PMID- 29034101
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220318
IS  - 2056-4724 (Print)
IS  - 2056-4724 (Electronic)
IS  - 2056-4724 (Linking)
VI  - 3
IP  - 5
DP  - 2017 Sep
TI  - Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with 
      literature review.
PG  - 249-253
LID - 10.1192/bjpo.bp.117.005538 [doi]
AB  - BACKGROUND: Optimal anti-epileptic drug (AED) treatment maximises therapeutic 
      response and minimises adverse effects (AEs). Key to therapeutic AED treatment is 
      adherence. Non-adherence is often related to severity of AEs. Frequently, 
      patients do not spontaneously report, and clinicians do not specifically query, 
      critical AEs that lead to non-adherence, including sexual dysfunction. Sexual 
      dysfunction prevalence in patients with epilepsy ranges from 40 to 70%, often 
      related to AEDs, epilepsy or mood states. This case reports lamotrigine-induced 
      sexual dysfunction leading to periodic non-adherence. AIMS: To report 
      lamotrigine-induced sexual dysfunction leading to periodic lamotrigine 
      non-adherence in the context of multiple comorbidities and concurrent 
      antidepressant and antihypertensive pharmacotherapy. METHOD: Case analysis with 
      PubMed literature review. RESULTS: A 56-year-old male patient with major 
      depression, panic disorder without agoraphobia and post-traumatic stress disorder 
      was well-controlled with escitalopram 20 mg bid, mirtazapine 22.5 mg qhs and 
      alprazolam 1 mg tid prn. Comorbid conditions included complex partial seizures, 
      psychogenic non-epileptic seizures (PNES), hypertension, gastroesophageal reflux 
      disease and hydrocephalus with patent ventriculoperitoneal shunt that were 
      effectively treated with lamotrigine 100 mg tid, enalapril 20 mg qam and 
      lansoprazole 30 mg qam. He acknowledged non-adherence with lamotrigine secondary 
      to sexual dysfunction. With lamotrigine 300 mg total daily dose, he described no 
      libido with impotence/anejaculation/anorgasmia. When off lamotrigine for 48 h, he 
      described becoming libidinous with decreased erectile dysfunction but persistent 
      anejaculation/anorgasmia. When off lamotrigine for 72 h to maximise sexual 
      functioning, he developed auras. Family confirmed patient's consistent monthly 
      non-adherence for 2-3 days during the past year. CONCLUSIONS: Sexual dysfunction 
      is a key AE leading to AED non-adherence. This case describes dose-dependent 
      lamotrigine-induced sexual dysfunction with episodic non-adherence for 12 months. 
      Patient/clinician education regarding AED-induced sexual dysfunction is warranted 
      as are routine sexual histories to ensure adherence. DECLARATION OF INTEREST: No 
      financial interests. K.R.K. is Editor of BJPsych Open; he took no part in the 
      peer-review of this work. COPYRIGHT AND USAGE: (c) The Royal College of 
      Psychiatrists 2017. This is an open access article distributed under the terms of 
      the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
FAU - Kaufman, Kenneth R
AU  - Kaufman KR
AD  - , MD, FRCPsych, DLFAPA, FAES, Departments of Psychiatry, Neurology and 
      Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New 
      Jersey, USA.
FAU - Coluccio, Melissa
AU  - Coluccio M
AD  - , BS, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New 
      Brunswick, New Jersey, USA.
FAU - Sivaraaman, Kartik
AU  - Sivaraaman K
AD  - , MD, Department of Neurology, Rutgers Robert Wood Johnson Medical School, New 
      Brunswick, New Jersey, USA.
FAU - Campeas, Miriam
AU  - Campeas M
AD  - , BA, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New 
      Brunswick, New Jersey, USA.
LA  - eng
PT  - Journal Article
DEP - 20171004
PL  - England
TA  - BJPsych Open
JT  - BJPsych open
JID - 101667931
PMC - PMC5627137
EDAT- 2017/10/17 06:00
MHDA- 2017/10/17 06:01
PMCR- 2017/10/04
CRDT- 2017/10/17 06:00
PHST- 2017/07/07 00:00 [received]
PHST- 2017/08/07 00:00 [revised]
PHST- 2017/08/23 00:00 [accepted]
PHST- 2017/10/17 06:00 [entrez]
PHST- 2017/10/17 06:00 [pubmed]
PHST- 2017/10/17 06:01 [medline]
PHST- 2017/10/04 00:00 [pmc-release]
AID - S2056472400002349 [pii]
AID - bjporcpsych005538 [pii]
AID - 10.1192/bjpo.bp.117.005538 [doi]
PST - epublish
SO  - BJPsych Open. 2017 Oct 4;3(5):249-253. doi: 10.1192/bjpo.bp.117.005538. 
      eCollection 2017 Sep.