From the Guidelines
Medications used to treat inappropriate sexual behaviors in geriatric males include hormone-modulating agents and psychiatric medications, with selective serotonin reuptake inhibitors (SSRIs) such as sertraline, fluoxetine, or citalopram being commonly prescribed to reduce sexual urges. According to the most recent evidence 1, daily SSRIs are recommended as first-line agents of choice in the treatment of premature ejaculation, which can be a factor in inappropriate sexual behaviors. The use of off-label SSRIs is favored over the tricyclic antidepressant clomipramine due to a better side effect profile 1.
When considering treatment options, it's essential to weigh the potential benefits against the risks, particularly in geriatric patients who may be more susceptible to adverse effects. The American Geriatrics Society Beers Criteria for potentially inappropriate medication can be a useful resource in assessing the safety of medications in older adults 1.
Some key considerations when prescribing medications for inappropriate sexual behaviors in geriatric males include:
- Ruling out underlying medical conditions that may be contributing to the behavior, such as delirium or pain
- Monitoring for potential side effects, such as metabolic changes with antipsychotics or bone density loss with hormone-modulating agents
- Considering the use of SSRIs, such as sertraline (50-200 mg daily), fluoxetine (20-60 mg daily), or citalopram (20-40 mg daily), to reduce sexual urges while also addressing depression or anxiety
- Avoiding the use of medications that may exacerbate the condition, such as those with anticholinergic or sedative effects
Ultimately, the goal of treatment is to improve the patient's quality of life while minimizing the risk of adverse effects. By carefully selecting and monitoring medications, healthcare providers can help geriatric males with inappropriate sexual behaviors to manage their symptoms and improve their overall well-being.
From the FDA Drug Label
Male and Female Sexual Dysfunction with SSRIs Although changes in sexual desire, sexual performance and sexual satisfaction often occur as manifestations of a psychiatric disorder, they may also be a consequence of pharmacologic treatment. In particular, some evidence suggests that selective serotonin reuptake inhibitors (SSRIs) can cause such untoward sexual experiences Table 5 Adverse EventSertraline Hydrochloride TabletsPlacebo Ejaculation Failure1(Primarily Delayed Ejaculation) 14% 1% Decreased Libido26%1%
- Medications used to curb sexual behaviors:
- Sertraline is an SSRI that can cause decreased libido and ejaculation failure, which may be used to curb sexual behaviors in geriatric males.
- The use of sertraline for this purpose should be approached with caution, as it is not a direct indication for the medication. 2
From the Research
Medications for Treating Sexual Behaviors in Geriatric Males
- The following medications are used to treat inappropriate sexual behaviors in geriatric males:
- Serotoninergics (e.g., tricyclic antidepressants [TCAs], selective serotonin reuptake inhibitors [SSRIs]) as first-line agents 3
- Antiandrogens (cyproterone acetate or medroxyprogesterone acetate) as second-line agents 3
- LHRH agonists (e.g., leuprolide, triptorelin) and estrogens as third-line agents 3
- Medroxyprogesterone acetate was found to be well-tolerated and effective in reducing inappropriate sexual behavior in geriatric males 4
- Citalopram, an SSRI, was found to have minimal reduction of inappropriate sexual behavior, while atypical antipsychotics such as olanzapine and risperidone were effective in some cases but had adverse effects 4
- Estrogen therapy, preferably a patch, has been recommended for elderly demented men with sexual disinhibition 5
Non-Pharmacological Interventions
- Non-pharmacological treatment is generally recommended as first-line therapy over pharmacological treatment 6
- Distraction/diversion of the patient when inappropriate sexual behaviors occur is a common non-pharmacological intervention 6