Amitriptyline and Sexual Function: A Systematic Review Updated for Sexual Health Practice

Area of Science:

• Pharmacology
• Clinical Medicine
• Psychiatry

Background:

• Amitriptyline is a widely used first-line treatment for various conditions.
• Existing data on amitriptyline-associated sexual dysfunction (SD) is limited and outdated.
• A comprehensive understanding of SD risks with amitriptyline is needed.

Purpose of the Study:

• To systematically review the literature on amitriptyline and sexual dysfunction.
• To determine the frequency, characteristics, and predictors of SD associated with amitriptyline.
• To provide updated insights for clinical practice.

Main Methods:

• Systematic literature review following PRISMA guidelines.
• Inclusion of 14 publications, including 8 randomized clinical trials.
• Analysis of SD frequency, gender differences, types, disease specificity, and time course.

Main Results:

• Overall SD frequency was 5.7%, with 11.9% in males and 1.7% in females.
• SD was significantly higher in depressive patients (6.9%) versus non-depressive patients (0.8%).
• SD impacted male arousal and libido more, and female libido, decreasing over 8 weeks.

Conclusions:

• Amitriptyline-associated SD predominantly affects depressive and male patients.
• SD occurs across the sexual response cycle in men, primarily libido in women.
• SD risk can be predicted by co-existing insomnia, somnolence, or nausea.