Valproic Acid Metabolism and its Consequences on Sexual Functions

Abstract

VPA interferes with the endocrine system at multiples levels causing several reproductive and sexual dysfunctions in women and men with epilepsy, especially when administered in pubertal age. Since VPA is a first line AED both in children and adult with epilepsy and long-term medication with this drug is sometimes necessary, it is very important for physicians to implement strict monitoring of patients taking VPA in order to identify these kinds of side effects at an early stage.

The effects of oxcarbazepine, levetiracetam, and lamotrigine on semen quality, sexual function, and sex hormones in male adults with epilepsy

“…It has been reported that the incidence of sexual dysfunction in male patients with epilepsy is 5 times higher than that in healthy people, and the incidence of sexual hyperactivity is about 2.9% . A number of studies have shown that epilepsy and AEDs (especially older AEDs) have a complex effect on male sex hormones, reproductive organs, and sexual function, leading to a decrease in fertility in male patients with epilepsy . In this study, the marriage rate and birth rate of the male adult patients with epilepsy were significantly lower than those of the healthy group, which may be related to the patients’ anxiety caused by seizures and different degrees of social discrimination.…”

“…There have also been studies reporting that when measuring the genital blood flow in patients with epilepsy, patients with temporal lobe epilepsy had less blood flow to the genitals; this may, to some extent, explain the sexual dysfunction . Newer AEDs (OXC, LEV, or LTG) might affect sexual function less than older AEDs . They can cause sexual dysfunction by affecting the secretion of sex hormones or by increasing the inhibition of GABA, inhibiting nerve conduction and reducing the transmission of sexual stimuli .…”

“…About 38%‐71% of men with epilepsy have sexual dysfunction, and fertility rates are only one‐third to one‐half of the rate in healthy people . Studies have investigated the effects of seizures themselves and some older antiepileptic drugs (AEDs; carbamazepine [CBZ], phenobarbital [PB], phenytoin [PHT], and valproic acid [VPA]) on the reproductive and sexual function of male patients with epilepsy . There have been relatively few studies of newer AEDs (oxcarbazepine [OXC], levetiracetam [LEV], or lamotrigine [LTG]), and some of them are controversial .…”

“…2 Studies have investigated the effects of seizures themselves and some older antiepileptic drugs (AEDs; carbamazepine [CBZ], phenobarbital [PB], phenytoin [PHT], and valproic acid [VPA]) on the reproductive and sexual function of male patients with epilepsy. [3][4][5] There have been relatively few studies of newer AEDs (oxcarbazepine [OXC], levetiracetam [LEV], or lamotrigine [LTG]), and some of them are controversial. 6,7 In this study, newly diagnosed male adult patients with epilepsy were randomized to receive OXC, LEV, or LTG monotherapy to observe the quality of semen, sexual function, and sex hormones before and after treatment, and to explore the effects of these AEDs on the reproductive and sexual functions of male adult patients with epilepsy.…”

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

“…Decreased sexual desire and anorgasmia have also been described in bipolar women receiving valproate 140 . In men, valproate treatment may cause erectile dysfunction 141 .…”