Substituted benzamides such as sulpiride, levosulpiride, and amisulpride raise serum prolactin. The resultant hyperprolactinemia may occasion sexual adverse effects such as decreased sexual drive and poor erectile function. Herein, we report a case of amisulpride-related ejaculatory delay, a sexual adverse effect more commonly associated with serotonin reuptake inhibitor therapy.
Mr. P, a 32-year-old male with a seven-year history of schizophrenia developed ejaculatory dysfunction shortly after marriage. He had been receiving amisulpride at a dose of 100 mg/day for the past 18 months without symptoms of sexual dysfunction. After the onset of ejaculatory delay, for reasons apparently related to his psychiatric status, his physician raised the dose of amisulpride to 200 mg/day and maintained the dose at this level for the next four months. During this time the complaint of ejaculatory delay transformed to decreased libido and anorgasmia. The anorgasmia was apparent even during masturbation and despite the intact ability to achieve an adequate erection.
He reported his sexual complaints at this stage. Amisulpride was immediately withdrawn and he was advised zotepine at a dose that was rapidly stepped up to 100 mg/day; serum prolactin, which was estimated at 39 ng/ml just before the discontinuation of amisulpride, decreased to 5 ng/ml three months after the initiation of zotepine. His sexual functioning normalized within a month of the initiation of zotepine, and this improvement was maintained at an 8-month follow up.
It is unclear why ejaculatory delay developed after 18 months of uneventful treatment with amisulpride 100 mg/day; perhaps the differences between coital and masturbatory demands were responsible. There was, however, a clear relationship between the escalation of amisulpride dose from 100 mg/day to 200 mg/day and the development of anorgasmia despite intact erectile functioning. A PubMed search using the search terms amisulpride with sexual dysfunction, ejaculatory delay, or anorgasmia was conducted on October 23, 2012, and no precedents were found. However, in other searches, one report was identified which described the use of low-dose levosulpride to successfully treat premature ejaculation; in this study, the prolongation of ejaculatory latency was unrelated to serum prolactin levels, and the authors hypothesized that increased dopaminergic activity associated with low dose levosulpride may have improved erectile functioning and hence improved the ability of the patients to maintain erection during longer intercourse. The mechanism of amisulpride-associated ejaculatory dysfunction in our patient is therefore obscure. We believe that our report of ejaculatory dysfunction with low dose amisulpride therapy may be the first in literature.
1. Bostwick JR, Guthrie SK, Ellingrod VL. Antipsychotic-induced hyperprolactinemia Pharmacotherapy. 2009;29:64–73
2. Inder WJ, Castle D. Antipsychotic-induced hyperprolactinaemia Aust N Z J Psychiatry. 2011;45:830–7
3. Porst H. An overview of pharmacotherapy in premature ejaculation J Sex Med. 2011;8(Suppl 4):335–41
4. Greco E, Polonio-Balbi P, Speranza JC. Levosulpiride: A new solution for premature ejaculation? Int J Impot Res. 2002;14:308–9