Safety Update for SSRI and SNRI Medicines

The Therapeutic Goods Administration (TGA) has issued a safety update for selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs). The product information for these medicines previously contained warnings of the potential for sexual dysfunction. These documents will now consistently advise that these adverse effects can persist after patients stop treatment.

Medicines affected by this issue are:

• SSRIs – citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline; and
• SNRIs – desvenlafaxine, duloxetine, and venlafaxine.

Sexual dysfunction associated with SSRIs and SNRIs may include reduced libido, erectile dysfunction, ejaculation disorder, priapism, genital numbness, and dyspareunia. It is estimated that these effects resolve with continued use of the medication in up to 10% of patients. However, for some patients, these effects may persist for weeks or even years after discontinuing therapy.

The term post-SSRI sexual dysfunction (PSSD) was formally described in 2006. The prevalence of this condition is unknown, and symptoms are likely to be underreported. It is known that many patients are hesitant to discuss sexual issues with their prescriber. One study demonstrated that 14% of individuals spontaneously reported sexual dysfunction, while 58% reported sexual dysfunction when directly asked. As sexual adverse effects can have a negative impact on patient compliance and treatment prognosis, it is important for healthcare professionals to be proactive in this area.

The TGA encourages reporting of all suspected adverse effects.