Anxiolytics and Antiepileptics Canadian Medications

Anxiolytics

Benzodiazepines

Benzodiazepines have been associated with decreased libido, anorgasmia, erectile dysfunction and inability to achieve ejaculation. Most published reports concern alprazolam.

Alprazolam

A series of case reports have described decreased libido in both men and women, anorgasmia in women and inhibition of ejaculation in men following short-term treatment with alprazolam. These side effects were reversed shortly after discontinuing treatment. In one study, 32 patients on alprazolam for anxiety disorders completed a questionnaire comparing their sexual function after several weeks of treatment with their pre-drug function.

Fifty per cent reported decreased libido and a similar percentage described their ability to achieve orgasm as much worse than before starting the drug. Four of nine men recorded erectile difficulties, including one man who was unable to achieve erection. A small percentage of patients noted an improvement in sexual function on therapy. The authors found that reducing the drug dose or changing medication reduced or reversed unwanted sexual side effects.

Chlordiazep oxide

Ejaculatory incompetence was reported in one man taking 20 mg/day.

Clonazepam

Occasional cases of anorgasmia in females and impaired erectile function in males have been described following the use of clonazepam in the treatment of panic disorders. In the cases cited, normal sexual function was regained when the dose of clonazepam was reduced.

Diazepam

Decreased libido and problems with erection have been reported in two men taking diazepam at doses of 25 and 40 mg/day, respectively. Neither was sedated and normal sexual function returned following a change to another benzodiazepine, clonazepam.

Lorazepam

In two case reports, lorazepam has been implicated in causing delayed ejaculation and complete loss of libido with short-term use at doses of 1-3 mg/day. Normal sexual function returned within 1 week of cessation of treatment. Lorazepam has also been used in the treatment of premature ejaculation.

Antiepileptics

Sexual dysfunction in epilepsy

Lack of interest in sex is a very common finding in epileptic patients, it is reported in 33 to 66% of men and 14 to 50% of women. Most of these figures are based on retrospective data, which depend on the patient’s long-term memory. This may be a problem for some epileptic patients. Two studies have quantitatively assessed sexual function in epileptics. One showed decreased nocturnal penile tumescence in men. The other looked at penile and vaginal blood flow in response to erotic visual stimulation.

Both epileptic patients and healthy controls reported the same degree of subjective sexual arousal, indicating similar libido, but blood flow to the genital areas was significantly reduced in the epileptic group, illustrating a dissociation between libido and potency. Several factors have been proposed to explain hyposexuality in epilepsy. It may be a consequence of an altered social or emotional development, particularly relating to poor self esteem or an association between sexual arousal and seizure activity.

Alternatively, as sexual dysfunction usually only arises after the onset of seizure activity, a direct effect of the epileptic discharges on the limbic system in the hypothalamus has been suggested. Furthermore, there is clear evidence that epilepsy is associated with disturbances of the hypothalamic-pituitary axis, affecting both gonadotrophin and prolactin secretion. For example, prolactin levels rise markedly shortly after a seizure. Finally, the role of antiepileptic drugs themselves in producing sexual disturbances needs to be considered.