Struggling with premature ejaculation (PE)? It can be a challenging condition, but you’re not alone. As many as one in three men will experience PE at some point in their life.¹ Don’t let embarrassment keep you from seeking PE treatment, because with affordable telehealth options at RedBox Rx, you can connect with a licensed medical provider online and enjoy your privacy.

There are many treatment options to compare for premature ejaculation. Medication treatment has been shown to be effective for many people with PE, including selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft^®) and paroxetine (Paxil^®). Learn how these two oral medications compare in effectiveness, side effects and mechanisms of action.

What is sertraline (Zoloft^®)?

Sertraline, a generic version of Zoloft^®, belongs to the class of SSRI medications. It works by increasing the amount of serotonin in the brain to improve mental balance.² The balancing of serotonin in the brain makes sertraline useful in treating a variety of conditions, including anxiety, depression, OCD, PTSD and premature ejaculation.³

In the treatment of PE, sertraline has shown promise in clinical studies to help delay ejaculation and increase sexual satisfaction of both patients and partners.⁴ There are two ways sertraline can be administered to treat PE: as a daily or as-needed dose.

With the daily dose approach, sertraline can take several weeks to reach its full effect.⁵ Common daily doses of sertraline are 25 mg, 50 mg and 100 mg.⁶ Sertraline has also been studied in as-needed doses for men on a day they are likely to have sex. One study showed that taking a 50 mg or 100 mg dose at 5 p.m. on days they wished to perform did have a positive effect on delaying ejaculation. For a single, larger dose, sertraline reaches peak effect between four and eight hours after ingestion. It should be noted in that study that participants did take sertraline daily for two weeks prior to switching to an as-needed model, ultimately suggesting that it can still take a couple of weeks for sertraline to be fully effective.⁷

What is paroxetine (Paxil^®)?

Paroxetine, a generic version of Paxil^®, is an SSRI that works by increasing serotonin to balance the brain. It is prescribed to treat a variety of conditions, including anxiety, depression and OCD.⁸ The ejaculatory response is linked to dopamine and serotonin levels in the brain, so paroxetine is also used to treat PE. In studies, paroxetine has been effective in delaying ejaculation, increasing sexual frequency, and improving sexual satisfaction.⁹

The recommended use of paroxetine is one daily dose of 10 mg, 20 mg, 30 mg or 40 mg. However, it has been tested as an on-demand drug for PE with success in limited studies. For many users, it can take four to six weeks for paroxetine to take full effect.¹⁰

What are the differences between sertraline and paroxetine?

Sertraline and paroxetine are both SSRIs that work similarly to treat PE. There have been studies to compare the two, but results were not statistically significant enough to show that one drug performed better than the other.¹¹

In some studies, sertraline has shown to be better tolerated than paroxetine.¹² However, in other studies, both medications were well tolerated by all participants.¹³ Individuals may need to work with their provider to find the SSRI that works best for them.

How effective are sertraline and paroxetine for premature ejaculation?

Both sertraline and paroxetine have shown significant improvement in the ejaculatory interval (time to ejaculation).

For example, sertraline helped male study participants extend their average ejaculatory interval from less than one minute to over seven minutes.¹⁴ In a different study, approximately 84% of men reported an increase in ejaculatory interval after a four-week trial of paroxetine.¹⁵

How do the side effects compare for sertraline and paroxetine?

Sertraline and paroxetine share many potential side effects, including:¹⁶

• Fatigue/lethargy

• Diarrhea

• Dizziness

• Drowsiness

• Insomnia

• Nausea

• Decreased libido

• Headache

• Sweating

• Dry mouth

Side effects exclusive to sertraline include:

• Constipation

• Erectile dysfunction

Side effects exclusive to paroxetine:

• Indigestion

• Tremor

• Tingling

• Anorexia

Above side effects can happen in short- or long-term use of sertraline or paroxetine. However, there are some long-term side effects that have been reported by users of SSRIs. In one study of patients using SSRIs long term (three-15 years), common side effects included weight gain, sexual dysfunction, withdrawal effects and emotional numbness.¹⁷ Long-term use of sertraline has been linked to a small increased risk of diabetes as well.¹⁸

Can sertraline and paroxetine be taken together?

It is not recommended to take sertraline and paroxetine together. Because both increase serotonin levels in the brain, there is a risk of serotonin syndrome. Symptoms of serotonin syndrome include confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering, shaking and blurred vision. Please seek immediate medical attention if you experience these symptoms.¹⁹

Are sertraline and paroxetine available over the counter?

Sertraline and paroxetine are not available over the counter, and both require a prescription.²⁰

Sertraline (Zoloft^®) vs. Paroxetine (Paxil^®) for PE Comparison Chart

How RedBox Rx can help

RedBox Rx makes receiving medication treatment for PE easy and affordable.

Benefits of RedBox Rx include:

• Transparent, affordable, flat rates for PE medications with SSRIs for $25 per month, every month.

• $25 online consultations with a U.S. licensed medical provider.

• No insurance required. FSA and HSA eligible.

• No office wait times or scheduling issues typical with physical medical practices.

• Free shipping directly to you.

Start your PE treatment today with our quick and easy online assessment.