Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature review
Background Optimal anti-epileptic drug (AED) treatment maximises therapeutic response and minimises adverse effects (AEs). Key to therapeutic AED treatment is adherence. Non-a...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2017-09-01
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| Series: | BJPsych Open |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472400002349/type/journal_article |
| _version_ | 1811157106115477504 |
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| author | Kenneth R. Kaufman Melissa Coluccio Kartik Sivaraaman Miriam Campeas |
| author_facet | Kenneth R. Kaufman Melissa Coluccio Kartik Sivaraaman Miriam Campeas |
| author_sort | Kenneth R. Kaufman |
| collection | DOAJ |
| description |
Background
Optimal anti-epileptic drug (AED) treatment maximises therapeutic
response and minimises adverse effects (AEs). Key to therapeutic AED
treatment is adherence. Non-adherence is often related to severity of
AEs. Frequently, patients do not spontaneously report, and clinicians do
not specifically query, critical AEs that lead to non-adherence,
including sexual dysfunction. Sexual dysfunction prevalence in patients
with epilepsy ranges from 40 to 70%, often related to AEDs, epilepsy or
mood states. This case reports lamotrigine-induced sexual dysfunction
leading to periodic non-adherence.
Aims
To report lamotrigine-induced sexual dysfunction leading to periodic
lamotrigine non-adherence in the context of multiple comorbidities and
concurrent antidepressant and antihypertensive pharmacotherapy.
Method
Case analysis with PubMed literature review.
Results
A 56-year-old male patient with major depression, panic disorder without
agoraphobia and post-traumatic stress disorder was well-controlled with
escitalopram 20 mg bid, mirtazapine 22.5 mg qhs and alprazolam 1 mg tid
prn. Comorbid conditions included complex partial seizures, psychogenic
non-epileptic seizures (PNES), hypertension, gastroesophageal reflux
disease and hydrocephalus with patent ventriculoperitoneal shunt that
were effectively treated with lamotrigine 100 mg tid, enalapril 20 mg qam
and lansoprazole 30 mg qam. He acknowledged non-adherence with
lamotrigine secondary to sexual dysfunction. With lamotrigine 300 mg
total daily dose, he described no libido with
impotence/anejaculation/anorgasmia. When off lamotrigine for 48 h, he
described becoming libidinous with decreased erectile dysfunction but
persistent anejaculation/anorgasmia. When off lamotrigine for 72 h to
maximise sexual functioning, he developed auras. Family confirmed
patient's consistent monthly non-adherence for 2–3 days during the past
year.
Conclusions
Sexual dysfunction is a key AE leading to AED non-adherence. This case
describes dose-dependent lamotrigine-induced sexual dysfunction with
episodic non-adherence for 12 months. Patient/clinician education
regarding AED-induced sexual dysfunction is warranted as are routine
sexual histories to ensure adherence.
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| first_indexed | 2024-04-10T05:00:29Z |
| format | Article |
| id | doaj.art-976fd8d8573e4e2aa27a716869a482c4 |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-10T05:00:29Z |
| publishDate | 2017-09-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-976fd8d8573e4e2aa27a716869a482c42023-03-09T12:28:42ZengCambridge University PressBJPsych Open2056-47242017-09-01324925310.1192/bjpo.bp.117.005538Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature reviewKenneth R. Kaufman0Melissa Coluccio1Kartik Sivaraaman2Miriam Campeas3Departments of Psychiatry, Neurology and Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USADepartment of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USADepartment of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USADepartment of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA Background Optimal anti-epileptic drug (AED) treatment maximises therapeutic response and minimises adverse effects (AEs). Key to therapeutic AED treatment is adherence. Non-adherence is often related to severity of AEs. Frequently, patients do not spontaneously report, and clinicians do not specifically query, critical AEs that lead to non-adherence, including sexual dysfunction. Sexual dysfunction prevalence in patients with epilepsy ranges from 40 to 70%, often related to AEDs, epilepsy or mood states. This case reports lamotrigine-induced sexual dysfunction leading to periodic non-adherence. Aims To report lamotrigine-induced sexual dysfunction leading to periodic lamotrigine non-adherence in the context of multiple comorbidities and concurrent antidepressant and antihypertensive pharmacotherapy. Method Case analysis with PubMed literature review. Results A 56-year-old male patient with major depression, panic disorder without agoraphobia and post-traumatic stress disorder was well-controlled with escitalopram 20 mg bid, mirtazapine 22.5 mg qhs and alprazolam 1 mg tid prn. Comorbid conditions included complex partial seizures, psychogenic non-epileptic seizures (PNES), hypertension, gastroesophageal reflux disease and hydrocephalus with patent ventriculoperitoneal shunt that were effectively treated with lamotrigine 100 mg tid, enalapril 20 mg qam and lansoprazole 30 mg qam. He acknowledged non-adherence with lamotrigine secondary to sexual dysfunction. With lamotrigine 300 mg total daily dose, he described no libido with impotence/anejaculation/anorgasmia. When off lamotrigine for 48 h, he described becoming libidinous with decreased erectile dysfunction but persistent anejaculation/anorgasmia. When off lamotrigine for 72 h to maximise sexual functioning, he developed auras. Family confirmed patient's consistent monthly non-adherence for 2–3 days during the past year. Conclusions Sexual dysfunction is a key AE leading to AED non-adherence. This case describes dose-dependent lamotrigine-induced sexual dysfunction with episodic non-adherence for 12 months. Patient/clinician education regarding AED-induced sexual dysfunction is warranted as are routine sexual histories to ensure adherence. https://www.cambridge.org/core/product/identifier/S2056472400002349/type/journal_article |
| spellingShingle | Kenneth R. Kaufman Melissa Coluccio Kartik Sivaraaman Miriam Campeas Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature review BJPsych Open |
| title | Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature review |
| title_full | Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature review |
| title_fullStr | Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature review |
| title_full_unstemmed | Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature review |
| title_short | Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature review |
| title_sort | lamotrigine induced sexual dysfunction and non adherence case analysis with literature review |
| url | https://www.cambridge.org/core/product/identifier/S2056472400002349/type/journal_article |
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