Sexual Disorder Medications Flashcards
cyproheptadine (Periactin)
Indication: allergic rhinitis; urticaria; most commonly used appetite stimulant in cats
Dose: 4mg-12mg between one to two (1-2) hours before sexual activity.
Monitoring: None required.
Mechanism: H1 receptor antagonist with mild anti-serotonergic effects
ADEs: sedation; reversal of antidepressant therapeutic effects; confusion; weight gain; anticholinergic effects
Off-Label: antidepressant-induced sexual dysfunction (works best with anorgasmia (mean dose 8.6mg); appetite stimulant (therefore anorexia and bulimia); acute management of serotonin syndrome; counteract excessive sweating in SRIs; counteract vivid dreams in SRIs
avanafil (Stendra)
Indication: Erectile Dysfunction
Dose: 100mg 15 minutes before sexual activity – one dose per day; MAX=200mg; warning about concomitant use with alcohol
Monitoring: No monitoring required.
Mechanism: Phosphodiesterase (type 5) – PDE5 Inhibitor
Advantages: Faster onset (marketing able to get the label to say “as early as fifteen minutes before sexual activity”); not effected by meals; usual duration is 2 hours
Disadvantages: avoid nitrates in ANY form (nitroglycerin, amyl nitrate (“poppers”), or isosorbide dinitrate); severe caution with patients on alpha-adrenergic blockers because of severe hypotension; avoid 3A4 inhibitors which substantially increases and extends effects (max dose here is 50mg);
ADEs: Serious: dose-related impairment of color discrimination; sudden loss of hearing with tinnitus and vertigo; substantial decreases in BP; priapism; Common: headache, nasal congestion, flushing
bremelanotide (Vyleesi)
Indication: Hyposexual sexual desire disorder (HSDD) in PREmenopausal women
Dose: SQ: 1.75mg/0.3mL to abdomen or thigh 45 minutes before sexual activity; no more than one dose in a day, and no more than 8 doses per month
Monitoring: None required.
Mechanism: melanocortin receptor agonist; a peptide with only seven amino acids (metabolism involves only hydrolysis)
Advantages: No particular advantages
Disadvantages: 40% dropped out of trials; only 8% benefited; not studied in postmenopausal women or in men; increases interest rather than sexual performance
ADEs: Serious: transient increase in BP and drop in pulse after dose for up to twelve hours; focal hyperpigmentation (includes face, gingiva, and breasts)-higher risk in people with darker skin-only resolves in half the patients; Common: nausea (40%); flushing; injection site reactions; headache; vomiting
Facts: Before it came out, had a marketing campaign to highlight HSDD (www.unblush.com).
flibanserin (Addyi)
Indication: Hyposexual sexual desire disorder (HSDD) in PREmenopausal women (“pink Viagra”)
Dose: 100mg (discontinue after eight weeks if no improvement); FDA warning about concomitant use with alcohol – no alcohol for at least two (2) hours before use
Monitoring: None required (BP?)
Mechanism: mixed agonist-antagonist on postsynaptic serotonergic receptors with 5-HT1A agonist and 5-HT2A antagonist effects
Advantages: None
Disadvantages: Weak efficacy data (“if Viagra is a Triple expresso, Addyi is a Dixie cup of cafeteria coffee – Dr. Carlat – effect of Viagra is 80% improvement; Addyi is 8-13%); not studied in postmenopausal women or in men; increases interest rather than sexual performance
ADEs: Serious: severe hypotension, syncope (both worse if taken during the daytime); Common: dizziness, somnolence, nausea, fatigue, insomnia, dry mouth
tadalafil (Cialis)
Indication: Erectile Dysfunction; Benign Prostatic Hyperplasia; Pulmonary Arterial Hypertension (as a brand name Adcirca)
Dose: PRN Dosing: 10mg thirty minutes before sexual activity; adjust by 5-10mg based on response; MAX = 20mg, one dose per day
Daily Dose: 2.5mg daily; MAX=5mg daily
Monitoring: No monitoring required.
Mechanism: Phosphodiesterase (type 5) – PDE5 Inhibitor
Advantages: Can be a daily administration (but may have daily side effects); Long lasting effects of 36 hours (nickname: “the weekend pill”)
Disadvantages: avoid nitrates in ANY form (nitroglycerin, amyl nitrate (“poppers”), or isosorbide dinitrate); severe caution with patients on alpha-adrenergic blockers because of severe hypotension; avoid 3A4 inhibitors which substantially increases and extends effects (max dose here is 10mg PRN or 2.5mg daily)
ADEs: Serious: dose-related impairment of color discrimination; sudden loss of hearing with tinnitus and vertigo; substantial decreases in BP; priapism; Common: headache; nausea; dyspepsia; flushing; back pain; muscle aches.
testosterone
Indication: hypogonadism; marketing has convinced the public that “low T” is a public health scourge (use ONLY with measured low testosterone (free AND total) and symptoms)
Dose: multiple formulations (depot (cheapest), buccal ER, gels, and pills); Schedule III medication
Monitoring: hematocrit, bone density, LFTs, testosterone
Mechanism: anabolic and andronergic testosterone receptor agonist
ADEs: Serious: thromboembolic events (DVT, PE), myocardial infarction, stroke, worsening BPH, increased risk of prostate cancer; Common: nausea; headache; insomnia; anxiety; acne; water and electrolyte retention; local effects (i.e., gum irritation, application sire irritation and pain)
sildenafil (Viagra)
Indication: Erectile Dysfunction; Pulmonary Arterial Hypertension (as a brand name Revatio)
Dose: PRN Dosing: 50mg thirty minutes before sexual activity; MAX = 100mg, one dose per day; If >65, start at 25mg; Avoid taking with a high-fat meal (delays onset) or alcohol (hypotension)
Monitoring: No monitoring required.
Mechanism: Phosphodiesterase (type 5) – PDE5 Inhibitor
Advantages: Longest track record.
Disadvantages: avoid nitrates in ANY form (nitroglycerin, amyl nitrate (“poppers”), or isosorbide dinitrate); severe caution with patients on alpha-adrenergic blockers because of severe hypotension; avoid 3A4 inhibitors which substantially increases and extends effects (max dose here is 25mg);
ADEs: Serious: dose-related impairment of color discrimination; sudden loss of hearing with tinnitus and vertigo; substantial decreases in BP; priapism; Common: headache, dyspepsia/heartburn, flushing.
Fun Facts: Duration of action about 2hrs; MDMA users often use it to counteract sexual ADEs (combination called “sextacy”)
vardenafil (Levitra)
Indication: Erectile Dysfunction
Dose: PRN Dosing: 10mg one hour before sexual activity; MAX = 20mg, one dose per day; If >65, start at 5mg; Avoid taking with a high-fat meal (levels decease by 50%)
ODT: 10mg one hour before sexual activity (no increase) (peppermint flavored)
Monitoring: No monitoring required.
Mechanism: Phosphodiesterase (type 5) – PDE5 Inhibitor
Advantages: ODT form, otherwise no significant benefits over cheaper options
Disadvantages: avoid nitrates in ANY form (nitroglycerin, amyl nitrate (“poppers”), or isosorbide dinitrate); severe caution with patients on alpha-adrenergic blockers because of severe hypotension; avoid 3A4 inhibitors which substantially increases and extends effects (max dose here is 5mg);
ADEs: Serious: dose-related impairment of color discrimination; sudden loss of hearing with tinnitus and vertigo; substantial decreases in BP; priapism; Common: flushing, nasal congestion, headache, dyspepsia/heartburn.
