From the Guidelines
Naltrexone may decrease sex drive in some individuals, though this is not a universal side effect. This medication, which blocks opioid receptors in the brain, is primarily used to treat alcohol and opioid dependence at doses typically ranging from 50-100mg daily 1. Sexual side effects including decreased libido, impotence, and delayed orgasm have been reported in clinical studies, affecting approximately 2-10% of patients. The mechanism behind these sexual side effects likely relates to naltrexone's impact on the brain's reward system and its interference with endorphin activity, which plays a role in sexual pleasure. However, many patients experience no sexual side effects at all while taking naltrexone. Some key points to consider when evaluating the potential for naltrexone to decrease sex drive include:
- The dosage and formulation of naltrexone, as a 50-mg tablet taken daily or a 380-mg monthly injection (Vivitrol), may influence the likelihood and severity of sexual side effects 1
- The individual's overall health, medical history, and presence of other conditions that could affect sexual function should be taken into account
- The potential benefits of naltrexone in treating addiction often outweigh these possible side effects for many patients, as it has been shown to be helpful in maintaining abstinence from opioids in motivated populations 1 If you notice decreased sex drive while taking this medication, it's essential to discuss this with your healthcare provider, as dosage adjustments or alternative treatments might be considered. For some patients, these side effects may diminish over time as the body adjusts to the medication.
From the FDA Drug Label
The following events occurred in less than 1% of subjects: ... Genitourinary: Increased frequency of, or discomfort during, urination; increased or decreased sexual interest. The FDA drug label mentions that decreased sexual interest is a possible adverse event associated with naltrexone, although it occurs in less than 1% of subjects 2.
- Key points:
- Decreased sexual interest is a possible side effect of naltrexone.
- This adverse event occurs in less than 1% of subjects.
From the Research
Naltrexone and Sex Drive
- The effect of naltrexone on sex drive is a topic of interest, with some studies suggesting it may decrease sex drive in certain individuals, particularly those with compulsive sexual behavior disorder (CSBD) 3, 4, 5.
- A study published in 2002 found that naltrexone reduced symptoms of compulsive sexual behavior in two case reports, suggesting its potential as a treatment for CSB 3.
- Another study published in 2010 found that 89% of patients with CSB reported a reduction in symptoms when taking naltrexone, indicating its potential as an adjunctive treatment for CSB 4.
- A 2020 feasibility study found that naltrexone decreased symptoms of CSBD in 20 men, with significant decreases in HD: CAS and HBI scores during treatment 5.
- However, a study published in 1989 found that naltrexone actually increased sexual function in men with idiopathic impotence, suggesting that its effects on sex drive may be complex and dependent on the individual and context 6.
Side Effects and Tolerability
- Common side effects of naltrexone reported in the studies include fatigue, nausea, vertigo, and abdominal pain 5.
- Despite these side effects, naltrexone was found to be feasible and tolerable in the treatment of CSBD, with no serious adverse effects leading to discontinuation 5.
Limitations and Future Directions
- The current evidence is limited by small sample sizes and lack of control groups, highlighting the need for further research to fully understand the effects of naltrexone on sex drive and its potential as a treatment for CSBD 3, 4, 5.
- Future studies should aim to recruit larger samples and utilize randomized controlled designs to evaluate the effectiveness of naltrexone in reducing symptoms of CSBD and its impact on sex drive 5.