Increased libido associated with donepezil treatment: a case report

Area of Science:

• Neuroscience
• Gerontology
• Pharmacology

Background:

• Alzheimer's disease (AD) is a progressive neurodegenerative disorder.
• Behavioral and psychological symptoms of dementia (BPSD) can significantly impact patient well-being and care.
• Sexual disinhibition, though uncommon, can manifest as a challenging BPSD.

Observation:

• A 79-year-old female patient with AD experienced a notable increase in libido.
• This occurred after an escalated dosage of donepezil, an acetylcholinesterase inhibitor, concurrently administered with tianeptine.
• The patient's increased libido resolved upon donepezil withdrawal and recurred upon its reintroduction, with a Naranjo score of 7 suggesting a probable causal link.

Findings:

• Donepezil, commonly prescribed for Alzheimer's disease, may be associated with increased libido as an adverse effect.
• The case suggests a dose-dependent relationship between donepezil and hypersexual behavior.
• Acetylcholinesterase inhibitors might influence neurotransmitter systems modulating sexual behavior.

Implications:

• Clinicians should be vigilant for hypersexuality as a potential side effect of donepezil treatment in dementia patients.
• Further research is warranted to elucidate the mechanisms of acetylcholinesterase inhibitor-induced sexual side effects.
• This case highlights the importance of individualized medication management in AD to mitigate challenging behavioral symptoms.