Medications that cause erectile dysfunction

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What medications may cause erectile dysfunction?

Several factors can cause or contribute to erectile dysfunction. One example is the medications a person takes. Medicines that affect sex drive, blood flow, and sexual organ function may increase the incidence of erectile dysfunction.

Medically reviewed by Matt Coward, MD, FACS — Written by Rachel Nall, MSN, CRNA on November 11, 2020

This article is a repost which originally appeared on MEDICALNEWSTODAY

Edited for content

Several factors can cause or contribute to erectile dysfunction. One example is the medications a person takes. Medicines that affect sex drive, blood flow, and sexual organ function may increase the incidence of erectile dysfunction.

Erectile dysfunction (ED) is the inability to achieve or maintain an erection. It is a common condition that affects males of all ages and varying levels of health and fitness.

This article lists some medications that may cause or contribute to ED, and outlines some treatment options. Finally, we offer some tips to help prevent ED.

Medications that may cause ED
Certain medications may contribute to ED, although they are not usually the sole cause of the condition.

A person who suspects their ED may be due to a particular medication should talk to their doctor. Where possible, a healthcare professional may recommend changing the dosage or switching medicines.

A person should not stop taking their medications unless their doctor tells them to do so.

Some medications that may contribute to ED are below.

Anti-hypertensives

Anti-hypertensives are prescription medications to help lower blood pressure. They may contribute to ED, though doctors have not yet established why this is the case.

Examples include:

  • beta-blockers, such as metoprolol and atenolol
  • clonidine
  • spironolactone
  • some diuretics, such as hydrochlorothiazide and furosemide

Immunosuppressants

Immunosuppressants reduce the activity of the immune system. A person may take them to help control an autoimmune condition or prevent organ rejection following an organ transplant procedure.

One potential side effect of immunosuppressants is impaired sexual function.

Examples include:

  • sirolimus
  • everolimus
  • tacrolimus
  • cyclosporine

Anti-androgens

Androgens are hormones associated with male characteristics. Anti-androgens block some aspect of these hormones. Doctors may prescribe them for several conditions, such as heartburn or prostate cancer.

Examples of anti-androgens include:

  • ketoconazole
  • flutamide
  • bicalutamide
  • nilutamide
  • enzalutamide

GnRH agonists

Gonadotropin-releasing hormone (GnRH) agonists are a class of medications that doctors sometimes prescribe to treat prostate cancer. They may reduce sexual desire in men.

Examples include:

  • leuprolide (Lupron)
  • goserelin (Zoladex)

Corticosteroids

Corticosteroids are drugs that mimic the effects of certain hormones inside the body. People typically take them to help reduce inflammation.

These drugs can also reduce testosterone levels. This may lead to decreased sexual desire and sexual function in some men.

Examples of corticosteroids include:

  • prednisone
  • prednisolone
  • hydrocortisone

Antidepressants

Antidepressants are medications that doctors may prescribe to treat or prevent the recurrence of clinical depression.

Some antidepressants may inhibit sexual desire, which may affect sexual performance. Others may also delay ejaculation.

Examples of antidepressants that may cause ED include:

  • selective serotonin reuptake inhibitors (Lexapro, Prozac)
  • noradrenaline reuptake inhibitors (Wellbutrin, Zyban)
  • tricyclic antidepressants (Pamelor)

Antipsychotics

Antipsychotics are drugs primarily prescribed for the treatment of psychosis. They may inhibit sexual desire, which may then affect sexual performance.

Examples include:

  • aripiprazole (Ability)
  • olanzapine (Zyprexa)
  • risperidone (Risperdal)

Anti-epileptics

Anti-epileptics are medications that doctors prescribe to help prevent epileptic seizures. They may affect a man’s ability to orgasm.

Examples include:

  • gabapentin (Neurontin)
  • topiramate (Topamax)

Recreational drugs

Aside from medications, some recreational drugs can also affect sexual arousal and performance. Examples include:

  • alcohol
  • hallucinogens
  • narcotics, such as heroin
  • stimulants, such as cocaine and methamphetamines

Drugs to treat opioid addiction may also lead to erectile dysfunction. These drugs include methadone and buprenorphine.

What is ED?

ED is the medical term for when a person has difficulty achieving or maintaining an erection. While this may occur periodically for all males, those with ED experience more frequent and routine episodes.

The ability to achieve and maintain an erection is dependant on several factors, including:

  • sexual arousal
  • sufficient blood flow to the penis
  • nerve sensation

An issue with any of the above factors may lead to ED.

Treatments for ED

A doctor may recommend treatments that can enhance sexual performance while allowing a person to continue taking potentially life-saving or life-extending medications. Some examples are below.

Self-care

Often, ED treatments begin with making changes to a person’s routine. These include:

  • adopting healthful eating habits
  • increasing daily exercise
  • maintaining a healthful weight
  • limiting or avoiding alcohol
  • quitting smoking
  • avoiding using recreational drugs
  • sleeping well

Males who experience mental health issues, such as stress, anxiety, or depression, may also benefit from seeing a mental health professional. These conditions can negatively impact sexual desire and sexual function. As a result, successful treatment may help manage ED.

Medications

A doctor may prescribe one of the following medications to help treat ED.

Phosphodiesterase type-5 inhibitors

Phosphodiesterase type-5 (PDE 5) inhibitors are medications that relax and widen the blood vessels to promote blood flow. The American Urological Association (AUA) recommend that males take PDE 5 inhibitors 1–2 hours before having sex.

Examples of PDE 5 inhibitors include:

  • tadalafil (Cialis)
  • vardenafil (Levitra)
  • avanafil (Stendra)
  • sildenafil citrate (Viagra)

PDE 5 inhibitors are not suitable for people taking nitrates.

Injections

A vasodilator is a medication that helps widen the blood vessels, increasing blood flow.

One potential ED treatment involves injecting the vasodilator directly into the penis or urethra.

Testosterone therapy

According to the AUA, the vast majority of ED cases are due to reduced blood flow to the penis. They add that low testosterone levels may affect a person’s sex drive, but are rarely the cause of ED.

If low testosterone levels contribute to ED, a doctor may consider testosterone therapy (TT). This technique involves regularly administering testosterone in one of the following forms:

  • an injectable medication
  • a gel
  • a patch applied to the skin.

However, the AUA state that TT does not improve erections in males with normal testosterone levels or in those with low testosterone levels who experience ED as their only symptom.

Devices

A vacuum erection device (VED) consists of a plastic tube and a pump. The plastic tube fits over the penis, forming a seal against the body’s skin. Using the pump creates a vacuum around the penis, which causes an erection.

Once the penis is erect, the person slips an elastic ring onto the base of the penis. This retains the blood inside the penis for up to 30 minutes.

According to the AUA, around 75% of males who receive proper training on using a VED can achieve an erection when using these devices.

Surgical treatments

If lifestyle measures and medical treatments are ineffective, doctors may recommend surgical options for ED. These are outlined below.

Penile implant procedure

The main surgical option for ED is inserting a penile implant. This device sits permanently inside the penis, making it rigid enough for a person to have sex.

There are two types of penile implant:

  • Semi-rigid implant: Bendable silicone rods that a person can bend downward for urinating or upward for sex.
  • Inflatable implant: Fluid-filled cylinders attached to a rod inside the scrotum. Using the pump forces fluid into the cylinders, causing the penis to enlarge and stiffen.

Vascular surgery

Vascular surgery for ED helps improve blood flow to the penis. Doctors usually reserve this procedure for younger males with good vascular with ED due to pelvic trauma.