S/x on Dr/gs Reference
← Back to the matrix
Clinical evidence

Antipsychotics (prolactin-raising)

D2 antagonist·Medication side-effects

Effect across the cycle

DesireInhibitory: Hyperprolactinemia and D2 blockade lower libido.
ArousalInhibitory: Impaired arousal and genital response.
PerformanceInhibitory: Erectile and ejaculatory impairment via alpha-blockade.
ClimaxInhibitory: Anorgasmia and ejaculatory dysfunction.
ExperienceInhibitory: Reward blunting reduces subjective quality.
MemoryNeutral: Not a primary memory effect.

Mechanism

D2 blockade in the tuberoinfundibular pathway raises prolactin, suppressing LH/FSH into hypogonadism; mesolimbic D2 blockade independently reduces libido and reward; alpha-adrenergic blockade impairs erection and ejaculation. Highest-risk agents: haloperidol, risperidone, paliperidone, amisulpride.

Pharmacokinetics
Prolactin rises early; sexual effects track exposure.
Reversibility
Improves on switching to or augmenting with a prolactin-sparing agent.

Sex differences & notes

Risperidone paradoxically has among the highest hyperprolactinemia rates due to poor blood-brain-barrier penetration and greater pituitary exposure.

Key sources

  • Serretti & Chiesa 2011