Change in sexual dysfunction with aripiprazole: a switching or add-on study

Abstract

Sexual dysfunction and raised prolactin are common adverse effects of many anti-psychotics. Aripiprazole is an atypical anti-psychotic associated with a reduction in prolactin level in anti-psychotic-induced hyperprolactinemia. Our hypothesis was that switching from another anti-psychotic to aripiprazole would be associated with a reduction in sexual dysfunction. An open label switch to aripiprazole was offered to 27 subjects with inadequate therapeutic response or intolerance to another anti-psychotic, who were followed up for 26 weeks. Serial clinical ratings included the Anti-psychotic Non-Neurological Side-Effects Rating Scale (ANNSERS), and the Sexual Functioning Questionnaire. Our primary analysis point was week 12. In both sexes, there was a significant reduction in prolactin by week 12 (P = 0.003), accompanied by a significant improvement in libido (P = 0.028). In males, both erectile and ejaculatory difficulties were also significantly reduced (P = 0.04 and P = 0.017, respectively). In females, menstrual dysfunction was also significantly reduced at week 12 (P = 0.04). By week 26, the changes in all of the above remained significant, and were accompanied by a significant increase in satisfaction in overall sexual functioning (P = 0.007), despite the fact that 54.5% of subjects at were also taking their original antipsychotic. There was also a significant decrease in the total ANNSERS score (P < 0.001) and a significant improvement in all other measures of psychopathology (PANSS, CGI-S/I, GAF-S/D, and QoL). We conclude that switching to aripiprazole or the addition of aripiprazole to another antipsychotic regime is associated with a reduction in sexual dysfunction.

Bilateral mammary duct ectasia induced by sulpiride-associated hyperprolactinemia: A case report

“…Hyperprolactinemia is rapidly reversed following the discontinuation of amisulpride treatment (20) or once the patient has been switched to a prolactin-sparing antipsychotic, such as quetiapine (21), olanzapine, ziprasidone or aripiprazole. The addition of the partial agonist aripiprazole (22), including the use of dopamine agonists, to the treatment was an alternative approach. However, thi is associated with a risk of worsening or inducing psychosis, which would require specialist services.…”

Improvement in antipsychotic-induced hyperprolactinemia with the addition of aripiprazole in schizophrenic patients

“…Previous studies [13][14][15][16] have shown that switching from prolactin-raising antipsychotics to aripiprazole is useful for treating antipsychotic-induced hyperprolactinemia in schizophrenic patients, with no significant changes in overall psychopathology. However, clinicians generally hesitate to change antipsychotic regimens, especially in clinically stable patients maintaining a high level of functioning, since such a strategy is sometimes accompanied by the risk that psychotic symptoms may worsen later.…”

A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men

“…In males, after switching treatment to aripiprazole, ejaculatory difficulty was significantly reduced [Mir et al 2008]. A descending view in one study did not find such correlation between elevated prolactin level and antipsychotic-induced sexual dysfunction [Westheide et al 2008].…”

“…Increase in serum prolactin level in patients with schizophrenia during antipsychotic treatment correlated with orgasmic dysfunction [Rettenbacher et al 2010]. In patients treated with prolactin-raising and prolactinsparing antipsychotics, EjD was associated with the prolactin raising medications [Knegtering et al 2008].Aripiprazole is an antipsychotic associated with a reduction in prolactin level in antipsychoticinduced hyperprolactinemia [Mir et al 2008]. In males, after switching treatment to aripiprazole, ejaculatory difficulty was significantly reduced [Mir et al 2008].…”