Treatment Options of Sexually Inappropriate Behavior in Dementia
1. The most common individual treatment choices were Haloperidol (15%), Thioridazine (11%), and Risperidone (10%).
- Antipsychotics are commonly used for treating behavioral and psychotic symptoms of dementia, but consider FDA black box warning for elderly.
- The antidepressants Paroxetine, Citalopram, Clomipramine and Fluoxetine have been used, with Citalopram being the most commonly prescribed of these drugs.
- Mechanism: Antidepressants (primarily SSRIs) can cause sexual dysfunction as a side effect and may offer additional benefits for other behavioral symptoms for their anti-obsessional effects.
- The anticonvulsant drugs Carbamazapine and Gabapentin, which are the only two anticonvulsants reportedly used with favorable results.
- Mechanism: not known.
- Gabapentin: known to cause reduced libido, anorgasmia, and erectile dysfunction.
- Carbamazepine: associated with lower testosterone levels in young women with epilepsy.
- Valproate salts have not proved useful.
4. Beta Blocker:
- One case report of Pindolol, a beta blocker, where Pindolol completely eliminate this behavior in 2 weeks (dose up to 40 mg)
- Mechanism: via a decrease of the adrenergic drive.
- Note: Propranolol 360 mg was effective in controlling verbal and physical aggression, but not sexually aggressive and inappropriate behavior.
- Note: beta blocker’s are contraindicated in patients with heart block and asthma
5. H2 receptor Antagonist:
- Cimetidine is a H2 receptor antagonist and also has antiandrogen effects. It blocks the androgen receptor in the pituitary or the hypothalamus, reducing sexual desire in individuals of both sexes and affecting arousal and orgasm.
6. Cholinesterase inhibitors:
- Mechansim: may affect sexual function in many ways, including altering testosterone levels, but exact mechanism not known.
- Two case reports with rivastigmine (with dose upto 3 mg).
- Note: some cases of emergence of inappropiate sexual behavior in patients taking donepezil.
7. Gonadotropin-releasing hormone analogs:
- Mechanism: suppress testosterone production by stimulating the secretion of pituitary LH and FSH, with subsequent increase in estrogen levels and decrease of testosterone.
- two case reports of the use of Leuprolide Acetate (7.5 mg intramuscularly every month).
- (A) Medroxyprogesterone: Indirectly decreases the level of testosterone by inhibiting the secretion of pituitary LH and FSH.
- (B) Cyproterone acetate: Inhibits the interaction between endogenous androgens and androgen receptors, as well as reducing the biosynthesis of androgens.
- (C) Finasteride: 5α-reductase inhibitor which inhibits the conversion of testosterone to active dihydrotestosterone.
- Annals of Long-Term Care: Clinical Care and Aging. 2015;23(6):39-42.
- Curr Treat Options Neurol (2016) 18: 41.
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Dr. Harvinder Singh, M.D. (Admin)
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