From the FDA Drug Label
Changes in sexual desire, sexual performance and sexual satisfaction often occur as manifestations of psychiatric disorders or diabetes, but they may also be a consequence of pharmacologic treatment Because adverse sexual reactions are presumed to be voluntarily underreported, the Arizona Sexual Experience Scale (ASEX), a validated measure designed to identify sexual adverse reactions, was used prospectively in 4 MDD placebo-controlled adult trials In these trials, duloxetine delayed-release capsules-treated male patients experienced significantly more sexual dysfunction, as measured by the total score on the ASEX and the ability to reach orgasm, than placebo-treated male patients Duloxetine delayed-release capsules-treated female patients did not experience more sexual dysfunction than placebo-treated female patients as measured by ASEX total score. Healthcare providers should routinely inquire about possible sexual adverse reactions in duloxetine delayed-release capsules-treated patients Table 5: Mean Change in ASEX Scores by Gender in MDD Placebo-Controlled Adult Trials Male Patients : ASEX Total (Items 1 to 5) 0.56 b -1.07 Item 4 — Ease of reaching orgasm 0.40 c -0.24 Key points:
- Duloxetine can cause significant sexual side effects in males, including erectile dysfunction and ejaculation disorder.
- Female patients did not experience more sexual dysfunction than placebo-treated female patients.
- The Arizona Sexual Experience Scale (ASEX) was used to measure sexual function in clinical trials.
- Healthcare providers should inquire about possible sexual adverse reactions in patients taking duloxetine 1.
From the Research
Duloxetine can cause significant sexual side effects in many patients, including decreased libido, difficulty achieving orgasm, and delayed ejaculation in men, with these effects occurring in approximately 30-50% of patients. The sexual dysfunction typically begins within the first few weeks of treatment and may persist throughout therapy. These effects occur because duloxetine increases serotonin levels in the brain, which can inhibit sexual function. Serotonin specifically dampens the dopamine and norepinephrine pathways that are important for normal sexual response.
Management Strategies
If sexual side effects become problematic, several management strategies exist, including:
- Waiting for tolerance to develop (which sometimes occurs after 2-3 months)
- Reducing the dose if clinically appropriate
- Taking scheduled drug holidays
- Discussing with your doctor about switching to an antidepressant with fewer sexual side effects such as bupropion (Wellbutrin) 2. Never stop taking duloxetine suddenly as this can cause withdrawal symptoms.
Evidence
A study published in 2013 found that the addition of sildenafil or tadalafil can be an effective strategy for managing antidepressant-induced erectile dysfunction in men 2. Another study published in 2011 found that the probability of continued or emergent sexual dysfunction after duloxetine treatment was associated with the response status of the patients, and that the incidence of treatment-emergent dysfunction did not differ significantly between duloxetine and placebo treatment groups in patients who responded to treatment 3.
Key Points
- Duloxetine can cause significant sexual side effects in many patients
- The sexual dysfunction typically begins within the first few weeks of treatment and may persist throughout therapy
- Management strategies exist, including waiting for tolerance to develop, reducing the dose, taking scheduled drug holidays, or switching to an antidepressant with fewer sexual side effects
- Never stop taking duloxetine suddenly as this can cause withdrawal symptoms. It is essential to discuss any concerns about sexual side effects with your doctor to determine the best course of action.