Clomipramine is an antidepressant from the tricyclic family (TCA). It is also one of the first drugs tested for its effect on premature ejaculation. While it has some ejaculation delaying effect, it’s not an approved drug for the treatment of premature ejaculation. Even as an off-label solution, SSRIs are better options for treating premature ejaculation since they have a stronger delaying effect and fewer side effects.
A Word of Caution
Before we start, we just want to be clear about one thing. All the drugs listed here are strong medicine and available only via a doctor’s prescription. Never use a prescription drug for which you do not have a prescription. Your health is not something you want to risk, and taking medication without a professional medical advice poses serious health risks.
If you consider using a drug treatment for premature ejaculation, please consult a physician first and respect his instructions. This page’s goal is only to present the options available, but it isn’t a professional medical opinion. I’m not aware of every counter indication those drugs may have, neither your particular health condition. Your doctor is, that’s why he’s the one you should trust.
If you are looking for an over-the-counter product to treat premature ejaculation, delay creams, sprays or condoms could be effective solutions.
How Clomipramine Works
Clomipramine, just like SSRIs, increases the serotonin level. It’s this increased serotonin level that helps the body to inhibit the ejaculatory reflex. A lack of serotonin is indeed one of the suspected cause of premature ejaculation.
Clomipramine Efficacy
Even if clomipramine does delay ejaculation1, it’s less effective than some SSRIs1. That’s one of the reasons why SSRIs are privileged over clomipramine in the treatment of premature ejaculation. Since enough data shows clomipramine’efficacy, it can still be prescribed off-label to treat PE. For example, clomipramine can be favored to SSRIs in the case of a patient that do not tolerate well the SSRI.
About Efficacy Measure
We measure premature ejaculation drug efficacy with a unit called ITEL fold increase. You can read more about how different treatment are compared together here. In short, IELT stands for Intravaginal Ejaculation Latency Time. It’s a stopwatch measure of the intercourse time, from the start of the penetration to the ejaculation. We calculate a couple average IELT by timing all their sexual relations on a specified period.
We calculate the fold increase like this: (IETL after / IETL before) – IETL before. For example, let’s take a couple that has a 1 min average IELT that increases to 2 min after treatment. It represents a 1-fold increase: (2/1) – 1 = 1. If it increases to 3 min, it’s a 2-fold increase: (3/1) – 1 = 2.
SSRI vs. Clomipramine for premature ejaculation
Studies show that clomipramine delay ejaculation by about 4.6 fold. Although it’s a considerable delay effect, it’s still less than paroxetine.
You can find here a table that summarizes the mean IELT fold increase of clomipramine compared to several SSRI type1-2.
| Drug | Dose | IELT Increase |
|---|---|---|
| Clomipramine | 25-50 mg/day | 4.6 |
| Paroxetine | 10-40 mg/day | 8.8 |
| Sertaline | 25-200 mg/day | 4.1 |
| Fluoxetine | 5-20 mg/day | 3.9 |
| Fluvoxamine | Do not have any ejaculation delay effect | |
| Dapoxetine | 30-60 mg/1-3h before sex | 2.5-3.0 |
Source: Treatment of Premature Ejaculation with Dapoxetine (2013) McMahon Chras G.. Chapter 20 in Premature Ejaculation, from Etiology from diagnosis and treatment, Jannini, Emmanuele, McMahon, Chris G., Waldinger, Marcel D., Springer-Verlag Mailand, 2013 p.256, ISBN 978-88-470-2646-9.
Clomipramine Usage for Premature Ejaculation
There is two type of drug usage for premature ejaculation: daily and on-demand. On-demand usage drugs are pills that you need to take 2 hours before having sex. Daily usage drugs are pills that you take each day for a prolonged effect.
Daily Usage
Clomipramine has the best effect when taken every day. However, paroxetine is still a more effective PE daily drug based on the available data.
On-Demand Usage
While on-demand usage of clomipramine also suggests ejaculation delaying effect3, dapoxetine is the standard approved on-demand drug to treat premature ejaculation.
Clomipramine Side Effect
One of the downsides of clomipramine treatment for premature ejaculation is its list of adverse effect. Clomipramine present a long list of possible side effects. Among the most common, we can note dry mouth, constipation, loss of appetite, sleepiness and weight gain4. More serious side effects are also possible, albeit more rare4. Those severe side effects include seizures, mania, liver problems and increased suicidal risk in young adults. Please note that this isn’t a complete list of all potential side effects. For a better portrait of clomipramine side effects, please consult a professional medical opinion, like a doctor or a pharmacist.
SSRI Discontinuation Syndrome
Stopping the usage of clomipramine can lead to a discontinuation syndrome. The withdraw of clomipramine can cause several adverse effects like nausea, abdominal pain, diarrhea, insomnia, headache, nervousness, anxiety and/or dizziness5. If you wish to stop this drug, it’s best to talk to your doctor first so he can plan a gradual withdraw to minimize the discontinuation syndrome.
Wish for Pregnancy
Since we don’t know a lot about clomipramine effects on spermatozoid, some specialists suggest stopping gradually any antidepressant usage for men who are looking to father a child. Since the spermatozoa take some time to regenerate, it’s advised to use a condom for 3 months after the drug stoppage6.
Sources:
- Waldinger MD, Zwinderman AH, Schweitzer DH, Olivier B (2004) Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis. Int J Impotence Res 16:369–38, Althof SE, Abdo CHN, Dean J, Hackett G, McCabe M, McMahon CG, Rosen RC, Sadovsky R, Waldinger MD, Becher E, Broderick GA, Buvat J, Goldstein I, El-Meliegy AI, Giuliano F, Hellstrom WJG, Incrocci L, Jannini E, Park K, Parish S, Porst H, Rowland D, Segraves R, Sharlip I, Simonelli C, Tan HM (2010) International society for sexual medicine’s guidelines for the diagnosis and treatment of premature ejaculation. J Sex Med. 7:2947–2969
- Pryor JL, Althof SE, Steidle C, Rosen RC, Hellstrom WJ, Shabsigh R et al (2006) Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials. Lancet 368:929–937
- Abdel-Hamid IA, El Naggar EA, El Gilany AH (2001) Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation. Int J Impot Res 13(1):41–45
- “Clomipramine Hydrochloride”. The American Society of Health-System Pharmacists.
- ANAFRANIL® (clomipramine)” (PDF). TGA eBusiness Services. NOVARTIS Pharmaceuticals Australia Pty Limited. 7 December 2012.
- Treatment of Premature Ejaculation with Selective Serotonin Re-Uptake Inhibitors (2013) Waldinger MD. Chapter 19 in Premature Ejaculation, from Etiology from diagnosis and treatment, Jannini, Emmanuele, McMahon, Chris G., Waldinger, Marcel D., Springer-Verlag Mailand, 2013 p.229-240, ISBN 978-88-470-2646-9.
