Sertraline and fluoxetine are prescription antidepressants of the SSRI class (selective serotonin reuptake inhibitor). Both medications are available as generic versions, but the most popular trade names are Zoloft (Pfizer) for sertraline and Prozac (Eli Lilly & Co) for fluoxetine.
SSRIs increase serotonin levels in the brain, which can then improve or stablize mood in people suffering from depression, panic disorder, and other psychological conditions. Since SSRIs broadly affect chemical messaging between brain cells, they can also affect libido and sexual sensitivity. In fact, a common side effect of these antidepressants is that for some people, they decrease sexual appetite and delay orgasm.
Fortunately, we can take advantage of this side effect to treat men who suffer from premature ejaculation. Given how common this problem is — 20-30 percent of men experience premature ejaculation at some point in their lives — SSRIs are now commonly used to treat this condition.
Following over two decades of research, the verdict is clear: SSRIs significantly delay ejaculation and thus make sex more enjoyable for many men and their partners. In fact, SSRIs are considered the most effective pharmaceutical treatment for premature ejaculation. They can delay ejaculation timing from half a minute to 5-6 minutes or even longer. While the FDA so far hasn’t approved any SSRIs specifically for treating premature ejaculation, the American Urologic Association has recommended sertraline and other SSRIs for this purpose since 2004.
Even though their chemical design and function are very similar, the impact on ejaculation varies between different SSRIs. Many studies show that paroxetine (also known as Paxil) and sertraline are the most effective choices and outperform fluoxetine. It is thought that sertraline may delay ejaculation by 10 to 30 percent longer than fluoxetine, and paroxetine may be even more effective.
As for potential side effects, there’s no big difference between the two drugs and other major SSRI, especially as they are taken in low doses when treating premature ejaculation. Commonly observed side effects of low-dosage use are diarrhea, nausea, and mood changes. The intensity of these side effects tends to be mild to moderate and often resolve within the first 3 weeks of treatment. There are some minor differences between sertraline and fluoxetine: the former is somewhat more likely to cause diarrhea, while fluoxetine is more prone to causing sleep problems and a dry mouth. Talk to a doctor to learn more about the whole range of possible SSRI side effects.
While current studies indicate sertraline is more effective than fluoxetine, some peaople will choose to try both, each for a couple of months, to determine which strikes the best balance between effectiveness and side effects specifically for them.
In most clinical trials involving SSRIs for prmature ejaculation, participating men were provided a low daily dose of the drug for one month or longer.
Sertraline or fluoxetine can also be taken as needed, by taking a single dose 4-8 hours prior to sexual activity. This approach, while effective, may be inconvenient regarding timing, and is not as effective as daily dosing. Daily dosing does however, increase the risk of developing side effects. As needed dosing of sertraline is usually 50 or 100 mg, while fluoxetine is dosed at 20 or 40 mg. Dsily dosing of sertraline starts at 25 or 50mg and can be increased to 100mg. Daily dosing of fluoxetine can range from 20 to 60 mg.
Discuss with your doctor which treatment approach may work best for you.
Taking both drugs simultaneously isn’t advisable. There’s an increased risk of an irregular heartbeat which in very rare cases can be fatal. There is also risk of a rare but dangerous condition known as "seratonin syndrome". Moreover, taking both sertraline and fluoxetine together doesn’t provide any additional benefits for delaying ejaculation. Both drugs function in similar ways and trigger the same chemical reactions. Using either one of them should be enough.