Bupropion for Sexual Dysfunction

CLINICAL ACTIONS:

Bupropion for sexual dysfunction can be helpful when the patient’s concerns are arousal and orgasm. Bupropion is not indicated for sexual desire problems that do not include issues with arousal and orgasm.

  • Bupropion sustained-release 150 – 400 mg per day has been studied for the treatment of Hypoactive Sexual Desire Disorder (HSDD)
    • Start at lower dose
    • Follow up at 2-4 weeks
    • Most patients do not have trouble tolerating the medication

SYNOPSIS: 

Bupropion, a norepinephrine-dopamine reuptake inhibitor, is commonly used and has been approved for depression and smoking cessation.  Following multiple studies, it is also used off-label for the treatment of HSDD. While dopamine is often associated with addiction and craving, it is also effective in aiding the access of pleasurable response. Data from studies in individuals who are not depressed indicate that the drug is useful in the setting of orgasmic dysfunction, separate from antidepressive properties it may have.

KEY POINTS:

  • If after a month, the patient experiences little to limited improvement in orgasmic capability, either in ease of producing an orgasm or quality of orgasm, dose can be raised up to 400 milligrams
  • Blood pressure should be monitored before prescription and after a month as bupropion can raise blood pressure
  • Safety data for bupropion specifically for HSDD are not available but common side effects seen when used for depression include
    • tremor (13.5%), agitation (9.7%), dry mouth (9.2%), constipation (8.7%), excessive sweating (7.7%), dizziness (6.1%), and nausea/vomiting (4%)
    • Adverse events caused discontinuation of treatment in approximately 10% of study participants
  • Contraindications include but are not limited to the following (see FDA information in ‘Learn More’ Below)
    • Seizure disorder
    • Current or previous bulimia or anorexia nervosa
    • Monoamine Oxidase Inhibitors (MAOIs)
    • Patient is already on bupropion for smoking cessation

Learn More – Primary Sources:

ISSWSH Expert Consensus Panel Review: Hypoactive Sexual Desire Disorder 

Effect of Bupropion-SR on Orgasmic Dysfunction in Nondepressed Subjects: A Pilot Study

Disorders of Orgasm in Women: A Literature Review of Etiology and Current Treatments

Cochrane Review: Strategies for managing sexual dysfunction induced by antidepressant medication

FDA: Bupropion-SR

 

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