Efficacy and Safety of Tramadol for Premature Ejaculation: A Systematic Review and Meta-analysis

ObjectiveTo present a systematic review to assess efficacy and safety of tramadol for premature ejaculation.MethodsA literature search was performed using the Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded. Literature reviewed included meta-analyses and randomized and nonrandomized prospective studies. End points included intravaginal ejaculation latency time (in minutes), adverse events, and patient-reported outcome assessments. We used mean difference to measure intravaginal ejaculation latency time and odds ratio to measure adverse events rates. These odds ratios were pooled using a random or fixed effects model and were tested for heterogeneity. We used the Cochrane Collaboration's Review manager (RevMan) 5.1 software for statistical analysis.ResultsWe identified 7 publications that strictly met our eligibility criteria. Meta-analysis of extractable data showed that tramadol was associated with a 3-minute intravaginal ejaculation latency time increasing (mean difference 2.77 minutes; 95% CI 1.12-4.47; P = .001) and significantly more patients with adverse events rates compared with placebo (odds ratio 2.89; 95% CI 1.88-4.43; P < .0001). There were no differences between the tramadol and the paroxetine of intravaginal ejaculation latency time (mean difference −0.44; 95% CI −5.07 to 4.18; P = .85). In addition, patients saw significantly greater improvement in patient-reported outcome.ConclusionIn this diverse population, tramadol is an effective and safety pharmacologic therapy for premature ejaculation.