Sexual dysfunction with antipsychotics

Smith PJ, Talbert RL. Sexual dysfunction with antihypertensive and antipsychotic agents. Clin Pharm 1986 5(5) 373-84. 

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 There were no cases of sexual dysfunction after 3 months of treatment with aripiprazole in both patients who switched therapy due to lack of efficacy ( =41 age range 18-50 years) and those who took aripiprazole as a first antipsychotic drug [68. ... 

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