Chen Louis Wei-Hsi, Chen Melody Yun-Si, Lian Zhi-Ping, Lin Hung-Sheng, Chien Chia-Chang, Yin Hsin-Ling, Chu Yuan-Hsiang, Chen Kuo-Yen
1 Graduate School of Human Sexuality, Shu-Te University, Kaohsiung City, Taiwan.
2 Department of Neurology, Kaohsiung Chang Gang Memorial Hospital, and College of Medicine, Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
Am J Mens Health. 2018 Mar;12(2):370-379. doi: 10.1177/1557988317734519. Epub 2017 Oct 11.
Amitriptyline is an old drug but is still prevalently used as the first-line treatment for a variety of common diseases. Surprisingly, knowledge of sexual risks with amitriptyline comes from only one clinical trial and several case reports from three decades ago. In the current study, a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) related to amitriptyline and sexual dysfunction (SD) was performed. The frequency, gender-difference, types, disease-specificity and time course of SD, and the relationship between SD and nonsexual adversity were studied. A total of 14 publications, including 8 qualified randomized clinical trials, were eligible. The frequency of SD in overall, male and female patients was 5.7, 11.9 and 1.7%, respectively. SD was six-fold higher in men than women. The frequency of SD was 6.9% in depressive patients compared with 0.8% in non-depressive patients ( p = .008), and gradually decreased at 8 weeks after treatment ( p = .02). Amitriptyline impacted arousal and libido more than orgasm and ejaculation in male patients but mainly libido in female patients. SD was significantly correlated with insomnia linearly whereas somnolence and nausea dually. Therefore, amitriptyline-associated SD mainly occurs in depressive and male patients, disturbs each phase of the sexual response cycle in men but mainly libido in women, gradually decreases under long-term treatment, and can be predicted by the co-existence of insomnia, somnolence or nausea during treatment. Clinicians should caution and tailor the gender and disease vulnerability of amitriptyline in their practice.
阿米替林是一种老药，但仍普遍用作多种常见疾病的一线治疗药物。令人惊讶的是，关于阿米替林性风险的认识仅来自一项临床试验和三十年前的几例病例报告。在本研究中，按照系统评价和荟萃分析的首选报告项目（PRISMA）对与阿米替林和性功能障碍（SD）相关的文献进行了系统评价。研究了SD的发生率、性别差异、类型、疾病特异性和时间进程，以及SD与非性不良事件之间的关系。共有14篇出版物符合条件，其中包括8项合格的随机临床试验。总体、男性和女性患者中SD的发生率分别为5.7%、11.9%和1.7%。男性SD的发生率是女性的6倍。抑郁患者中SD的发生率为6.9%，而非抑郁患者中为0.8%（p = 0.008），且在治疗8周后逐渐下降（p = 0.02）。在男性患者中，阿米替林对性唤起和性欲的影响大于性高潮和射精，但在女性患者中主要影响性欲。SD与失眠呈显著线性相关，与嗜睡和恶心呈双重相关。因此，阿米替林相关的SD主要发生在抑郁患者和男性患者中，干扰男性性反应周期的各个阶段，但在女性中主要影响性欲，在长期治疗下逐渐下降，并且可以通过治疗期间失眠、嗜睡或恶心的共存来预测。临床医生在实践中应谨慎使用阿米替林，并根据性别和疾病易感性进行调整。
