From the Guidelines
Cyproheptadine is not a recommended treatment for sexual dysfunction due to its limited evidence and potential side effects. The available evidence for cyproheptadine in treating sexual dysfunction is limited and conflicting, with most studies focusing on its use for nightmare disorder rather than sexual dysfunction 1.
Mechanism and Dosage
Cyproheptadine works by blocking serotonin receptors, which could potentially counteract the sexual side effects of SSRIs, but this mechanism may also reduce the effectiveness of antidepressants. The typical dosage ranges from 4-8 mg taken 1-2 hours before sexual activity or 4-16 mg daily, but side effects commonly include sedation and increased appetite, which may limit its usefulness.
Alternative Treatments
For erectile dysfunction, the American College of Physicians recommends initiating therapy with a PDE-5 inhibitor in men who seek treatment and do not have a contraindication to PDE-5 inhibitor use, based on high-quality evidence 1. The choice of a specific PDE-5 inhibitor should be based on individual preferences, including ease of use, cost of medication, and adverse effects profile.
Precautions and Considerations
Cyproheptadine should be avoided in patients with glaucoma, urinary retention, or those taking MAOIs. Before trying cyproheptadine or any other treatment for sexual dysfunction, patients should discuss their options with their healthcare provider, considering other approaches like adjusting antidepressant dosage, switching medications, or adding bupropion, which might be more appropriate.
Quality of Life and Safety
Given the limited evidence for cyproheptadine in treating sexual dysfunction and the availability of more effective and evidence-based treatments like PDE-5 inhibitors, prioritizing patient safety and quality of life suggests that cyproheptadine should not be the first choice for treating sexual dysfunction. Instead, healthcare providers should consider evidence-based treatments that have been proven to improve sexual function and overall quality of life.
From the Research
Effectiveness of Cyproheptadine for Treating Sexual Dysfunction
- Cyproheptadine, an antihistamine with 5HT-2 antagonist properties, has been studied as a potential treatment for sexual dysfunction induced by serotonin reuptake inhibitors (SRIs) 2.
- A study published in 1995 found that cyproheptadine improved sexual function in 5 out of 7 patients with SRI-induced sexual dysfunction, although the improvement was transitory in 2 patients 2.
- However, a more recent review of management strategies for antidepressant-induced sexual dysfunction did not find sufficient evidence to support the use of cyproheptadine as a treatment option 3.
- Other studies have investigated the use of various medications, including phosphodiesterase inhibitors (e.g., sildenafil, tadalafil) and bupropion, as potential treatments for antidepressant-induced sexual dysfunction 3, 4.
- The current evidence suggests that the management of antidepressant-induced sexual dysfunction requires an individualized approach, considering factors such as the specific antidepressant used, the type and severity of sexual dysfunction, and the patient's overall health status 5.
Comparison with Other Treatments
- Compared to other treatments, such as bupropion and phosphodiesterase inhibitors, cyproheptadine has limited evidence supporting its use for treating sexual dysfunction induced by antidepressants 3, 4.
- A study published in 2002 found that bupropion-sustained release was effective in treating SSRI-induced sexual side effects in both men and women 4.
- Another study published in 1998 reviewed the management of SSRI-induced sexual dysfunction and found that serotonin antagonists and dopamine agonists, such as cyproheptadine, had been used to treat SSRI-induced dysfunction with generally positive results, but noted the need for controlled studies to determine prevalence and effectiveness 6.
Limitations of Current Evidence
- The current evidence for the use of cyproheptadine in treating sexual dysfunction induced by antidepressants is limited by the small number of studies and the lack of controlled trials 2, 3, 6.
- Further research is needed to fully understand the effectiveness of cyproheptadine and other treatments for antidepressant-induced sexual dysfunction, as well as to identify the most effective management strategies for individual patients 3, 5.