Efficacy and safety of tramadol in patients with premature ejaculation: evidence based review

Abstract

Objective: Premature ejaculation (PE) is the most prevalent male sexual dysfunction, affecting 20-30% of all men. In recent years, many pharmacological alternatives have been used to treat PE. One of the treatments that has recently proved to be promising in the treatment of PE is on demand use of tramadol. However, some studies have showed inconsistent results regarding its use. Thus, the aim of this study was to review the most current evidence on the efficacy and safety of tramadol in the treatment of PE. Data sources: National Guideline Clearing House, NICE, Canadian Medical Association Practice Guidelines, DARE, Cochrane, PubMed and TRIP Database. Methods: We searched for meta-analyses systematic reviews, observational studies and clinical guidelines / evidence-based guidelines published in Portuguese, Spanish and English, using the MeSH terms ‘tramadol’ and ‘premature ejaculation’. The Strength of Recommendation Taxonomy (SORT) scale of the American Academy of Family Physicians was used to assign levels of evidence and strength of recommendations. Results: Fifty six articles were found and, amongst these, seven met the inclusion criteria: two clinical practice guidelines, four meta-analyses, and one systematic review. Most studies showed that the use of tramadol is effective when compared to placebo, but not when compared with the use of paroxetine. However, the use of different methodologies contributed to the heterogeneity of the results, reducing the strength of the conclusions obtained. Conclusion: According to the evidence, this review allowed us to conclude that the use of tramadol in the treatment of PE has limited evidence (SORT B). Further studies of high quality, including a greater number of individuals with homogenous inclusion criteria and outcomes are needed in order to obtain stronger conclusions about the long term use of tramadol in the treatment of PE.