Anticholinergic Medications and Increased Sexual Expression
The evidence does not support that anticholinergic medications cause increased sexual expressions; rather, anticholinergics are consistently associated with sexual dysfunction, including decreased libido and impaired arousal. 1
Anticholinergics and Sexual Dysfunction
Anticholinergic medications typically cause sexual dysfunction, not increased sexual activity. The mechanism involves broad muscarinic receptor blockade that negatively affects multiple physiological systems, including sexual function. 1
Common Anticholinergic Medications That Cause Sexual Problems:
Overactive bladder agents (e.g., oxybutynin, trospium, solifenacin) are strongly anticholinergic and poorly tolerated in many patients, though one small study in women with MS showed no significant impact on sexual function measures. 1, 2
Older antihistamines (e.g., diphenhydramine, hydroxyzine) have strong anticholinergic effects that contribute to overall anticholinergic burden. 1
Muscle relaxants (e.g., cyclobenzaprine) possess strong anticholinergic properties that affect cognition and functionality. 1
Antipsychotic medications with anticholinergic properties are associated with sexual dysfunction, hyperprolactinemia, and decreased libido—not increased sexual expression. 1, 3, 4
Important Clinical Distinction
When antipsychotics are used, anticholinergic agents are often prescribed to manage extrapyramidal side effects, which further increases anticholinergic burden and worsens sexual dysfunction. 1 This combination therapy is associated with increased rates of sexual dysfunction, not increased sexual expression. 1
Anticholinergic Burden Effects:
"Anticholinergic burden" from multiple anticholinergic drugs adversely affects cognition, functional status, and activities of daily living scores. 1
The Drug Burden Index demonstrates that sedating or strongly anticholinergic medications are associated with decline in cognition and functional status. 1
Anticholinergic effects include vision problems, urinary retention, constipation, and cognitive impairment—all of which would impair rather than enhance sexual function. 1
Medications That May Increase Libido
If you are looking for medications that can paradoxically increase sexual expression, consider:
Donepezil (an acetylcholinesterase inhibitor—the opposite of anticholinergic) has been reported in case reports to cause increased libido, with resolution upon withdrawal and recurrence upon reintroduction. 5
Some antiepileptic drugs like oxcarbazepine, lamotrigine, and levetiracetam may improve sexual function, though these are not anticholinergics. 6
Clinical Pitfall to Avoid
Do not confuse disinhibited sexual behavior in dementia or psychiatric conditions with medication-induced increased libido. Inappropriate sexual expressions in patients with dementia or psychosis are typically manifestations of the underlying disease process, not anticholinergic medication effects. 5 In fact, anticholinergic medications used to treat these conditions typically worsen cognitive function and would not be expected to increase sexual expression. 1