Risk of Decreased Libido in Adult Females Taking Atomoxetine
Decreased libido in adult females taking atomoxetine for ADHD is uncommon and occurs at rates similar to placebo, making it a minimal clinical concern in this population. 1
Evidence from FDA Drug Labeling
The FDA-approved prescribing information for atomoxetine provides the most authoritative data on sexual side effects in adults:
Decreased libido occurred in 3% of adult patients treated with atomoxetine versus 1% of placebo patients across controlled trials (N=1,697 atomoxetine, N=1,560 placebo). 1
The FDA label does not report sex-specific rates for decreased libido, grouping all adult patients together. 1
Sexual dysfunction appears to be significantly more problematic in adult males than females, with male-specific sexual adverse events (erectile dysfunction 8%, ejaculation disorders 4%) being more prominent than the general decreased libido category. 1
Sex-Specific Analysis from Clinical Research
The most comprehensive pooled analysis examining sexual and genitourinary adverse events provides critical sex-stratified data:
Female patients showed clinically similar rates of sexual and genitourinary adverse events between atomoxetine and placebo, with no statistically significant differences reported. 2
In contrast, adult male patients experienced relatively more sexual adverse events with atomoxetine compared to placebo, including decreased libido (4.6% vs 3.0%). 2
The sexual adverse event profile for atomoxetine in females appears benign, unlike the male population where these effects are more clinically relevant. 2
Clinical Context and Comparison
Multiple clinical reviews confirm the sex-specific pattern:
Sexual problems were reported more frequently with atomoxetine than placebo in adult trials, but these reports predominantly reflected male sexual dysfunction (dysuria, erectile dysfunction, ejaculation disorders). 3, 4
Approximately 2% of patients overall experienced sexual dysfunction with atomoxetine, but this figure is heavily weighted by male patients. 5
The adverse event profile in adult females taking atomoxetine more commonly includes nausea, dry mouth, decreased appetite, and constipation rather than sexual dysfunction. 1
Important Clinical Considerations
When counseling adult female patients about atomoxetine:
Decreased libido is not a prominent adverse effect in women and occurs at rates barely distinguishable from placebo (approximately 3% vs 1%). 1
If sexual dysfunction does occur, it typically manifests early in treatment (within the first 2-3 weeks based on male data), though female-specific timing data are limited. 2
Sexual adverse events are likely underreported in clinical trials due to patient and physician reluctance to discuss them, so routine inquiry is recommended. 1
Metabolizer Status Impact
Poor CYP2D6 metabolizers (approximately 7% of Caucasians) experience higher rates of all adverse effects due to 6-8 fold higher drug exposure. 1
In poor metabolizers, dry mouth (35% vs 17%) and other side effects are more common, though sex-specific sexual dysfunction data for poor metabolizers are not separately reported for females. 6