Paraphilic Disorders Medication

Updated: Dec 03, 2015
  • Author: Guy E Brannon, MD; Chief Editor: David Bienenfeld, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications. Agents employed in the management of paraphilic disorders include antidepressants, antiandrogens, phenothiazines, anxiolytics, long-acting gonadotropin-releasing hormone (GnRH) agonists, and mood stabilizers.

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Antidepressants

Class Summary

Antidepressants may be used to decrease aggression and treat underlying illness.

Fluoxetine (Prozac)

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used to treat impulse-control problems or underlying illness. It selectively inhibits presynaptic serotonin reuptake, with minimal or no effect on reuptake of norepinephrine or dopamine.

Paroxetine (Paxil, Pexeva)

Paroxetine is a potent selective inhibitor of neuronal serotonin reuptake; it also has a weak effect on norepinephrine and dopamine neuronal reuptake. Paroxetine is not FDA approved for use in children. An oral suspension is available.

Citalopram (Celexa)

Citalopram is the newest SSRI and appears to have the most benign adverse effect profile, with fewer sexual adverse effects than other SSRIs. It is not FDA approved for children. An oral solution is available.

Sertraline (Zoloft)

Sertraline is a selective inhibitor of neuronal serotonin reuptake; it also has a weak effect on norepinephrine and dopamine neuronal reuptake.

Fluvoxamine (Luvox CR)

Fluvoxamine is a potent selective inhibitor of neuronal serotonin reuptake. It does not significantly bind to alpha-adrenergic, histamine, or cholinergic receptors and thus has fewer adverse effects than do tricyclic antidepressants (TCAs).

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Antimanic agents

Class Summary

These medications serve to stabilize the patient’s mood.

Lithium (Lithobid)

Lithium is indicated for bipolar disorder. It influences reuptake of serotonin or norepinephrine at the cell membrane.

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Antidepressant, Alpha-2 Antagonists

Class Summary

The mixed serotonergic and noradrenergic drugs have effects on serotonin and norepinephrine.

Mirtazapine (Remeron)

Mirtazapine exhibits both noradrenergic and serotonergic activity. In cases of depression associated with severe insomnia and anxiety, it is superior to other SSRIs.

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Progestin

Class Summary

Antiandrogenic agents are given to reduce androgen serum levels.

Medroxyprogesterone (Depo-Provera, Provera)

Medroxyprogesterone, a derivative of progesterone, is used in the management of breast cancer, secondary amenorrhea, and abnormal uterine bleeding, as well as in contraception. It may be used to reduce sex drive.

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Antipsychotics, Phenothiazines

Class Summary

Phenothiazines are effective in treating emesis, possibly through their effects in the dopaminergic mesolimbic system.

Fluphenazine

Fluphenazine is an antipsychotic used to treat underlying illness or decrease aggression.

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Anxiolytics

Class Summary

These agents help induce impulse control.

Buspirone

Buspirone is a unique anxiolytic that differs from benzodiazepines in that it does not exert anticonvulsant or muscle relaxing effects for generalized anxiety disorder (GAD). It is a serotonin agonist with serotonergic neurotransmission and some dopaminergic effects in the central nervous system (CNS). It has an anxiolytic effect but may take as long as 2-3 weeks to achieve full efficacy.

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Luteinizing Hormone-Releasing Hormone Analog

Class Summary

Long-acting GnRH agonists are used to reduce release of gonadotropin hormones.

Triptorelin (Trelstar)

Triptorelin is a synthetic decapeptide agonist analogue of GnRH, also known as luteinizing hormone (LH)-releasing hormone (LHRH). By reducing LH, follicle-stimulating hormone (FSH), and testosterone, it may lead to reduced sex drive.

Leuprolide acetate (Lupron, Eligard)

Leuprolide is a synthetic nonapeptide analogue of GnRH. When continuously administered, it acts as a potent inhibitor of gonadotropin secretion.

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Anticonvulsants

Class Summary

These agents are used to treat bipolar disorders.

Valproic acid (Depakote, Depakene, Depacon, Stavzor)

Valproic acid is indicated for manic episodes associated with bipolar disorder. The recommended plasma concentration is 50-125 µg/mL.

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