Q: I am a 35 years old healthy married male. I am experiencing premature ejaculation with an urge to urinate at the end of long foreplay and before the start of penetration. I consulted a doctor who has prescribed Clofranil (clomipromine) (25 mg) to be taken four hours before coitus. There is sign of improvement seen only as long as tablet is used, but after taking prescribed medicine, I started experiencing drowsiness / uneasiness etc. What are the side effects of Clofranil?

A:Premature ejaculation can be caused by a combination of psychological and physical factors. The physical factors can be treated with Paxil (once a day) and / or lidocaine jel used topically 15 - 30 minutes before sexual intercourse. Clomipramine is usually used as a second line therapy for PE. Some of the side effects of clomipramine are fatigue, dizziness, lightheadedness, headaches, confusion, agitation, insomnia, nightmares, increased anxiety, seizures, dry mouth, constipation, sweating, difficulty urinating and dizziness when standing up from sitting / lying down position. Withdrawal symptoms can occur when clomipramine is stopped abruptly (agitation, fatigue, nausea, headaches, insomnia, sometimes activation of mania and rebound of depression or anxiety) and is gradually withdrawn by reducing the daily dose by approximately 25% weekly.