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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Erectile dysfunction (ED) affects men of all ages and across the globe. It is most common in men over 40 years old, though it happens frequently in younger men, too. While having occasional problems with erections is normal, ongoing ED is often a sign of an underlying medical issue, or it can be a side effect of a medication (Sooriyamoorthy, 2021).
Read on to learn more about what common drugs can cause ED and why.
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Why do some drugs cause erectile dysfunction?
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 is 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 happen (Huri, 2017). In other words, ED and sexual dysfunction are possible side effects of many prescription drugs.
What drugs can 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 of these medications include:
- Selective serotonin reuptake inhibitors (SSRIs): Several antidepressants, especially SSRIs, can impact your ability to get an erection. Researchers think 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 incredibly complex in these patients when their 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 impact erectile function. This happens because they dampen the sympathetic nervous system, which plays a key role in getting and maintaining an erection (Terentes-Printzios, 2021).
Do blood pressure medications cause erectile dysfunction?
- Amphetamine/dextroamphetamine (Adderall): Adderall can 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, 2021). Another potential side effect of Adderall is reducing a person’s overall sex drive.
- 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 are also involved in having a healthy erection (MedlinePlus, 2021).
- Chemotherapy and radiation: Sexual function and desire can be impacted in many ways by a cancer diagnosis. Chemotherapy and radiation can make it worse through both 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 depress other body systems too. They can lower your body’s testosterone levels, which in turn can impact sex drive and the ability to have an erection (Sooriyamoorthy, 2021).
Acid reflux medication
- Cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac): These acid reflux drugs are known to reduce sexual desire and function in men by affecting histamine (similar to the reason that antihistamines can also cause ED) (MedlinePlus, 2021).
Erectile dysfunction and diabetes: are they linked?
- 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 it 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 man to orgasm or ejaculate. However, other antiepilepsy drugs like lamotrigine may improve sexual function (Yang, 2016).
- Antipsychotics (e.g., aripiprazole, risperidone): 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).
What can I do to fix my drug-related ED?
There are many simple options to fix ED caused by medication. You can work with your healthcare provider to adjust your dose, switch to a different medication, or—if stopping your treatment isn’t an option—simply try ED medication, which is safe and effective.
It’s important to remember that the interplay between physical, emotional, and pharmaceutical factors contributing to ED are complicated. Erections are so 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).
This is all to say that addressing ED that arises when taking a new medication can be a complex and sensitive process. Unfortunately, many patients will respond by stopping an important medication, which is risky and unnecessary (Scranton, 2013). Having an honest, open conversation with your healthcare provider is the first step. Fortunately, there are many routes you and your healthcare provider can take together to make sure you are both physically healthy and can enjoy a satisfying sex life as well.
Go through the following questions with your healthcare provider:
Testing for erectile dysfunction
1. Is my medication still necessary?
The first step in fixing drug-related ED is to connect with your healthcare provider to reevaluate if the medication causing the problem is still necessary. Here are a couple of things your healthcare provider will look at:
- Do you still have the health problem for which you’re taking this medication? You may be able to stop taking it if your condition has sufficiently improved.
- How long have you been taking this medication? Many medication side effects, including sexual dysfunction, can resolve or improve once your body has adjusted to the medication. Some medications, like opioids or antihistamines, are taken on a short-term basis, and ED related to these drugs should resolve when you stop taking them.
Having a candid, honest conversation with your healthcare provider can help give them the fullest picture of your health issues, all the medications you are taking, and the side effects you are experiencing so they can safely guide any changes to your treatment plan.
2. Can I adjust this medication?
Many of these drugs only impair sexual function for a short time; strategically timing when you take your prescribed dose can often help. If appropriate, reducing your dose (in consultation with your provider) may also help. Remember: Never stop taking a medication or change your dose without discussing it with your provider first.
3. Is there an alternative medicine?
If your health condition still requires medication, the next step is to see whether there’s an alternative that can treat your condition without causing erection problems. An example of this is a patient taking beta-blockers (such as propranolol) to prevent migraine headaches. If the patient experiences ED as a side effect of the propranolol, it may be appropriate to switch his treatment to Topamax, which is also used to prevent migraines and isn’t generally associated with ED. Or, if a patient is taking an SSRI antidepressant and experiencing ED, it may be an option to switch to an antidepressant like buproipion (brand name Wellbutrin; see Important Safety Information) which is less associated with ED.
Many medications can be used as alternatives to one another. Speak to your healthcare provider about side effects and desired outcomes to see if you can devise a different treatment strategy that works for you.
Erectile dysfunction (ED) and mental health
4. Are ED medications right for me?
Sometimes, you just don’t have the option to stop or reduce your medication that’s contributing to ED. Maybe you’ve had a worse adverse reaction to another medication, there isn’t a good alternative drug option available, or an alternative may be unavailable in your state, health insurance plan, or budget. There are many medications designed to treat ED in these cases, such as sildenafil (brand name Viagra; see Important Safety Information) and tadalafil (brand name Cialis; see Important Safety Information). Explore the main differences between ED medications and discuss which might be right for you with your healthcare provider.
If you’re experiencing ED as a side effect of your medication, it’s a good idea to also work on some lifestyle improvements to see if they help. Things like eating healthy, exercising, quitting smoking, limiting alcohol, and getting enough sleep can all improve sexual performance (not to mention your overall health!). Reach out to your healthcare provider to discuss the next steps to maintaining both your health and a satisfying sex life.
- 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
- 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., & Stetcher, 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
- Sharbaf Shaor, N., Marwaha, R., & Molla, M. (2021). Dextroamphetamine and amphetamine. [Updated June 5, 2021]. In: StatPearls [Internet]. Retrieved on Dec. 1, 2021 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. (2021). Erectile Dysfunction. [Updated Aug. 12, 2021]. In: StatPearls [Internet]. Retrieved on Dec. 1, 2021 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/