Can Risperdal (risperidone) cause sexual dysfunction?

Sexual Dysfunction with Risperdal (Risperidone)

Yes, Risperdal (risperidone) commonly causes sexual dysfunction in both men and women, with rates significantly higher than some other antipsychotic medications.

Prevalence and Types of Sexual Dysfunction

• Sexual dysfunction is a frequent adverse effect of risperidone treatment, with prevalence rates varying from 18% to 96% depending on the assessment method used 1, 2
• In male patients, studies have found sexual dysfunction rates of 43% to 50% with risperidone, which is higher than rates seen with olanzapine (16-34%) 2
• In female patients, sexual dysfunction occurs in up to 93% of women taking risperidone compared to 83% in those taking olanzapine 3
• The most common types of sexual dysfunction with risperidone include:
  • Decreased libido (most common across all assessment scales) 2
  • Erectile dysfunction in men 1
  • Ejaculatory disturbances including retrograde ejaculation 1
  • Orgasmic dysfunction 3

Mechanism of Action

• Risperidone's sexual side effects are primarily related to two pharmacological properties:
  • Strong dopamine D2 receptor blockade leading to hyperprolactinemia 1, 4
  • Potent alpha-1 adrenergic receptor antagonism contributing to ejaculatory disturbances 1
• Hyperprolactinemia is dose-dependent and more pronounced in female patients 1
• Risperidone is classified as a "prolactin-elevating antipsychotic" along with haloperidol and amisulpride, in contrast to "prolactin-sparing" antipsychotics like olanzapine, clozapine, quetiapine, and aripiprazole 4

Reproductive System Effects

• In addition to direct sexual dysfunction, risperidone can cause:
  • Galactorrhea (abnormal milk production) in both men and women 5, 1
  • Gynecomastia (breast enlargement) in 2.3% of patients 5
  • Amenorrhea (cessation of menstruation) in approximately 30% of pre-menopausal women 1
• These effects are consequences of hyperprolactinemia induced by risperidone 1

Comparative Rates with Other Medications

• Direct comparison studies show risperidone causes significantly more sexual dysfunction than quetiapine (50% vs 16%) 6
• Risperidone is associated with higher rates of sexual dysfunction compared to olanzapine, clozapine, quetiapine, and aripiprazole 4
• In a study of female patients with schizophrenia, risperidone caused sexual dysfunction in 93% compared to 83% with olanzapine 3

Clinical Implications

• Sexual dysfunction is often underreported by patients but is a major cause of medication non-compliance 1
• The subjective impact of sexual side effects varies significantly between individuals 1
• Sexual dysfunction can exacerbate psychotic symptoms in patients whose delusions focus on sexual themes 1
• Long-term hyperprolactinemia may have additional health consequences including increased risk of osteoporosis 1

Management Options

• For patients experiencing significant sexual dysfunction with risperidone, consider:
  • Dose reduction if clinically appropriate 1
  • Switching to a prolactin-sparing antipsychotic such as olanzapine, quetiapine, aripiprazole, or clozapine 1, 4
  • For erectile dysfunction specifically, phosphodiesterase-5 inhibitors like sildenafil may be helpful 4
• Clinicians should proactively assess sexual function in patients taking risperidone, as many patients will not spontaneously report these issues 1, 6

Sexual dysfunction with risperidone is a significant clinical concern that affects quality of life and medication adherence. Awareness of this common side effect and appropriate management strategies are essential for optimal patient care.