This is a systematic review and meta-analysis on the efficacy of ondemand tramadol for the treatment of lifelong premature ejaculation.

METHODS: A systematic review and meta-analysis with metaregression of trials evaluating the use of tramadol to treat premature ejaculation using intravaginal ejaculation latency time as a measure.Relevant studies were identified using PubMed, Ebscohost,MEDLINE, EMBASE and the Cochrane Collaboration Library.

RESULTS: This analysis included 8 publications. Study of the intravaginal ejaculation latency time (IELT) among 599 patients showed that tramadol was effective in subjects with premature ejaculation as seen by the significant difference in mean IELT of tramadol treated patients versus those receiving placebo (mean difference 2.43 minutes; 95% CI 0.93-3.93; P=0.002). The effect on IELT between tramadol and paroxetine was not statistically significant (mean difference -0.58; 95% CI -5.81 to 4.65; P=0.83).Meta-regression analysis showed that the lower the dose of tramadol,the higher its benefit in the prolongation of IELT, however, there was no significant difference (95% CI regression coefficient -0.0956 to 0.0322). There was a significant difference in adverse effects profile of tramadol versus placebo (risk ratio 2.48; 95% CI 1.55-3.98; overall effect Z= 3.79; P<0.0002) and overall therapeutic effectiveness between tramadol compared to placebo (risk ratio 0.55; 95% CI 0.46-0.67; P<0.00001).

CONCLUSION: On-demand tramadol is an effective treatment for lifelong premature ejaculation. It significantly prolongs the intravaginal ejaculation latency time. The overall adverse events and overall therapeutic effectiveness are significantly greater during treatment with tramadol.