Smith P J, Talbert R L
Clin Pharm. 1986 May;5(5):373-84.
The physiology of the normal sexual response, epidemiology of sexual dysfunction, and the pharmacologic mechanisms involved in antihypertensive- and antipsychotic-induced problems with sexual function are discussed, with recommendations for patient management. The physiologic mechanisms involved in the normal sexual response include neurogenic, psychogenic, vascular, and hormonal factors that are coordinated by centers in the hypothalamus, limbic system, and cerebral cortex. Sexual dysfunction is frequently attributed to antihypertensive and antipsychotic agents and is a cause of noncompliance. Drug-induced effects include diminished libido, delayed orgasm, ejaculatory disturbances, gynecomastia, impotence, and priapism. The pharmacologic mechanisms proposed to account for these adverse effects include adrenergic inhibition, adrenergic-receptor blockade, anticholinergic properties, and endocrine and sedative effects. The most frequently reported adverse effect on sexual function with the antihypertensive agents is impotence. It is seen most often with methyldopa, guanethidine, clonidine, and propranolol. In contrast, the most common adverse effect on sexual function with the antipsychotic agents involves ejaculatory disturbances. Thioridazine, with its potent anticholinergic and alpha-blocking properties, is cited most often. Drug-induced sexual dysfunction may be alleviated by switching to agents with dissimilar mechanisms to alter the observed adverse effect while maintaining adequate control of the patient's disease state.
本文讨论了正常性反应的生理学、性功能障碍的流行病学，以及抗高血压药和抗精神病药引起性功能问题所涉及的药理机制，并给出了患者管理建议。正常性反应所涉及的生理机制包括神经源性、心理性、血管性和激素性因素，这些因素由下丘脑、边缘系统和大脑皮层中的中枢进行协调。性功能障碍常归因于抗高血压药和抗精神病药，是导致患者不依从治疗的一个原因。药物引起的影响包括性欲减退、性高潮延迟、射精障碍、男性乳房发育、阳痿和阴茎异常勃起。为解释这些不良反应而提出的药理机制包括肾上腺素能抑制、肾上腺素能受体阻滞、抗胆碱能特性以及内分泌和镇静作用。抗高血压药对性功能最常报道的不良反应是阳痿。最常出现在甲基多巴、胍乙啶、可乐定和普萘洛尔使用时。相比之下，抗精神病药对性功能最常见的不良反应涉及射精障碍。硫利达嗪因其强大的抗胆碱能和α受体阻滞特性而被提及最多。通过换用机制不同的药物，可以在维持对患者病情充分控制的同时，减轻药物引起的性功能障碍，从而改变所观察到的不良反应。
