Off-Label Cabergoline for Anorgasmia

One of the neat things about prescribing medicines is that once a medication has been approved by the Food & Drug Administration for any given indication, physicians are free to prescribe it "off-label" for any other purpose.  Obviously this requires a lot of trust on the part of the patient.  But it also allows for innovation & pushing of boundaries by practitioners.

When I first went to medical school (a quarter century ago!), we used the phrase "standing on the shoulders of giants".  In other words, we are able to accomplish much today because of visionaries & leaders before us.  And so it takes brave & bold men & women to clear a path in new & different directions.

I mention all this as a preface to an abstract presented at the annual meeting of the American Urologic Association last month in which 50 of 72 men noted improvement in their orgasms and 26 of those 50 noted return of normal orgasm, all as a result of cabergoline, a dopamine receptor agonist.  We've known of dopamine for quite a while as involved in reward-driven learning.  Dopamine is also important in movement control, as seen from its absence in Parkinson's disease.  Dopamine is a precursor to noradrenaline and adrenaline as well as serving as a neurotransmitter in its own right.

Cabergoline is typically offered to patients w/hyperprolactinemia in an attempt to increase dopamine and thereby decrease prolactin.  While hyperprolactemia resulting from a prolactinoma is relatively rare, anorgasmia from anti-depressant and/or anti-psychotic use is prevalent.  The latter is associated with an increase in prolactin which has been noted to increase transiently post-orgrasm (thus preventing another one), thus preventing another.  Anorgasmia is such a well-known side effect especially of the selective serotonin reuptake inhibitors (SSRIs) that physicians have started prescribing off-label use of SSRIs to treat premature ejaculation, the exact opposite of anorgasmia.

So not suprisingly, once you get around & over all the physiology, it makes sense that cabergoline might help patients reach orgasm when they previously couldn't.  All the male patients received 0.5mg twice weekly.  A boost of testosterone in any shape or form was also useful in reaching orgasm.  

Take home points for today?  Cabergoline, used to treat hyperprolactinemia, is associated w/improvement in orgasm in men average age 63yo who took it  for close to 9mo to a year.  So if you're unable to reach orgasm as a result of SSRI's, perhaps off-label use of cabergoline might make a difference.

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