Sexual dysfunction risperidone

Risperidone produces at least as much sexual dysfunction as FGAs, but other SGAs (which have a weaker effect of prolactin) are less likely to have this effect. 

Risperidone can be administered once or twice daily in doses ranging from 2 to 6mg/day. Risperidone is well tolerated with comparatively few mild side effects. It can cause drowsiness, weight gain, dizziness, nausea, indigestion, diarrhea, and sexual dysfunction. Finally, risperidone does not increase the risk for agranulocytosis or seizures. 

Furthermore, risperidone-induced galactorrhea associated with a raised prolactin has been reported (1020,1021), as have amenorrhea and sexual dysfunction (1022). 

In eight patients with major depressive disorder without psychotic features, who did not respond to serotonin re-uptake inhibitors therapy when risperidone was added, all improved within 1 week. Furthermore, risperidone also seemed to have beneficial effects on sleep disturbance and sexual dysfunction (47). In an open study in 30 healthy subjects who took risperidone 1 mg orally... 

Risperidone has also been used in combination with topiramate in a Spanish multicenter study in 58 patients (28 men and 30 women mean age 41 years) with bipolar I disorder, with manic but not mixed episodes (20). Risperidone (mean dose 2.7 mg/day) and topiramate (mean dose 236 mg/day) were started with a maximum 48-hour time difference risperidone was used for acute manic symptoms and topiramate for longer-term stabilization and prevention of relapse. The incidence of any adverse event was 64%, mostly somnolence, paresthesia, dizziness, tremor, weight loss (n = 27 mean change -1.1 kg), extrapyramidal disorders, gastrointestinal effects, and cognitive disturbances. One patient developed tardive dyskinesia during the study and there were five dropouts because of adverse effects adverse effects that required withdrawal of risperidone but not topiramate were amenorrhea (n = 3) and sexual dysfunction (n = 1). 

Similarly, risperidone caused extrapyramidal symptoms in fewer patients (24%) than haloperidol did (43%) in a two-phase study in patients with acute bipolar mania (phase I, 3 weeks, patients receiving either risperidone 1-6 mg/day, haloperidol 2-12 mg/day, or placebo (32). Plasma prolactin concentration was higher with risperidone (no data provided) prolactin-related adverse events included non-puerperal lactation, breast pain, dysmenorrhea, and reduced libido or sexual dysfunction these effects occurred in six patients on risperidone (4%) and in two on haloperidol (1.3%). 

Risperidone-induced galactorrhea associated with a raised prolactin has been reported (149,150,151), as have amenorrhea and sexual dysfunction (9). It is suggested that this condition can occur after many weeks of risperidone treatment, with small dosages (2-4 mg/day), and at times even after drug withdrawal. 

A similar design was used in 249 patients with schizoaffective disorder who received injectable risperidone for 6 months (initial dose 25 mg in 82% of patients, end-point doses ranging from 25 mg in 49% of patients to 75 mg in one) oral risperidone supplementation was needed in 19% (mean modal dose 3 mg/day) (228). Three patients died during the study with heart attack, stroke, and gastrointestinal bleeding other important adverse events were increases in body weight and body mass index (mean increases 1.4 kg and 0.5 kg/m2), sexual dysfunction (4%), and new-onset diabetes mellitus (0.4%). 

In eight patients with major depressive disorder without psychotic features, who did not respond to serotonin reuptake inhibitors therapy when risperidone was added, all improved within 1 week. Furthermore, risperidone also seemed to have beneficial effects on sleep disturbance and sexual dysfunction (272). In an open study in 30 healthy subjects who took risperidone 1 mg orally before and after venlafaxine dosing to steady state, the oral clearance of risperidone fell by 38% and the volume of distribution by 17%, resulting in a 32% increase in AUC renal clearance of 9-hydroxyrisperidone also fell by 20% (273). The authors concluded that these small effects were consistent with the fact that venlafaxine is unlikely to alter the clearance of risperidone, which is mainly by CYP2D6. 

Clozapine and olanzapine are the most likely of the atypical agents to cause anticholinergic (anti-muscarinic) effects. They are more likely than other atypicals to cause weight gain (glucose tolerance may be impaired and should be monitored in susceptible individuals) and are second only to quetiapine in their sedative effects. Sexual dysfunction and skin problems are rare with atypical antipsychotics. Risperidone and amisulpride are as likely as classical antipsychotics to raise prolactin concentrations and cause galactorrhoea. 

C Risperidone. Although the incidence of adverse effects associated with hyperprolactinemia is rare with atypical antipsychotics, risperidone can inaease prolactin levels in a dose-dependent manner. Blockade of the dopaminergic tone in the hypothalamus and 5HT-2 antagonism by risperidone may explain this effect. Other adverse eff associated with persistent prolactin elevation include sexual dysfunction, female menstrual disorders, and reduced bone mineral density. 

Atypical antipsychotics such as aripiprazole, olanzapine, que-tiapine, risperidone, and ziprasidone are effective as monotherapy or adjunctive therapy with lithium and valproate in the treatment of acute mania. Some antipsychotics have the potential to cause adverse effects such as extrapyramidal reactions, sedation, depression, emotional blunting, sexual dysfunction, weight gain, and orthostatic hypotension. Prophylactic use of antipsychotics may be needed for some patients with recurrent mania or mixed states, but the risks versus benefits must be weighed because of long-term adverse effects (e.g., obesity, type 2 diabetes, hyperlipidemia, hyperprolactinemia, cardiac disease, and tardive dyskinesia). ... 

Sexual function A study of 100 men with psychotic disorders found that the rate of sexual dysfunction was highest for risperidone, followed by trifluoperazine and olanzapine, measured on three different scales [73 ]. Rates of sexual function varied according to the scale used decreased libido was the most prevalent except for orgasmic disorders for risperidone on the ASEX scale. 

Sexual function A 3-month, open-label study evaluating a switch from risperidone microspheres to paliperidone palmitate reported a significant decrease in serum prolactin levels and a fourfold reduction in sexual dysfunction measure on the Arizona Sexual Experience Scale [197 j. 

A retrospective study of risperidone microsphere use over lyear foxmd that 12.6% experienced adverse effects leading to discontinuation which included most commonly extrapyramidal side effects, hyperprolactinemia, weight gain and sexual dysfunction [243 ]. 

Nebhinani N, Grover S, Avasthi A. Sexual dysfunction in male subjects receiving trifluoperazine, risperidone, or olanzapine rates vary with assessment questionnaire. Prim Gare Companion CNS Disord 2012 14(2). 

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