopa | ||
| Prazosin | ||
| Phenoxybenzamine | ||
| Reserpine | ||
| 11. | Antipsychotics | - α-blocking properties and possibly also calcium channel blocking |
| Chlorpromazine | - Postsynaptic dopamine antagonism, leading to inhibition of motivation and increased prolactin | |
| Haloperidol | - Agonistic serotonergic effects | |
| Perphenazine | - Histamine receptor antagonism | |
| Thioridazine | - Blockage of acetylcholine receptors | |
| Butaperazine | ||
| Chlorprothixene | ||
| 12. | Opiates | - Blockade of presynaptic opioid receptors involved in the ejaculatory circuit. |
| Methadone | - Inhibit LH and T. | |
| Tramadol | - Inhibit thyroid-stimulating hormone. | |
| 13. | Antiepileptics | - Inhibition of calcium currents appears to lead to reduced neurotransmitter release and attenuation of postsynaptic excitability |
| Carbamazepine | - Increases the level of sex hormone-binding globulin, leading to reduction of free or bioavailable testosterone | |
| Gabapentin | ||
| Pregabalin | ||
| 14. | Muscle relaxants | - Inhibitory effect on GABAB receptors at the lumbosacral spinal cord level |
| Baclofen | - Inhibition of motor efferent nerves | |
| 15. | 5-α reductase inhibitors | - Deleterious effect on the biosynthesis and function of neurosteroids in the central nervous system, blocking neurogenesis |
| Dutasteride | - Accumulation of cholesterol in neurons, leading to neurodegeneration | |
| Finasteride | ||
| 16. | Ganglionic blocker | - Blocks nicotinic receptors at sympathetic ganglia. |
| Hexamethonium | ||
| 17. | Alcohol | - Sedative effects |
| - Increases in prolactin | ||
| - Increases estrogen | ||
| - Decreases in 5-α-reductase | ||
| - Localized gonadal tissue damage | ||
GABA: gamma-aminobutyric acid, LH: luteinizing hormone, T: testosterone.