Does Risperdal (risperidone) have known sexual side effects in males?

Sexual Side Effects of Risperdal (Risperidone) in Males

Yes, Risperdal (risperidone) is known to cause significant sexual side effects in males, including erectile dysfunction, ejaculatory dysfunction, and decreased libido. 1, 2, 3

Common Sexual Side Effects

Risperidone can affect male sexual function through multiple mechanisms:

• Ejaculatory dysfunction - Including retrograde ejaculation (where semen enters the bladder instead of being expelled), reduced ejaculatory volume, and anejaculation 2, 3
• Erectile dysfunction - Difficulty achieving or maintaining erections 1
• Decreased libido - Reduced sexual desire 1, 4

Mechanisms of Sexual Dysfunction

Risperidone causes sexual side effects through two primary mechanisms:

1. Alpha-1 adrenergic receptor antagonism:

   • Risperidone's strong alpha-1 receptor blocking properties can cause retrograde ejaculation by altering sympathetic tone 3
   • This mechanism is dose-dependent, with higher doses (e.g., 8 mg/day) more likely to cause ejaculatory problems 3

2. Hyperprolactinemia:

   • Risperidone significantly increases prolactin levels through dopamine receptor blockade 5
   • Elevated prolactin can contribute to decreased libido, erectile dysfunction, and reduced ejaculatory volume 2, 5

Clinical Significance

• Sexual dysfunction with risperidone is common, affecting approximately 50-70% of male patients 4
• These side effects can significantly impact:
  • Medication adherence and compliance 3, 4
  • Quality of life 1
  • Patient willingness to continue treatment 2

Risk Factors and Monitoring

• Dose-related effects: Higher doses of risperidone increase the risk of sexual side effects 3
• Monitoring recommendations:
  • Clinicians should proactively inquire about sexual function before starting risperidone and regularly during treatment 2
  • Patients may not spontaneously report sexual dysfunction due to embarrassment 4

Management Options

For patients experiencing sexual dysfunction on risperidone:

• Dose reduction may resolve symptoms, particularly for ejaculatory dysfunction 3
• Medication switching to an antipsychotic with lower risk of sexual side effects (e.g., aripiprazole, lurasidone) 1, 4
• Adjunctive treatments may be considered based on the specific dysfunction and underlying mechanism

Comparison to Other Antipsychotics

• Among atypical antipsychotics, risperidone has a higher risk of causing ejaculatory dysfunction compared to other agents 1
• Aripiprazole has shown lower odds of erectile and ejaculatory dysfunction compared to risperidone 1

Important Clinical Considerations

• Sexual side effects are often underreported by patients but can significantly impact treatment adherence 3, 4
• The FDA label for risperidone specifically lists sexual dysfunction (including erectile dysfunction, ejaculatory dysfunction, and decreased libido) as known adverse reactions 6
• Clinicians should balance the therapeutic benefits of risperidone against the potential impact on sexual function and quality of life 1, 4