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Paroxetine for Premature Ejaculation: How It Works, Dosage & More

Kristin Hall, FNP

Reviewed by Kristin Hall, FNP

Written by Geoffrey Whittaker

Published 06/22/2021

Updated 10/20/2023

Antidepressants like paroxetine (Paxil®) are usually prescribed for, well…depression. But believe it or not, some of these medications can also be used for the treatment of premature ejaculation (PE).

Premature ejaculation is a fairly common occurrence. In fact, it’s considered the most common type of sexual dysfunction.

In general, premature ejaculation is when you ejaculate before you (or your partner) would like. Some might argue that finishing early happens to pretty much everyone from time to time—and it isn’t always a cause for concern or something you need to treat. 

But if it happens consistently or bothers you or your partner, it’s worth looking into potential treatments. When left untreated, PE can affect your self-image, enjoyment of sex and relationships. 

The good news? There are many effective treatment options for premature ejaculation, including paroxetine.

Before using generic paroxetine or brand-name Paxil for PE, let’s talk about what it is, how it works and the side effects. 

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What Is Paroxetine (Paxil)?

Also sold under the brand name Paxil, paroxetine hydrochloride is a selective serotonin reuptake inhibitor (SSRI). SSRIs are a class of antidepressant medications commonly used to treat mental health conditions. 

SSRIs work by blocking the reuptake of serotonin (aka “the happy chemical”). This means it stops your brain’s nerve cells from reabsorbing serotonin. Since serotonin isn’t being reabsorbed too quickly, your brain’s serotonin levels increase.

Sometimes referred to as the “happiness molecule,” serotonin plays an essential role in regulating mood. It also affects your sleep cycles, appetite, bowel movements, sex drive and more.

The U.S. Food and Drug Administration (FDA) has approved paroxetine for the treatment of:

  • Generalized anxiety disorder (GAD)

  • Major depressive disorder (MDD)

  • Obsessive-compulsive disorder (OCD)

  • Panic disorder

  • Post-traumatic stress disorder (PTSD)

  • Premenstrual dysphoric disorder (PMDD)

  • Social anxiety disorder

But paroxetine’s uses aren’t limited to psychiatry—it can also be used off-label for the treatment of premature ejaculation. When a medication is prescribed “off-label,” it means a healthcare practitioner is prescribing it in a different way than how the FDA approved the drug.

Although it may sound dodgy, this is a legal and common practice for many prescription drugs. It helps people access safe, evidence-based treatments for conditions they can’t otherwise treat.

How Does Paroxetine for Premature Ejaculation Work?

If you were prescribed Paxil for premature ejaculation, you may be scratching your head. How can a medication designed to treat depression also stop you from arriving early, so to speak?

We’ll save you a few hours of scrolling through Google Scholar and PubMed by explaining the connection between SSRIs and ejaculation time. 

A common side effect of antidepressants is delayed ejaculation, which means it may take longer for you to orgasm. 

This is because certain types of serotonin — specifically, 5-HT1b and 5-HT2C — prolong ejaculatory latency (that is, how long it takes you to orgasm). Since SSRIs increase the amount of serotonin in the brain, they can delay ejaculation. 

If you don’t experience premature ejaculation, this can be pretty annoying. But if you tend to orgasm too early, this is more of a feature than a bug. 

Research suggests PE affects up to 30 percent of men. However, some reviews estimate that it could affect as much as 75 percent, depending on the definition you use.

Premature Ejaculation Treatment Options

Premature ejaculation is broadly defined as orgasming earlier than you’d like to. But the International Society for Sexual Medicine defines PE as a condition where you always (or almost always) ejaculate before penetration or within one minute of penetration.

That said, if you last slightly longer than a minute, and it’s still too quick for your liking, it may cause you some distress. In this case, it’s a good idea to look into treatment options.

Paroxetine and Other SSRIs for Premature Ejaculation

Paroxetine is one possible option for the treatment of PE. According to numerous clinical trials and reviews, it’s pretty effective at delaying ejaculation. 

A 2021 review looked at the current research on SSRIs for premature ejaculation. Researchers analyzed 31 placebo-controlled clinical studies with a total of over 8,000 participants. 

The review concluded that SSRI treatment seemed to improve self-perceived premature ejaculation symptoms. Most participants who used SSRIs felt they had more control over when they ejaculated. Plus, SSRIs seemed to improve overall sexual satisfaction. 

A randomized study from 2007 compared different SSRIs for treating premature ejaculation in 100 men. It looked at paroxetine, fluoxetine and escitalopram. According to a questionnaire, 100 percent of participants reported an improvement in their premature ejaculation symptoms. But the study didn’t find a major difference between the three SSRIs.

However, in a 2019 meta-analysis published in Therapeutic Advances in Urology, paroxetine came out on top. The review looked at various clinical trials and found that, compared to fluoxetine and escitalopram, paroxetine was better at increasing intravaginal ejaculatory latency time (IELT) — that is, how long participants lasted during vaginal sex.

According to a 2006 double-blind clinical study, paroxetine may also be more effective than dapoxetine. This SSRI is designed to treat premature ejaculation.

In this trial, men who took paroxetine experienced significant improvements in IELT and sexual satisfaction compared to those who used dapoxetine. Dapoxetine is also sold under the brand name Priligy®, though we should note it’s not currently approved in the U.S.

All in all, the evidence shows that paroxetine can be pretty helpful for the treatment of premature ejaculation — excellent news for those who want to last longer in bed. 

Other than paroxetine, SSRIs that can treat PE include fluoxetine, escitalopram and sertraline. There’s also some evidence that clomipramine, a tricyclic antidepressant, can treat premature ejaculation. 

Paroxetine for Premature Ejaculation Dosage

So we know paroxetine can help with premature ejaculation. But how much paroxetine does one need? And when do you need to take it?

In most studies on paroxetine for premature ejaculation, dosages of 20 milligrams (mg) a day were associated with improved symptoms. 

Generally, paroxetine is prescribed for once-a-day use. You can take it in the morning or at night. It may take a few days or weeks of treatment before you notice a difference. 

Some studies, like this 2008 meta-analysis, looked into the question of when to take paroxetine for premature ejaculation. Although paroxetine for PE can be used on-demand — that is, as needed rather than every day — men seem to prefer taking a daily pill so it’s easier to have spontaneous sex. Who can argue with that logic? 

On-demand paroxetine use can be effective, though: A 1999 review found that taking 20 milligrams of paroxetine three to four hours before sexual intercourse can delay ejaculation.

But that doesn’t mean you should take 20 milligrams of paroxetine before sex every time you have sex. If you’re getting action more than once a day (go you!), there’s no need to take it twice.

In fact, we strongly warn you against increasing or changing your dosage without medical guidance. A very high dose of SSRIs can lead to adverse events like serotonin syndrome.

This can cause some less-than-sexy side effects, like:

  • Change in mood

  • Disorientation

  • Dry mouth 

  • Flushed skin

  • Hyperthermia (overheating) 

  • Nausea

  • Vomiting

  • Rapid heart rate

  • Restlessness

  • Sweating

  • Tremors

  • Twitching or shivering 

In some cases, serotonin syndrome can be a medical emergency. If you’ve (accidentally or purposefully) taken too much paroxetine, get immediate medical help.

When using any prescription drug treatment, it’s crucial to follow the advice of the healthcare professional who prescribed it. Don’t freestyle it!

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Side Effects of Paroxetine for PE

Although paroxetine is generally safe and well-tolerated, there are some potential side effects and risks.

Common paroxetine side effects include:

  • Drowsiness

  • Dry mouth

  • Loss of appetite

  • Sleep disturbance

  • Sweating

Some rarer adverse events include:

  • Feelings of apathy

  • Changes in mood

  • Chest pain

  • Constipation 

  • Diarrhea

  • Dizziness

  • Fast heartbeat or palpitations

  • Headaches

  • Nausea

  • Skin issues

  • Tremors

When meeting with the healthcare professional who prescribes paroxetine for you, it’s important that you tell them about any medication and supplements that you’re using. Paroxetine shouldn’t be mixed with certain drug treatments, like monoamine oxidase inhibitors (MAOIs), thioridazine or pimozide.

Erectile dysfunction is one of the possible side effects of antidepressants — and yes, it’s possible to experience erectile dysfunction from paroxetine. This can be quite a bummer, especially if you’re using paroxetine to improve sexual dysfunction in the first place.

If this happens, you might want to explore alternative PE drug treatments or try a medication for improving erectile function, such as tadalafil (generic Cialis®) or sildenafil (generic Viagra®). While tadalafil is a daily pill, sildenafil is taken on demand a few hours before sexual intercourse.

These ED medications, called PDE5 inhibitors, may not be suitable for everyone. While PDE5 inhibitors are generally safe, they shouldn’t be mixed with certain medications, recreational drugs or supplements.

Most of the side effects of paroxetine are dose-dependent, meaning you might not experience them if you’re using a lower dosage. If you’d like to use paroxetine for premature ejaculation but aren’t fond of the side effects, chat with a healthcare professional about whether a different dosage might be appropriate.  

Alternatives to Paxil for PE

While many people get great results using Paxil for premature ejaculation, it’s not for everyone. Every person’s body is different, and what might help one guy last longer in bed may not work for the next one.

Fortunately, there are many treatments for premature ejaculation. You could try:

  • Topical PE treatments. Treatments like our Clockstopper benzocaine wipes and lidocaine-infused Delay Spray are applied directly to the penis. These topical products reduce sensitivity by slightly numbing the skin, which can help you last longer.

  • Other antidepressants. Clomipramine, fluoxetine and sertraline can treat premature ejaculation as well as depression.

  • Sildenafil. Better known by the brand name Viagra, sildenafil can treat both premature ejaculation and erectile dysfunction — a double-whammy for treating sexual dysfunction.

  • Tramadol. Usually used for pain, tramadol can be beneficial for those with PE. However, since it’s an opioid and, therefore, potentially addictive, tramadol is seldom prescribed for the treatment of premature ejaculation.

With that said, it’s sometimes possible to control ejaculation without pharmacological treatment. You can try drug-free techniques like:

  • The start-stop method. This is where you stop just before you orgasm and continue when the urge to ejaculate goes away. The cool kids call this “edging,” but it’s a pretty common exercise for premature ejaculation.

  • The squeeze technique. This is where you squeeze the head of your penis between your thumb and index finger for 30 seconds or so. It can decrease your level of arousal, which delays orgasm.

  • Pelvic floor exercises. Although most people associate kegels with women, there are many benefits of pelvic floor exercises for men. Research shows these exercises can help with erectile dysfunction and premature ejaculation.

Another way to stop premature ejaculation? Wear a condom.

Obviously, this isn’t a viable option if you’re trying to conceive. But for everybody else, condoms can help you last longer because they reduce sensitivity — not to mention the added bonus of protecting against STIs (sexually transmitted infections) and unintended pregnancy.

Many men also use the age-old trick of masturbating before sex. If you’re one of the lucky guys who don’t have a problem getting an erection soon after ejaculating, this could work.

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The Final Word on Paroxetine for PE

Paroxetine is an evidence-based treatment for premature ejaculation. Whether you’re dealing with lifelong premature ejaculation or have noticed a recent decrease in your staying power, paroxetine can help you last longer in bed.

Here’s what to keep in mind:

  • Paroxetine is effective at treating PE. Research has shown that SSRIs can be a safe way to treat premature ejaculation, and some studies name paroxetine as the most effective SSRI treatment for PE.

  • It does have some side effects. Some people experience adverse effects when using paroxetine. These side effects can include drowsiness, dry mouth and difficulty sleeping.

  • There are other options for the treatment of premature ejaculation. Paroxetine doesn’t work for everyone. If the side effects are a little too intense or if it just doesn’t seem to improve your PE, there are other premature ejaculation treatments and tricks that could help you slow your roll.

Premature ejaculation can be frustrating to deal with — but it may help to know you’re not alone. And beyond medication, there are some non-medical ways to last longer in bed. Read our blog posts on how to control ejaculation and how to last longer in bed for some practical tips.

Need some professional guidance? Our platform can connect you with a medical professional so you can seek treatment for premature ejaculation from the comfort of your home. When you’re ready to take that step, we’ll be right here!

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Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kristin Hall, FNP

Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership. 

She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH

Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare. 

Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.

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