Medications That Can Cause Erectile Dysfunction

If you’re experiencing difficulty achieving or maintaining reliable erections, it’s crucial to consider your medications. Medication is responsible for erectile dysfunction in 1 out of 4 cases. Keep reading to learn more about which medications are likely culprits, which ones are not, and what steps to take if you’re having problems. 

According to the National Institutes of Health (NIH), over 100 different medications can cause erection problems. 

However, identifying which medications are most likely to cause erectile dysfunction can be challenging. Differentiating between erectile dysfunction caused by a medication and erectile dysfunction resulting from an underlying health condition is difficult. Furthermore, the vast number of medications that can contribute to erectile dysfunction complicates comprehensive study. Recent research aimed to shed light on this issue by examining ten years of FDA reports from individuals who experienced adverse effects from their medication. The study identified ten medications most commonly associated with erectile dysfunction:

• Finasteride (Propecia, Proscar): Often used to treat hair loss and enlarged prostate, this medication can impact sexual function.

• Dutasteride (Avodart): Similar to finasteride, it is used for prostate issues and can also cause erectile dysfunction.

• Amlodipine (Norvasc, Katerzia): A medication for high blood pressure, though not typically linked to erectile dysfunction, appeared in the study.

• Paliperidone (Invega): An antipsychotic drug that can interfere with sexual function.

• Citalopram (Celexa): An antidepressant known to cause sexual side effects, including erectile dysfunction.

• Sertraline (Zoloft): Another antidepressant commonly associated with erectile dysfunction.

• Isotretinoin (Absorica, Claravis, Zenatane): Used for severe acne, it has been reported to affect sexual function.

• Escitalopram (Lexapro): An antidepressant that can contribute to erectile dysfunction.

• Quetiapine (Seroquel): An antipsychotic medication with potential sexual side effects.
• Simvastatin (Zocor): Used to lower cholesterol, it is not typically linked to erectile dysfunction but appeared in the study.

Interestingly, two medications on this list—amlodipine and simvastatin—are not usually associated with erectile dysfunction. Researchers speculate that other health issues or medications might be complicating the findings. 

Types of Medication That Can Cause Erectile Dysfunction

Erectile dysfunction can be significantly impacted by various medications, with some categories being particularly notorious for either causing or exacerbating the condition. Beyond the commonly cited medications, numerous types can contribute to erectile dysfunction. Among these, five significant categories stand out as prominent offenders:

Prostate and Hair-Loss Medications: 5-alpha-reductase Inhibitors (5-ARIs) and Erectile Dysfunction

Medications that target benign prostatic hyperplasia (BPH) and male-pattern hair loss often involve the use of 5-alpha-reductase inhibitors (5-ARIs). These drugs work by inhibiting the enzyme 5-alpha-reductase, which converts testosterone into dihydrotestosterone (DHT). While reducing DHT levels can be effective for treating prostate enlargement and promoting hair regrowth, it can also have significant side effects, including erectile dysfunction and other sexual problems.

Finasteride (Propecia, Proscar) and dutasteride (Avodart) are two common 5-alpha-reductase inhibitors.

• Finasteride (Propecia, Proscar): This medication is commonly prescribed for two main conditions—male-pattern baldness and BPH. By reducing DHT levels, finasteride helps to shrink the prostate and potentially improve hair growth. However, its effect on DHT can also lead to erectile dysfunction by disrupting the hormonal balance necessary for normal sexual function. Men using finasteride may experience difficulties achieving or maintaining an erection, reduced libido, and, in some cases, delayed ejaculation.
• Dutasteride (Avodart): Like finasteride, dutasteride treats BPH and is sometimes prescribed for hair loss. It has a more profound effect on reducing DHT levels because it inhibits both types of 5-alpha-reductase enzymes, compared to finasteride’s selective inhibition. This potent reduction in DHT can further exacerbate sexual side effects, including erectile dysfunction, decreased sexual desire, and ejaculatory disorders.

The mechanism behind these side effects involves the crucial role of DHT in sexual health. DHT is a potent androgen that contributes to the development and maintenance of male sexual characteristics and plays a role in sexual function. By significantly lowering DHT levels, 5-ARIs can disrupt this balance, leading to problems such as erectile dysfunction.

Antidepressants/Psychiatric Medications and Erectile Dysfunction

Erectile dysfunction can be a multifaceted issue influenced by various factors, including the use of psychiatric medications. Depression itself can lead to decreased libido and erectile dysfunction. Still, the medicines prescribed to treat these conditions can also exacerbate these issues. Among psychiatric medications, several classes are mainly known for causing or worsening erectile dysfunction. 

Antidepressants: These are commonly used to manage mood disorders, but many can negatively affect sexual function. The most significant culprits include: 

• Selective Serotonin Reuptake Inhibitors (SSRIs): Drugs such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) are frequently prescribed for depression and anxiety. While effective in improving mood, SSRIs can interfere with sexual arousal and orgasm, leading to reduced libido and difficulty achieving or maintaining an erection.
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Medications like venlafaxine (Effexor), desvenlafaxine (Pristiq), and duloxetine (Cymbalta) are used for depression and anxiety disorders. SNRIs can similarly affect sexual function, contributing to erectile dysfunction by altering neurotransmitter levels that are critical for sexual arousal and performance.
• Monoamine Oxidase Inhibitors (MAOIs): This older class of antidepressants includes isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate). While less commonly used today, MAOIs can still cause sexual side effects, including erectile dysfunction, due to their impact on neurotransmitter balance.
• Tricyclic Antidepressants: Medications such as amitriptyline (Elavil), nortriptyline (Pamelor), and clomipramine (Anafranil) are known for their antidepressant effects but can also lead to erectile dysfunction and decreased sexual interest due to their anticholinergic properties and effects on serotonin levels.
• Benzodiazepines: This class of medications, including diazepam (Valium), lorazepam (Ativan), and oxazepam (Serax), is used to manage anxiety and panic disorders. While they can effectively reduce anxiety, benzodiazepines can also impair sexual function by affecting the central nervous system, leading to erectile dysfunction and reduced sexual desire.
• Antipsychotics: Medications used to treat severe mental health conditions, such as paliperidone (Invega), risperidone (Risperdal), and haloperidol (Haldol), can cause erectile dysfunction as a side effect. These drugs impact neurotransmitter systems that are crucial for sexual function, leading to difficulties with arousal and erection.

The mechanisms through which psychiatric medications contribute to erectile dysfunction are diverse. Some medicines may impair blood flow to the penis, making it challenging to achieve or sustain an erection. Others may affect sexual desire and response by altering brain chemistry and neurotransmitter levels. Additionally, the psychological impact of dealing with these side effects can further compound sexual dysfunction.

Antihistamines and Erectile Dysfunction

Antihistamines are widely used to manage symptoms associated with allergies, colds, and other conditions. These medications block histamine, a chemical involved in allergic responses, to alleviate symptoms like sneezing, itching, and runny nose. However, their impact extends beyond allergy relief—they can also interfere with erectile function, potentially leading to erectile dysfunction. Antihistamines are designed to counteract the effects of histamine, but they can also affect other physiological processes, including sexual function. Histamine plays a role in various bodily functions, including sexual arousal. By blocking histamine, antihistamines may inadvertently disrupt the balance required for healthy erections. Some common antihistamines linked to erectile dysfunction include:

• Diphenhydramine (Benadryl): This is a widely used antihistamine for relieving allergy symptoms and aiding sleep. While effective for these purposes, diphenhydramine can cause drowsiness and has been associated with erectile dysfunction. Its anticholinergic properties may interfere with nerve signals necessary for achieving and maintaining an erection.
• Dimenhydrinate (Dramamine): Often used to prevent and treat motion sickness, dimenhydrinate can have similar side effects related to sexual function. As with diphenhydramine, its anticholinergic effects might contribute to erectile dysfunction by affecting nerve activity and blood flow to the penis.
• Hydroxyzine: Used to treat anxiety, nausea, and allergies, hydroxyzine shares similar properties with other antihistamines that can disrupt sexual function. Its impact on histamine receptors and anticholinergic activity may contribute to difficulties with achieving and sustaining an erection.

The relationship between antihistamines and erectile dysfunction is primarily linked to their anticholinergic effects. Anticholinergic drugs block the action of acetylcholine, a neurotransmitter that is crucial for nerve function and smooth muscle contraction. This can lead to reduced blood flow and impaired nerve signalling necessary for an erection. Additionally, some antihistamines may affect the balance of other neurotransmitters involved in sexual arousal, further contributing to erectile dysfunction.

Diuretics and Erectile Dysfunction

When managing high blood pressure, many individuals encounter a range of medication options. While these medications are effective in controlling blood pressure, some can also contribute to erectile dysfunction. Diuretics, particularly thiazide diuretics and loop diuretics, as well as beta-blockers, are known to be more likely to cause erectile dysfunction. Diuretics and blood pressure medications work by reducing fluid levels in the body, decreasing blood volume, and lowering blood pressure. However, this reduction in blood volume can also impact blood flow to the penis, making it more challenging to achieve and maintain an erection. Additionally, these medications can influence hormonal and nerve functions that are crucial for sexual health. Some of the most common diuretic medications associated with erectile dysfunction include:

• Thiazide Diuretics: These are commonly prescribed to manage high blood pressure and include chlorothiazide, chlorthalidone, and hydrochlorothiazide. While effective in controlling blood pressure, thiazide diuretics can decrease blood flow to the penis, which may contribute to erectile dysfunction. The reduced blood volume can impact the ability to achieve and sustain an erection.
• Beta Blockers: This class of medications, including metoprolol (Lopressor), atenolol (Tenormin), and propranolol (Inderal), is used to lower blood pressure and manage heart conditions. Beta-blockers can influence blood flow and reduce sexual function by decreasing the availability of adrenaline and other hormones necessary for erectile function.
• Loop Diuretics: Medications such as furosemide and bumetanide fall into this category. They treat conditions like heart failure and edema by removing excess fluid from the body. While effective for these conditions, loop diuretics can also affect sexual function by altering blood volume and electrolyte balance, potentially leading to erectile dysfunction.

The primary mechanism through which these medications contribute to erectile dysfunction is by affecting blood flow. By reducing blood volume or altering hormone levels, these medications can interfere with the physiological processes necessary for achieving and maintaining an erection. Additionally, diuretics and beta blockers can impact the hormonal and neural pathways involved in sexual arousal. Not all blood pressure medications cause erectile dysfunction, and some may even have a neutral or positive impact on sexual function. For example, medications such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are less likely to cause erectile dysfunction. They may be preferable options for individuals experiencing sexual side effects.

Acid Reflux Medications and Erectile Dysfunction

Acid reflux medications, particularly those used to manage symptoms of gastroesophageal reflux disease (GERD), can have an unexpected side effect: erectile dysfunction. While these medications are effective in controlling acid production and alleviating symptoms of heartburn and indigestion, their impact on sexual function is worth noting.

Many acid reflux medications fall into the category of histamine-2 (H2) receptor antagonists, which work by blocking histamine receptors in the stomach. Histamine plays a role not only in regulating stomach acid but also in various physiological processes, including sexual function. By inhibiting histamine receptors, these medications can inadvertently affect blood flow and sexual arousal, potentially leading to erectile dysfunction. Common acid reflux medications linked to erectile dysfunction include:

• Cimetidine (Tagamet): Cimetidine is one of the earliest H2 receptor antagonists to treat acid reflux and other related conditions. While effective in reducing stomach acid production, cimetidine can have significant effects on sexual health. It has been associated with erectile dysfunction due to its influence on histamine receptors and its potential to alter hormone levels that are critical for maintaining erectile function.
• Ranitidine (Zantac): Ranitidine is a widely used medication for managing acid reflux by blocking histamine H2 receptors in the stomach. However, similar to cimetidine, ranitidine has been reported to contribute to erectile dysfunction. Its effects on histamine receptors can interfere with the physiological processes necessary for achieving and sustaining an erection.
• Nizatidine (Axid): Nizatidine, another H2 receptor antagonist, treats conditions related to excess stomach acid. While effective in managing acid reflux, nizatidine can also impact sexual function. The medication’s ability to block histamine receptors can lead to decreased blood flow and other factors that contribute to erectile dysfunction.