alpha blockers, where postural hypotension can be
a problem. In women, sildenafil has shown promise
for reversing the inadequate lubrication and delayed
orgasm induced by selective serotonin reuptake
inhibitors.53
Changing to an alternative drug is recommended
for men and women taking antihypertensives. Alpha
blockers, ACE inhibitors and calcium channel blockers
are not considered to cause erectile dysfunction,54
while several studies have suggested that angiotensin II
receptor antagonists may even improve sexual
function. Beta1-selective beta blockers such as
nebivolol may have potential advantages in these
patients.55
In patients taking antipsychotics, establish the cause
of the hyperprolactinaemia then consider dose
reduction or switching to prolactin-sparing drugs.
Relationship counselling and addressing patient-
specific concerns can be useful.28
In women, oestrogen cream can alleviate local
symptoms such as atrophic vaginitis and dyspareunia.
If a woman complains of sexual dysfunction while
on an injectable progestogen, another form of
contraceptive can be considered.34
Suggested solutions to gabapentin-induced
anorgasmia include dose reduction, timing of dose
away from planned coitus until anorgasmia no longer
occurs, substitution with a different medication, and
co-administration of other medications.35,36