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Updated: Feb 28, 2026

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Topiramate-associated sexual dysfunction: A systematic review.

Louis Wei-Hsi Chen1, Melody Yun-Si Chen2, Kuo-Yen Chen3

  • 1Graduate School of Human Sexuality, Shu-Te University, Kaohsiung City, Taiwan; Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Kaohsiung City, Taiwan.

Epilepsy & Behavior : E&B
|June 13, 2017
PubMed
Summary

Topiramate can cause sexual dysfunction (SD), including anorgasmia in women and erectile dysfunction in men. Prompt dose adjustment or drug substitution can resolve these issues, emphasizing the need for patient education and monitoring.

Keywords:
Erectile dysfunctionLibidoOrgasmSexual dysfunctionTopiramate

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Area of Science:

  • Neurology
  • Pharmacology
  • Sexual Medicine

Background:

  • Patients with epilepsy are at increased risk for sexual dysfunction (SD) due to pharmacotoxicity.
  • Topiramate is an antiepileptic drug that may contribute to SD.

Purpose of the Study:

  • To analyze the relationship between topiramate use and sexual function.
  • To identify and prevent topiramate-associated SD.

Main Methods:

  • A systematic review adhering to PRISMA guidelines was conducted.
  • 17 publications were analyzed to identify occurrences of SD in patients using topiramate.

Main Results:

  • Topiramate-associated SD, libido disorders, and orgasmic disorders occurred in 9.0%, 9.0%, and 2.6% of patients on polytherapy, respectively (Grade C evidence).
  • Anorgasmia was more common in females, while erectile dysfunction was prevalent in males.
  • SD typically emerged within 4 weeks of initiating topiramate but resolved upon dose reduction or drug substitution.

Conclusions:

  • Topiramate can cause various forms of SD, including anorgasmia and erectile dysfunction, even at therapeutic doses.
  • Vigilant monitoring and patient education are crucial for managing sexual health, particularly in patients on polytherapy.
  • Early intervention through dose modification or switching medication is recommended upon the onset of SD.