Clinical evidence
Gabapentinoids
α2δ calcium-channel ligand·Medication side-effects
Effect across the cycle
DesireInhibitory: Decreased libido reported.
ArousalInhibitory: Reduced arousal.
PerformanceInhibitory: Erectile dysfunction common in case series.
ClimaxInhibitory: Characteristic anorgasmia and ejaculatory failure.
ExperienceNeutral: No prominent subjective-quality signature.
MemoryNeutral: Not a primary memory effect.
Mechanism
Bind the α2δ subunit of voltage-gated calcium channels, inhibiting excitatory neurotransmitter release involved in orgasm. Characteristically cause anorgasmia and ejaculatory failure, plus decreased libido and erectile dysfunction, at doses as low as 50–300 mg/day and not clearly dose-related.
Sex differences & notes
One pregabalin case series reported dysfunction in ~41% (erectile dysfunction 51.6%, anorgasmia 32.3%, low libido 35.5%).
Key sources
- Hamed, Clin Neuropharmacol 2018
- Grant & Oh, Am J Psychiatry 2002