ReviewTopiramate-associated sexual dysfunction: A systematic review

- Limited polytherapy observational studies show that the frequency of topiramate-associated SD is 9.0%.
- Women mainly suffers anorgasmia whereas men principally erectile dysfunction.
- Topiramate causes sexual dysfunction under recommendation dose.
- Substitution or dose reduction of topiramate generally attenuates SD.

IntroductionSexual pharmacotoxicity renders patients with epilepsy at a risk for sexual dysfunction (SD). This study is aimed to analyze the relationship between sexual function and topiramate to avoid topiramate-associated SD.MethodsA systematic review following the PRISMA guidelines was performed to elucidate any SD occurrence in patients receiving topiramate.ResultsA total of 17 publications were reviewed. Based on limited polytherapy observational studies, the frequency of self-reported topiramate-associated SD, libido disorder, and orgasmic disorder in patients with polytherapy was 9.0%, 9.0%, and 2.6%, respectively (grade C evidence). Female patients mainly had anorgasmia, whereas male patients principally had erectile dysfunction. The daily dose of topiramate in patients with SD was within the recommended dose. Sexual adversity usually occurred from 4 weeks after topiramate use but favorably subsided without eventful complications after topiramate substitution or dose reduction in all patients.ConclusionsTopiramate can elicit different patterns of SD, especially anorgasmia in women and erectile dysfunction in men, even with a therapeutic dose. Detailed drug education and careful monitoring are necessary to maximize sexual health, especially in persons undergoing polytherapy and with other risks for SD. Moreover, a rapid response, such as substitution or reduction of the dose, is suggested when SD occurs during its use.