Citalopram and sexual dysfunction./nThe question concerns a 48-year-old man who has been treated fo

Fråga: Citalopram and sexual dysfunction. The question concerns a 48-year-old man who has been treated for the last 10 days with citalopram (Cipramil). Since the start of treatment the patient has developed impotence problems. Is this a known side-effect of citalopram?

Sammanfattning: Sexual dysfunction including impotence problems are known to occur with specific serotonin reuptake inhibitors, although in a lesser extent than with traditional tricyclic antidepressants or MAO inhibitors. Only one case of impotence has been reported to SADRAC in treatment with citalopram.

Svar: Antidepressants are a commonly used group of prescription drugs implicated in impotence. Both tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) are believed to have central and peripheral actions accounting for observed erectile dysfunction. Tricylic antidepressants have been associated with elevated serum prolactin levels and erectile dysfuntion. The MAOIs, associated with a higher incidence of sexual dysfunction, interfere with the metabolism of sympathomimetic amines and also cause central sedation. It has been reported that 16-31 per cent of patients complained of sexual dysfunction using MAOIs.

Using the selective serotonin reuptake inhibitor fluoxetine (a serotonin uptake inhibitor registered in the US) which has a lower sedation and anticholinergic adverse effect profile, only 8.3 per cent of patients experienced impotence-related side-effects according to (1). Sixteen out of 160 patients (10 per cent) reported decreased libido in a study on fluoxetine (2). A second serotonin reuptake inhibitor, sertraline, (only available on licence) has been associated with a 16.5 per cent incidence of sexual dysfunction in 156 men with retarded ejaculation as the most frequent effect (1). The lowest incidence of sexual dysfunction according to this reference (1) has been showed with fluvoxamine (0.01 per cent). The figure for paroxetine was stated to 3 per cent (1).

SADRAC contains one report of inhibited ejaculation associated with citalopram treatment. It was a 51-year-old man with depression who started treatment with citalopram (20 mg per day). After one week, ejaculation disturbances started. However, citalopram treatment was continued.

In FASS decreased libido and ejaculation disturbances are mentioned as less common side-effects associated with citalopram treatment.

We have also done a thorough literature search including relevant pharmacological handbooks, Medline and Drugline, but no further information could be found concerning citalopram and sexual dysfunction.

We recommend this case to be reported to SADRAC.