What medications are used to treat hypersexuality in elderly patients?

Medications for Hypersexuality in Elderly Patients

For elderly patients with hypersexual behavior, SSRIs (sertraline, paroxetine, fluoxetine, citalopram) should be used as first-line pharmacological treatment, starting with low doses and titrating slowly while monitoring for side effects. 1

Assessment Before Treatment

Before initiating medication, evaluate for:

• Underlying causes:

  • Medication side effects (hormone therapy, opioids)
  • Psychological factors (anxiety, depression)
  • Cognitive impairment or dementia
  • Neurological conditions

• Cardiovascular status:

  • Essential before hormonal treatments
  • Especially important when considering estrogen therapy

Pharmacological Treatment Algorithm

First-Line Treatment:

• SSRIs (sertraline, paroxetine, fluoxetine, citalopram)
  • Start with low doses and titrate slowly
  • Monitor for serotonin syndrome
  • Avoid in patients with bipolar disorder due to risk of mania 1
  • These medications have reasonable supporting data for treating abnormal sexual behaviors 2

Second-Line Treatment:

• Antiandrogens
  • Medroxyprogesterone acetate
  • Cyproterone acetate
  • Consider when SSRIs fail to control behavior 2

Third-Line Treatment:

• LHRH agonists (leuprolide, triptorelin)

  • Reserved for severe cases resistant to other treatments
  • Requires careful medical clearance

• Estrogen therapy (including Premarin)

  • Reserved for treatment-resistant cases
  • Requires cardiovascular risk assessment
  • Monitor for feminizing effects 1, 2

Special Considerations

For Patients with Dementia

• Hypersexual behavior occurs in 3-8% of patients with dementia 3
• Antipsychotics (e.g., risperidone) may be effective when hypersexuality is associated with delirium or psychosis 3
• Consider that hypersexuality may be part of a broader behavioral syndrome in dementia

Cardiovascular Risk

• Cardiovascular assessment is essential before initiating hormonal treatments
• Patients with heart failure should not engage in sexual activity if they have decompensated or advanced (NYHA class III or IV) heart failure until their condition is stabilized 4

Medication Side Effects

• Beta-blockers may contribute to sexual dysfunction (3x risk in some studies) 4
• Consider medication review to identify drugs that might be causing or exacerbating hypersexuality

Treatment Monitoring

• Regular assessment of behavior changes
• Cardiovascular monitoring with hormonal treatments
• Monitoring for feminizing effects with estrogen therapy
• Assessment for adverse effects of medications

Caution

• Combination therapy may be reasonable if monotherapy fails 2
• Limited data exists for treatment of hypersexuality in elderly females
• Evidence for pharmacological management comes primarily from case reports and small case series 2
• Always consider the severity of the behavior and potential risks to the patient and others when selecting treatment intensity