SexRx: Clonidine and your sex life

What This Medication Is Most Often Prescribed For

• High blood pressure
• Opiate or alcohol withdrawal
• Smoking cessation
• Glaucoma (topically)

How This Medication Works

Possible sexual side effects:

• Decreased sexual desire in both men and women
• Impotence
• Delayed or failure of ejaculation

How This Medication Can Affect Sexual Function

Clonidine is believed to prevent sexual stimulation or act as a sexual depressant. This may be due to one or more of the following actions of clonidine:

• Inhibiting stimulation of brain regions that regulate sexual activity by reducing the action of certain neurotransmitters (e.g., epinephrine)
• Reinforcing the action of other neurotransmitters (opiates and serotonin) that reduce sexual activity
• Producing mild sedation, which may improve sexual dysfunction caused by nervousness and anxiety (However, this sedative action can also decrease sex drive.)

Treatment Options

Wait it out

As you adjust to your new medication, the sexual side effects may go away.

Decrease the dosage

Oral clonidine doses of 0.2-0.8 mg/day have been associated with fewer sexual side effects than doses greater than 1.0 mg/day. Never change the amount of this medication that you take without first talking it over with your doctor.

The transdermal clonidine patch requires a lower dose of medicine to achieve a therapeutic effect equal to oral clonidine. Ask your doctor if this patch will work for you.

Switch medications

Depending on your condition, there may be other medications that can manage your medical symptoms without affecting sexual function. If switching is appropriate for you, your options include:

• Alpha-1 antagonists, such as prazosin or terazosin
• ACE inhibitor

Ask your doctor if switching medications is an option for you.

Try an antidote

Taking an antidote involves maintaining your current level of medication, while adding a second medication to offset the sexual side effects. Adding an additional medication to counteract the adverse effects of another should always be considered a last resort, because the antidote can also cause side effects and adversely interact with certain drugs. It is essential to discuss any other medications you are taking with your doctor.

Two drugs that have been used as antidotes are:

• Amantadine (Symmetrel) – Several case reports have shown amantadine to be an effective antidote for medication-related sexual dysfunction, however it has not yet been proven effective in a double-blind clinical study, which is the gold standard for drug efficacy.
• Sildenafil (Viagra) – Commonly known as a treatment for male impotence, sildenafil may also help women with sexual dysfunction. However, the expense of this drug may prohibit many patients from using it.

Consider herbal supplements

The efficacy of herbal supplements in treating sexual side effects of various medications is not clear. There have not been any double-blind clinical studies, only case reports, some of which have shown positive effects and others that have shown no effects. Care should also be taken with herbal products because they are not strictly regulated, as drugs are, and may interact negatively with certain medications. Ask your doctor about these two herbs commonly used to treat sexual dysfunction associated with medications:

• Yohimbine
• Ginkgo