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Erectile dysfunction (ED) affects people of all ages and across the globe. Though ED is most common in men over 40 years old, erectile dysfunction can happen frequently in younger men, too. Experiencing occasionally low sex drive or difficulty getting or maintaining an erection every now and then is perfectly normal. However, ongoing erectile dysfunction could be a sign of an underlying medical issue or a side effect of certain medications (Sooriyamoorthy, 2022). Drugs that can cause erectile dysfunction include antidepressants, blood pressure medications, stimulants, antihistamines, and more.
Continue reading to learn more about what common drugs can cause ED and why.
Drugs with sexual side effects
Believe it or not, an erection is a highly complex and surprisingly fragile process. It involves chemical signals, nerve impulses, complicated blood flow and blood pressure changes, along with the interplay between your heart, hormones, and even your mood.
When a medication changes how one of these systems works, it’s possible that a person’s ability to get or maintain an erection sufficient for satisfying sex will be impacted. Premature ejaculation, delayed ejaculation, reduced sensation, and decreased libido (sex drive) can also occur as a result of taking certain medications (Huri, 2017). In other words, ED and sexual dysfunction are possible side effects of many prescription drugs.
Medications that cause erectile dysfunction
Many medications affect the body through mechanisms that may help resolve a significant health problem (like high blood pressure or depression) but can also affect sexual function. Some drugs that cause erectile dysfunction include:
- Selective serotonin reuptake inhibitors (SSRIs): Several antidepressants, especially SSRIs, can impact your ability to get an erection. Researchers believe this happens because of their impact on hormones and chemical signals involved in sexual function (Rothmore, 2020). Because ED can itself be a symptom of depression and anxiety, treating it can be tricky in patients whose medication exacerbates sexual dysfunction, potentially worsening mental health issues (Jing, 2016). But don’t fret. There are options available to help you address your mental health issues without exacerbating ED.
Blood pressure medications
- Thiazide diuretics (e.g., hydrochlorothiazide): These diuretics (medications that cause you to urinate excess fluid) may impact sexual function through their influence on blood pressure and blood flow (including to the penis). Still, we don’t fully understand how these drugs affect ED.
- Beta-blockers (e.g., metoprolol, propranolol, atenolol): Beta-blockers are blood pressure drugs that frequently cause erectile dysfunction. This happens because they dampen the sympathetic nervous system, which plays a key role in getting and maintaining an erection (Terentes-Printzios, 2021).
- Amphetamine/dextroamphetamine (Adderall): Amphetamines, like Adderall, may cause erectile dysfunction and other sexual side effects. It impacts the cardiovascular system (including blood flow and constriction of blood vessels), which can impede a person’s ability to get and maintain an erection (Sharbaf Shaor, 2022; Chou, 2015).
- Diphenhydramine (Benadryl): Benadryl and other antihistamines can temporarily reduce sexual desire and cause ED through their impact on histamines. While histamines cause allergic discomfort, they play a positive role in the process of getting and maintaining a healthy erection (Mondillo, 2018).
- Chemotherapy and radiation: Sexual function and desire can be impacted in many ways by a cancer diagnosis. Chemotherapy and radiation can cause erectile dysfunction with their physiological impact on sexual function, as well as the emotional stress and physical discomfort of undergoing these treatments (MedlinePlus, 2021).
- Oxycodone (OxyContin and Percocet) and hydrocodone (Vicodin): Opioid pain medications are effective for managing pain but can also suppress other bodily systems. They can lower the body’s testosterone levels, which can impact sex drive and the ability to have an erection (Sooriyamoorthy, 2022; Semet, 2017).
Acid reflux medication
- Cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac): Like antihistamines, these acid reflux drugs are known to reduce sexual desire and function in men by affecting histamine, which plays a role in getting and maintaining an erection (MedlinePlus, 2021; Chou, 2015).
- Finasteride (Propecia or Proscar): Finasteride (see Important Safety Information) is used to treat benign prostatic hypertrophy (BPH) and hair loss in men. There is some evidence that the drug can impact sexual desire and function through its effects on testosterone and dihydrotestosterone (Shin, 2019).
- Some antiepileptic drugs (e.g., gabapentin, valproate, topiramate, pregabalin): Some drugs used to treat epileptic seizures are known to decrease libido and make it difficult for a person with a penis to orgasm or ejaculate. However, other antiepilepsy drugs like lamotrigine may improve sexual function (Yang, 2016).
- Antipsychotics (e.g., risperidone, haloperidol): Some drugs that are used to treat psychosis (a symptom of some mental health disorders like schizophrenia) can reduce libido, which can impact sexual performance (Park, 2012).
Drugs that cause erectile dysfunction: what can you do about it?
Addressing ED that arises when taking a new medication can be a complex and sensitive process. Unfortunately, many patients respond by stopping an important medication, which can be unsafe and often unnecessary (Scranton, 2013).
There are many available options to treat ED caused by medication. You can work with your healthcare provider to adjust your dose, try a different medication, or—if stopping treatment isn’t an option—try ED medication (like Viagra; see Important Safety Information), which is safe and effective for most people. Some people with certain medical conditions or who take certain medications may not be eligible for ED medication. Talk to your healthcare provider to find out if ED medication is the right choice for you.
It’s important to remember that the interplay between physical, emotional, and pharmaceutical factors contributing to ED are complicated. Erections are closely linked to mental and emotional factors like confidence, mood, and stress (all of which can be affected by a serious medical condition, too). What’s more, ED is often a symptom of the health conditions that necessitate the medications, which themselves may also cause ED as a side effect (Huri, 2017).
If you experience erectile dysfunction after taking a new medication, have an honest conversation with your healthcare provider. Fortunately, there are many options you and your provider can explore to ensure you are physically and sexually healthy, without sacrificing necessary medication.
- Chou, N. H., Huang, Y. J., & Jiann, B. P. (2015). The Impact of Illicit Use of Amphetamine on Male Sexual Functions. The Journal of Sexual Medicine, 12(8), 1694–1702. doi:10.1111/jsm.12926. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26147855/
- Huri, H., Ling, C., & Razack, A. (2017). Drug-related problems in patients with erectile dysfunctions and multiple comorbidities. Therapeutics and Clinical Risk Management, 13, 407-419. doi:10.2147/TCRM.S118010. Retrieved from https://ncbi.nlm.nih.gov/pmc/articles/PMC5384729/
- Jing, E. & Straw-Wilson, K. (2016). Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review. Mental Health Clinician, 6(4), 191-196. doi:10.9740/mhc.2016.07.191. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007725/
- Medline Plus. (2021). Drugs that may cause erection problems. NIH National Library of Medicine. Retrieved from https://medlineplus.gov/ency/article/004024.htm
- Mondillo, C., Varela, M. L., Abiuso, A. M. B., et al. (2018). Potential negative effects of anti-histamines on male reproductive function, Reproduction, 155(5), R221-R227. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29523718/
- Park, Y., Kim, Y., & Lee, J. (2012). Antipsychotic-induced sexual dysfunction and its management. World Journal of Men’s Health, 30(3), 153–159. doi:10.5534/wjmh.2012.30.3.153 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623530/
- Rothmore, J. (2020). Antidepressant-induced sexual dysfunction. The Medical Journal of Australia, 212(7). doi:10.5694/mja2.50522. Retrieved from https://www.mja.com.au/system/files/issues/212_07/mja250522.pdf
- Scranton, R., Goldstein, I., & Stecher, V. (2013). Erectile dysfunction diagnosis and treatment as a means to improve medication adherence and optimize comorbidity management. The Journal of Sexual Medicine,10(2), 551-561. doi:10.1111/j.1743-6109.2012.02998.x. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1743609515302575
- Semet, M., Paci, M., Saïas-Magnan, J., et al (2017). The impact of drugs on male fertility: a review. Andrology, 5(4), 640–663. doi:10.1111/andr.12366. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28622464/
- Sharbaf Shaor, N., Marwaha, R., & Molla, M. (2022). Dextroamphetamine and amphetamine. StatPearls. Retrieved on Nov. 8, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK507808/
- Shin, Y., Karna, K., Choi, B., & Park, J. (2019). Finasteride and erectile dysfunction in patients with benign prostatic hyperplasia or male androgenetic alopecia. World Journal of Men’s Health, 37(2), 157–165. doi:10.5534/wjmh.180029. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479090/
- Sooriyamoorthy, T. & Leslie, S. W. (2022). Erectile dysfunction. StatPearls. Retrieved on Nov. 8, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK562253/
- Terentes-Printzios, D., Iokeimidis, N., Rokkas, K., & Vlachopoulos, C. (2021). Interactions between erectile dysfunction, cardiovascular disease and cardiovascular drugs. Nature Reviews Cardiology, 19, 59–74. doi:10.1038/s41569-021-00593-6. Retrieved from https://www.nature.com/articles/s41569-021-00593-6
- Yang, Y. & Wang, X. (2016). Sexual dysfunction related to antiepileptic drugs in patients with epilepsy. Expert Opinion on Drug Safety, 15(1), 31-42. doi:10.1517/14740338.2016.1112376. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26559937/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.