Strategies for the Treatment of Antipsychotic-Induced Sexual Dysfunction and/or Hyperprolactinemia Among Patients of the Schizophrenia Spectrum: A Review

Abstract

There is limited evidence for the management of sexual dysfunction and/or hyperprolactinemia resulting from use of antipsychotics in patients with schizophrenia and spectrum. The aim of this study was to review and describe the strategies for the treatment of antipsychotic-induced sexual dysfunctions and/or hyperprolactinemia. The research was carried out through Medline/PubMed, Cochrane, Lilacs, Embase, and PsycINFO, and it included open labels or randomized clinical trials. The authors found 31 studies: 25 open-label noncontrolled studies and 6 randomized controlled clinical trials. The randomized, double-blind controlled studies that were conducted with adjunctive treatment that showed improvement of sexual dysfunction and/or decrease of prolactin levels were sildenafil and aripiprazole. The medication selegiline and cyproheptadine did not improve sexual function. The switch to quetiapine was demonstrated in 2 randomized controlled studies: 1 showed improvement in the primary outcome and the other did not. This reviewed data have suggested that further well-designed randomized controlled trials are needed to provide evidence for the effects of different strategies to manage sexual dysfunction and/or hyperprolactinaemia resulting from antipsychotics. These trials are necessary in order to have a better compliance and reduce the distress among patients with schizophrenia.

The Facts About Sexual (Dys)function in Schizophrenia: An Overview of Clinically Relevant Findings

“…In most studies on switching strategies of antipsychotics or adding a dopamine agonist, an increase in psychotic symptoms is not frequently reported. 97,98 In our clinical experience, switching medication in collaboration with the patient, with the explicit aim of finding the best tolerated antipsychotic that is still effective, nearly always leads to a better outcome, although sometimes a return to the original antipsychotic may be necessary.…”

“…The switch from risperidone to quetiapine was demonstrated in 2 randomized controlled studies, with one showing improvement in sexual functioning and lowering of prolactin levels. 72,104 Open label studies 98 reported improved sexual functioning for adjunctive therapy with aripiprazole, [104][105][106] vardenafil, 108 peony-glycyrrhiza-decoction, 109 carbegoline, 110 amantadine, 111,112 shakuyaku-kanzo-to 113 , and imipramine. 114 Open label studies described improvement in sexual performance when switching from antipsychotics that are strong dopamine antagonists (which often lead to elevated prolactin levels) to aripiprazole, 105,[115][116][117] ziprasidone, 118,119 olanzapine [120][121][122][123] , and quetiapine 124,125 (prolactin sparing antipsychotics); the switch to aripiprazole was the most studied strategy.…”

“…The review of Nunes 98 describes randomized, doubleblind controlled studies of treatment aimed to improve sexual dysfunction and/or decrease prolactin levels. Improvement of erectile functioning is described for adjunctive treatment with PDE-5-inhibitors like sildenafil, lodenafil and tadalafil.…”

“…114 Open label studies described improvement in sexual performance when switching from antipsychotics that are strong dopamine antagonists (which often lead to elevated prolactin levels) to aripiprazole, 105,[115][116][117] ziprasidone, 118,119 olanzapine [120][121][122][123] , and quetiapine 124,125 (prolactin sparing antipsychotics); the switch to aripiprazole was the most studied strategy. 98 In summary, strategies to treat antipsychotic-induced sexual dysfunction include lowering the dose, switching to a prolactin sparing antipsychotic, adding a dopamine agonist, aripiprazole, or a PDE-5-inhibitor. 98 These options are shown in figure 1.…”

Antipsychotics Induced Sexual Dysfunction

“…Also, it is important to try to understand the influence of sexuality on the individual's overall quality of life, in order to assess the need for adjusting treatment. Proper knowledge about the different pharmacological properties of antipsychotics which have effect on sexual performance may be helpful in choosing antipsychotic with a low risk of inducing sexual side effects [13]. Proper follow up is required as there is a chance of reduction in patient compliance to prescribed antipsychotics, when they identify the sexual dysfunction.…”