Sexual function adverse effects, drugs

Sexual function Adverse effects of finasteride on male sexual function are not uncommon (SEDA-30, 480). These effects are dose related, and in the low doses used to treat hair loss (1 mg/day) they are unusual. However, they can occur in certain instances, as in two patients with azoospermia and severe oligospermia resulting in infertility when they took finasteride 1 mg/ day for hair loss the drug was withdrawn and the sperm count recovered within 3-6 months [112 ]. 

Yohimbine, an indole alkaloid, is an -selective antagonist. It has no established clinical role. Theoretically, it could be useful in autonomic insufficiency by promoting neurotransmitter release through blockade of presynaptic 02 receptors. It has been suggested that yohimbine improves male sexual function however, evidence for this effect in humans is limited. Yohimbine can abruptly reverse the antihypertensive effects of an 2-adrenoceptor agonist such as clonidine—a potentially serious adverse drug interaction. 

Fluoxetine was the first SSRI to reach general clinical use. Paroxetine and sertraline differ mainly in having shorter half-lives and different potencies as inhibitors of specific P450 isoenzymes. While the SSRIs have not been shown to be more effective overall than prior drugs, they lack many of the toxicities of the tricyclic and heterocyclic antidepressants. Thus, patient acceptance has been high despite adverse effects such as nausea, decreased libido, and even decreased sexual function. 

The mechanisms by which thiazides affect erectile dysfunction or libido are unclear, but it has been suggested that they have a direct effect on vascular smooth muscle cells or reduce the response to catecholamines. Sexual dysfunction does not appear to be mediated by either a low serum potassium concentration or a low blood pressure. Since sexual dysfunction can adversely affect the quality of life of hypertensive patients, physicians or health-care providers should take an accurate baseline sexual history and monitor sexual status for changes during therapy. If there are significant changes in sexual function, diuretic therapy can be withdrawn and an alternative drug class substituted. However, not uncommonly sexual dysfunction will persist despite withdrawal of the diuretic, suggesting that elements of the hj pertensive state itself contribute to the process. 

Serotonin reuptake inhibitors (SSRI). These are currently the drugs of choice for the treatment of bulimia nervosa. The most frequently cited adverse effects include nausea, insomnia and diminution of sexual interest and/or impaired sexual function. 

The new wave of safer antidepressants introduced in the 1990s, led by fluoxetine (Prozac),is dominated by drugs that are serotonin-selective reuptake inhibitors (SSRIs). The SSRIs exhibit some adverse side effects, notably in impaired sexual function in both men and women, but because they are relatively safe physicians have been less inhibited about using them. This has extended the clin-... 

Understanding human sexual function and behavior and the various neurotransmitters and endocrine factors involved in the human sexual cycle is of paramount importance for proper diagnosis, understanding, and treatment of sexual dysfunction.1 Moreover, it is estimated that 20-85% of non-adherence to psychopharmacology is due to adverse sexual side-effects of the drugs. 

There is particular concern that the pharmacodynamic activities of some drugs may be expressed in consumers, and this concern has been paramount over the presence of hormonally active substances, and particularly those with the capacity to act as endocrine disrupters in humans or indeed, in environmental organisms. There is a considerable body of concerns that include adverse effects on sexual, thyroid, adrenal and reproductive function in humans and other animals, as well as genital abnormalities e.g. hypospadias) and effects on embryonic and foetal development. This has led to the tighter regulation of human pharmaceutical products in a number of countries from the point of view of environmental effects and environmental assess-... 

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