Tramadol

Also known as: tramadol, tramadol hydrochloride

Sexual Well-Being

In plain English

Tramadol is a pain medicine that, taken on demand, can delay ejaculation in men with premature ejaculation. Evidence shows it can help, but it can cause side effects and carries a risk of dependence, so it is used cautiously. Here it appears in compounded combinations for 'climax control.' It is a controlled substance.

The science

Tramadol is a centrally acting analgesic with mu-opioid receptor agonism and serotonin/norepinephrine reuptake inhibition; the serotonergic activity is thought to underlie its ability to prolong intravaginal ejaculatory latency time. A systematic review/meta-analysis (Martyn-St James 2015) found on-demand tramadol significantly more effective than placebo for premature ejaculation (with high heterogeneity), and a head-to-head randomized trial found it superior to paroxetine, sildenafil, and topical lidocaine for latency—but at the cost of more adverse events. Concerns include nausea, somnolence, dizziness, erectile/ejaculatory side effects, serotonin syndrome risk (especially with SSRIs), seizure risk, and dependence/withdrawal; tramadol is a Schedule IV controlled substance. Its use for premature ejaculation is off-label; compounded combination capsules/troches are not FDA-approved formulations and warrant conservative dosing.

References

• Martyn-St James et al., BMC Urol 2015 (tramadol for PE, systematic review/meta-analysis)
• Abu El-Hamd, Arab J Urol 2013 (on-demand tramadol/sildenafil/paroxetine/lidocaine RCT)