II. Causes
- See Medication Induced Sexual Dysfunction
- Tricyclic Antidepressants
- MAO Inhibitors
-
Selective Serotonin Reuptake Inhibitor (SSRI)
- Fluoxetine (54% incidence Sexual Dysfunction)
- Sertraline (56% incidence Sexual Dysfunction)
- Paroxetine (65% incidence Sexual Dysfunction)
- Escitalopram
- Trends toward increased Sexual Dysfunction (although question this, as Citalopram does not)
III. Management: Approach
- Observe for 4 to 6 weeks for adverse effects to subside
- Often Sexual Dysfunction improves with anxiety and depressed mood treatment
- Adjust current Antidepressant dosing
- Decrease Antidepressant dosage
- Alter timing of daily dose
- Consider 2 day drug holiday
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Not effective for Fluoxetine (Prozac)
- Consider adjunctive therapy (see below)
- Substitute another Antidepressant
- Minimal to no Sexual Dysfunction
- Low risk of Sexual Dysfunction (10-15%)
- Other expensive options
- Trintellix (Vortioxetine)
- Viibryd (Vilazodone)
IV. Management: Adjunctive therapy to improve sexual function
- Approach to specific Sexual Dysfunction problems
- Orgasm: all of the agents below
- Libido: Amantadine, Periactin, Yohimbine
- Erection: Sildenafil (Viagra), Amantadine, Buspar, Periactin, Yohimbine
- Low desire: Bupropion
- As Needed dosing
- Sildenafil (Viagra) 25-50 mg PO 0.5 to 4 hours before sexual activity
- Amantadine 100 to 400 mg PO prn 2 days before coitus
- Bupropion 75-150 mg PO prn 1 to 2 hours before coitus
- Periactin 4-12 mg PO prn 1 to 2 hours before coitus
- Dexedrine 5-20 mg PO prn 1 to 2 hours before coitus
- Yohimbine 5.4-10.8 mg prn 1 to 2 hours before coitus
- Daily Dosing
- Amantadine 75-100 mg PO bid to tid
- Bupropion 75 mg PO bid to tid
- Dexedrine 2.5 to 5 mg bid to tid
- Pemoline 18.75 mg PO qd
- Yohimbine 5.4 mg PO tid
- Avoid other medications with low efficacy (not recommended)
- Buspar
- Addyi (Flibanserin)
- Vyleesi (bremelanotide)