A 47 year old male is concerned that his drugs are causing medication induced sexual dysfunction. His primary provider has asked you to review his medications. What would I look at here?
- Amlodipine 5 mg daily
- Metoprolol 25 mg twice daily
- Fluoxetine 80 mg daily
- Bupropion 150 mg daily
- Lansoprazole 15 mg once daily
- Tums as needed
- Aspirin 81 mg daily
- Metformin 500 mg twice daily
When I first look at a medication list, I try to pull out really common medications that I am aware of that could cause medication induced sexual dysfunction. I like to come up with solutions to problems and this one likely does present a challenge.
SSRI’s are a notorious cause of medication induced sexual dysfunction. The fluoxetine is also at a substantially high dose. This makes me believe that the patient has significant mental health concerns. He is also taking the bupropion. There is potential to try to increase the bupropion dose and with that maybe we could reduce the fluoxetine if being used for something like depression.
There are blood pressure medications that can cause drug induced sexual dysfunction. The second medication that I would look at is the metoprolol. If being used simply for hypertension without any other compelling indications like previous MI, atrial fibrillation, etc. this is a medication we could possibly change. Amlodipine is a much better medication as far as its risk in contributing to medication induced sexual dysfunction. Increasing this dose would likely not cause further issues if the metoprolol could be reduced and/or discontinued.
When I think of sexual dysfunction and am able to work with patients on a problem like this, I also do my best to remind them that their medical conditions can cause these problems. In this situation, it would be an important point to remind the patient that his hypertension and diabetes could contribute to this problem. Any lifestyle changes he would be willing to make could help improve his sexual dysfunction.
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