Section 4.2

Medication-Induced Sexual Side Effects

Psychiatric medications may cause sexual side effects. Literature research studies have estimated a low incidence (1-2% of patients) for the development of medication-induced sexual side effects. However, other literature studies have reported much higher rates of sexual side effects.

The incidence of medication-induced sexual side effects remains controversial. Part of this controversy comes from the realization that psychiatric illnesses, by themselves, also cause changes in sexuality and periodic sexual difficulties. The clinician must therefore attempt to differentiate those sexual effects that are caused by the drugs, not by the disease.

The clinician should be aware of the sexual side effects for each specific medication (or medication group). This section highlights the reported sexual side effects for all the drugs in this Prescribing Guideline Manual. The possibility of sexual side effects should be discussed with each patient and closely monitored.

Antipsychotic Medications

Low Potency Major Tranquilizer Medications

Chlorpromazine, mesoridazine, thioridazine: increased libido in women, ejaculatory dysfunction, impotence

Clozapine, olanzapine: impotence

Low Dose Major Tranquilizer

Fluphenazine, haloperidol, loxapine, molindone, perhenazine, thiothixene, trifluoperazine: increased libido in women, ejaculatory dysfunction, impotence, priapism (with haloperidol)

Risperidone: decreased libido, ejaculatory dysfunction, impotence, orgasmic dysfunction

Antidepressant Medications

SSRI?s & dopaminergic acting medications

Fluoxetine, fluvoxamine, paroxetine, sertraline: decreased libido, ejaculatory dysfunction, impotence, orgasmic dysfunction

Bupropion: painful erection, ejaculatory dysfunction

Nefazadone: decreased libido, ejaculatory dysfunction

Tricyclic & similarly acting medications

Amitriptyline, nortriptyline, protriptyline, doxepin, desipramine, imipramine, trimipramine, clomipramine, amoxapine, maprotiline: increased or decreased libido, ejaculatory dysfunction, impotence, orgasmic dysfunction

Trazodone: decreased libido, ejaculatory dysfunction, priapism

Venlafaxine: decreased libido, ejaculatory dysfunction, impotence, orgasmic dysfunction

MAOI?s

Phenelzine, tranylcypromine: decreased libido, ejaculatory dysfunction, impotence, orgasmic dysfunction

Antianxiety Medications

Benzodiazepines:

increased or decreased libido

Buspirone

: increased or decreased libido, ejaculatory dysfunction, impotence

Mood Stabilizing Medications

Lithium

: none reported

Anticonvulsants

Carbamazepine:

impotence

Valproate:

none reported

Side Effects Medications

Amantadine:

none reported

Anticholinergics, antihistamines:

none reported

Adjunctive Medications

Thyroid Hormones:

none reported

Vasodilators

Beta Blockers:

decreased libido, ejaculatory dysfunction, impotence, orgasmic dysfunction

Dual Diagnosis

Disulfiram, naltrexone:

none reported

Psychostimulant Medications

Sympathomimetics:

none reported