Antipsychotic-Induced Sexual Dysfunction and Its Management

Abstract

Sexual dysfunction is a common condition in patients taking antipsychotics, and is the most bothersome symptom and adverse drug effect, resulting in a negative effect on treatment compliance. It is known that hyperprolactinemia is a major cause of sexual dysfunction. Based on the blockade of dopamine D2 receptors, haloperidol, risperidone, and amisulpride are classed as prolactin-elevating antipsychotics, while olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole are classed as prolactin-sparing drugs. Risperidone and the other typical antipsychotics are associated with a high rate of sexual dysfunction as compared to olanzapine, clozapine, quetiapine, and aripiprazole. With regard to treatment in patients suffering from sexual dysfunction, sildenafil was associated with significantly more erections sufficient for penetration as compared to a placebo. Subsequent studies are needed in order to provide physicians with a better understanding of this problem, thereby leading toward efficacious and safe solutions.

Genetics of antipsychotic drug outcome and implications for the clinician: into the limelight

“…In addition, APs may cause other sexual side effects such as erectile dysfunction, delayed orgasm and impaired lubrication (138Á140). Sexual side effects are most prevalent in those APs that have the most pronounced D2 antagonism, mainly typical APs and risperidone (141). One study suggests that erectile dysfunction and other sexual dysfunctions in men, as a side effect of AP treatment, is linked to a polymorphism of the dopamine D2 receptor ((141C Ins/Del [rs179973]) (142).…”

Sexual dysfunction related to typical and atypical antipsychotics in drug naive psychotic patients

“…On the basis of the blockade of dopamine D2 receptors, a study conducted by Park et al [4] classed haloperidol, risperidone, and amisulpride as prolactin-elevating antipsychotics, whereas olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole were classed as prolactinsparing drugs. They found that risperidone and the other typical antipsychotics are associated with a high rate of sexual dysfunction compared with olanzapine, clozapine, quetiapine, and aripiprazole.…”

“…The rate of incidence of sexual dysfunction has been estimated to be 31% in the general population and 60% in patients with schizophrenia treated with antipsychotics [1,2]. It is highly prevalent in both treated and untreated schizophrenic patients, affecting 30-80% of woman and 45-80% of men [3,4].…”

Antipsychotic-induced hyperprolactinaemia: case studies and review

“…Symptoms of hyperprolactinaemia are different in men and women 6. Men are likely to experience loss of libido and erectile dysfunction 7. Women are more likely to develop oligomenorrhoea and amenorrhoea.…”