As I’m sure many of us who commonly work with elderly patients in nursing homes have seen, patients can experience hypersexuality and exhibit behaviors that put themselves and other residents at risk as a result. Hypersexuality is defined by exhibiting behaviors and urges outside of the normal baseline at an intense and frequent amount, which can result in distress or impairment. Some behavioral examples include inappropriate touching of staff or other residents, pornography addiction, increased or excessive masturbation, increased risky sexual behavior, and increased promiscuity.
While in many circumstances this behavior is attributed to changes caused by neurological conditions such as dementia and Parkinson’s disease, with other possible causes being brain injuries and psychiatric disorders such as bipolar disorder. It’s important to remember that many commonly prescribed medications can also cause this problem. In this article, we’ll share the most common medications that cause hypersexuality.
Medications typically cause this complication because they lead to a dysregulation of neurotransmitters in the brain. In particular, agonism of the dopaminergic pathway appears to be associated with an increase in sexual function. Meanwhile, upregulation of the serotonergic pathway and downregulation of the dopaminergic pathway are generally associated with a decrease. It’s also important to know that testosterone levels are considered the primary mediator of sexual desire in both sexes, meaning changes here could affect sexual behaviors.
The most common prescription drugs that I’ve seen to cause hypersexuality work as dopamine agonists and include Pramipexole, Cabergoline, and Ropinerole. Looking for drugs that enhance dopamine effects is my first step in ruling out medications that cause hypersexuality. Pramipexole and ropinirole are agents that I’ve seen in practice most commonly used for the treatment of restless legs syndrome. I shared a case about pramipexole and hypersexuality previously on the blog.
Partial dopamine agonists such as Aripiprazole have also been shown to have this effect. Recall that this partial dopamine agonist action may also explain why it has a higher incidence of akathisia as well (excellent board exam nugget). Levodopa has also been shown to increase the risk of hypersexuality. Antihypertensives such as Clonidine and Methyldopa have some low to modest dopamine type action and should be considered as a potential cause as well.
Stimulants are another class of medication that may increase the action of dopamine in the brain. While used less commonly in elderly patients due to cardiovascular risks, I occasionally see them used to stimulate energy or for conditions like narcolepsy and MS.
Ultimately, the timing of when new medications are started or increased is one of the most important things I review when asked to consult on hypersexuality cases. While I focus on looking for many of the medications above, be aware of others that may rarely cause this issue.
If you are looking to learn more about the medications listed in this article, go check out the Real Life Pharmacology podcast!
- 30 medication mistakes PDF
- 18+ Page Drug Interaction PDF
- 10 Commandments of Polypharmacy Webinar based on my experiences in clinical practice
This article was written by Tommy Anderson, PharmD Candidate in collaboration with Eric Christianson, PharmD, BCGP, BCPS
Sources:
- https://addictionresource.com/drugs/effects-on-hypersexuality/
- https://www.sciencedirect.com/science/article/abs/pii/S1743609518301358
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3687056/#:~:text=In%20conclusion%2C%20aripiprazole%20can%20enhance,and%20suffering%20for%20the%20patient.
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8009557/
- https://www.goodrx.com/drugs/side-effects/these-drugs-may-be-affecting-your-sex-life?srsltid=AfmBOorFJKkqzKoyc7eynkQDRRzai_0fmjLMDOjyGjT7wHq0qzt_fDS3
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8563511/
- https://pubmed.ncbi.nlm.nih.gov/26923525/
0 Comments