Short communication An open-label series using loratadine for the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors Branka Aukst-Margetic ´ * , Branimir Margetic ´ Neuropsychiatric Hospital ‘‘Dr. Ivan Barbot’’ Vinogradska 55, Popovac ˇa 44317, Croatia Accepted 6 April 2005 Available online 23 May 2005 Abstract Objective: To assess the impact of loratadine as an add-on treatment of erectile dysfunctions associated with selective serotonin reuptake inhibitors (SSRIs). Methods: Nine patients diagnosed as major depressive disorder (MDD), with erectile dysfunction associated with the administration of SSRIs, completed a 2-week trial of loratadine in the dose of 10 mg/day. The International Index of Erectile Function Five (IIEF-5) was used as an assessment measure for diagnosing the presence and severity of erectile dysfunction. The 17-item Hamilton Rating Scale for Depression (HAM-D) was administered for screening the potential impact of depressive symptoms. Results: Baseline mean S.D. T IIEF-5 scores were 10.33 T 4.55 (range 5 – 20) and week 2 mean T S.D. IIEF-5 was 14.44 T 3.84 (range 10 – 22). Subjects had statistically significant improvement in their erectile functions on the IIEF-5 (t = À8.485; df =8; p = 0.000) and 55% reported subjective improvement of the erectile function. No significant changes on HAM-D 17 scores were registered. Baseline mean S.D. scores were 13.66 T 2.29 (range 10–17) and week 2 mean S.D. was 13.11 T 1.96 (range 10 – 16) (t = 1.47; df =8; p = 0.179). Conclusion: Our findings suggest the possible role of loratadine in the treatment of SSRI-associated sexual dysfunction. They are promising, but preliminary. Thus they should be replicated in a longer large-scale, double-blind, placebo-controlled trial. D 2005 Elsevier Inc. All rights reserved. Keywords: Erectile dysfunction; Loratadine; SSRI 1. Introduction Sexual dysfunctions as a side effect of antidepressant treatment with selective serotonin reuptake inhibitors (SSRIs) are common, occurring in at least one third of patients. They include erectile dysfunction, delayed ejacu- lation, anorgasmia, and decreased libido, and are observable in therapy with all kinds of SSRIs in varying frequencies (Rosen and Marin, 2003). They have been attributed to: increased serotonin activity on the serotonin type 2 (5-HT 2 ) and type 3 (5-HT 3 ) receptors inhibiting dopaminergic systems, inhibition of a-adrenergic and cholinergic recep- tors in genitourinary tract, or reduced nitric oxide produc- tion (Rosen and Marin, 2003; Labbate et al., 2003; Angulo et al., 2001). Their negative impact on patients’ quality of life may lead to medication non-compliance and conse- quently to relapse (Rotschild, 2000). Strategies used to treat these side effects include dose reduction, waiting for tolerance to develop, switching to a different antidepressant drug, and addition of antidotes such as ginko biloba, cyproheptadine, nefazodone (5-HT 2 antagonists), buspirone (5-HT 1A agonist), bethanechol (cholinergic), amantidine, methylphenydate, bupropion (dopaminergic), and yohim- bine (adrenergic), with varying degrees of success (Labbate et al., 2003; Rotschild, 2000). For most of them, available data are limited to case reports or small open-case series 0278-5846/$ - see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.pnpbp.2005.04.007 Abbreviations: DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; H, histamine; HAM-D, Hamilton Rating Scale for Depression; IIEF-5, International Index of Erectile Function Five; MDD, major depressive disorder; 5-HT, serotonin; SSRI, selective serotonin reuptake inhibitor. * Corresponding author. Fax: +385 44679005. E-mail address: branka.aukst-margetic@zg.htnet.hr (B. Aukst-Margetic ´). Progress in Neuro-Psychopharmacology & Biological Psychiatry 29 (2005) 754 – 756 www.elsevier.com/locate/pnpbp