Can buspirone be used to treat sexual side-effects caused by serotonin reuptake inhibitors?/nThe qu

Fråga: Can buspirone be used to treat sexual side-effects caused by serotonin reuptake inhibitors? The question concerns an obese 53-year-old man with atherosclerosis, diabetes, hyperlipidemia, a high ethanol intake and depression. He is treated with enalapril, aspirin, simvastatin, sildenafil and nefazodone. He suffers from decreased libido since starting the nefazodone treatment and has read on the Internet that buspirone can reverse this side-effect.

Sammanfattning: There is no solid clinical data showing a therapeutic value of buspirone in SSRI-related sexual dysfunction. The combination cannot be recommended on the basis of the current documentation.

Svar: Sexual side-effects such as decreased libido and delayed or impaired orgasm are fairly common with selective serotonin reuptake inhibitors (SSRIs) and can be treatment-limiting in many patients. In one case report it is stated that 12 out of 16 patients with SSRI-induced sexual dysfunction were much improved by buspirone treatment, that four patients experienced irritability and one patient had some kind of allergic reaction to buspirone (1).

In response to this case report, data from a study of the possible additive effects of buspirone and SSRIs on treatment-refractory depression were analysed retrospectively. Out of a total of 119 patients, 47 reported some degree of sexual dysfunction at baseline, ie after at least 4 weeks of SSRI treatment. Buspirone or placebo was added and a structured side-effect interview was performed weekly. Approximately 60 percent of the treated patients reported improvement of sexual function compared with 30 percent in the placebo group. The treatment effect was more pronounced among the 16 women (and just barely statistically significant), than among the 11 men (2).

Nefazodone is a serotonin reuptake inhibitor and 5HT-2-receptorblocker. Sexual dysfunction is not mentioned as a side-effect in the Swedish Catalogue of Approved Medical Products (FASS). A total of 184 nefazodone side-effects have been reported to the Swedish Adverse Drug Reactions Advisory Committee since 1996. There is one report concerning decreased libido and three concerning erectile or ejaculatory dysfunction.