Drugs That Cause Erectile Dysfunction

114 Medications Linked to Erection Problems

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Erectile dysfunction (ED), formerly known as impotence, is a condition that affects 52% of men between the ages of 40 and 70. It is strongly associated with aging and risk factors such as heart disease, high blood pressure, diabetes, obesity, high cholesterol, and hypogonadism (low testosterone).

Among the factors people sometimes overlook are the many drugs and medications that can directly or indirectly affect a person's ability to achieve or sustain an erection.

Middle aged Black man reading prescription drug label

Jose Luis Pelaez Inc / Getty Images

This article explores the long list of prescription, over-the-counter (OTC), recreational, and other drugs that can cause or contribute to erectile dysfunction.

Prescription Drugs

There are five categories of prescription drugs that have an increased potential to cause ED, either on their own or in combination with other risk factors such as aging or diabetes.

Antidepressants and Other Psychiatric Drugs

The sexual side effects of antidepressants and other psychiatric drugs are well known.

By altering levels of the "feel-good" hormone serotonin, antidepressants can cause an imbalance of other hormones that regulate sexual function. These include testosterone which influences sexual arousal and the ability to achieve an erection, and dopamine, which plays a role in orgasms.

Other types of psychiatric drugs can cause erection problems, including anxiolytics (anti-anxiety drugs) and antipsychotics.

Among the psychiatric drugs that have the potential to cause ED are:

High Blood Pressure Medications

Erectile dysfunction in people with hypertension (high blood pressure) can be a "Catch-22" situation. Hypertension can lead to ED by causing arteries to harden and narrow, limiting the flow of blood to the penis. But treating it with antihypertensive medications can affect erections by lowering the blood pressure and the volume of blood entering the penis.

There are several classes of drugs used to treat hypertension, including ACE inhibitorsangiotensin receptor blockers (ARBs), beta- blockers, calcium channel blockers, and diuretics ("water pills").

ED and Blood Pressure Drugs

While most high blood pressure medications have the potential to cause ED, the two commonly linked to erection problems are thiazide diuretics and, to a lesser degree, beta-blockers. By contrast, some ARBs may actually improve ED symptoms.

The high blood pressure drugs most commonly linked to ED include:

  • Aldactone (spironolactone)
  • Aldomet (methyldopa)
  • Apresoline (hydralazine)
  • Bethanidine
  • Bumex (bumetanide)
  • Calan (verapamil)
  • Capoten (captopril)
  • Catapres (clonidine)
  • Dibenzyline (phenoxybenzamine)
  • Diuril (chlorothiazide)
  • Esidrix (hydrochlorothiazide)
  • Haldol (haloperidol)
  • Hygroton (chlorthalidone)
  • Inderal (propranolol)
  • Ismelin (guanethidine)
  • Lasix (furosemide)
  • Lopressor (metoprolol)
  • Maxzide (triamterene)
  • Minipress (prazosin)
  • Normodyne (labetalol)
  • Procardia (nifedipine)
  • Regitine (phentolamine)
  • Serpasil (reserpine)
  • Tenex (guanfacine)
  • Tenormin (atenolol)
  • Vasotec (enalapril)
  • Wytensin (guanabenz)

Chemotherapy and Hormonal Agents

There are chemotherapy drugs and other anti-cancer agents that can cause ED.

These include hormonal drugs used to slow the progression of prostate cancer. These medications have anti-androgenic effects, meaning that they block the action of testosterone or lower testosterone. While this can slow the growth of a cancerous tumor, it can also lead to the loss of erectile function and fertility.

Among the drugs commonly link to this are:

  • Casodex (bicalutamide)
  • Cytoxan (cyclophosphamide)
  • Firmagon (degarelix)
  • Eulexin (flutamide)
  • Lupron (leuprorelin)
  • Myleran (busulfan)
  • Nilandron (nilutamide)
  • Nizoral (ketoconazole)
  • Zoladex (goserelin)

ED and Cancer

Cancer itself can also cause ED as well as radiation therapy and prostate surgery.

Opioids

Opioids are powerful narcotic drugs used to treat pain. One of the common side effects of opioid drugs is ED. This is caused when the drug impairs signals between the testes (testicles), pituitary gland, and hypothalamus of the brain. The blockage of communication can lead to a steep drop in testosterone and an increased risk of erection problems or reduced fertility.

The opioids most commonly linked to ED are:

Parkinson's Disease Medications

Parkinson's disease is treated with drugs known as anticholinergics that block the chemical acetylcholine and dopamine agonists that increase the effects of dopamine. Parkinson's is thought to be caused by an imbalance of acetylcholine and dopamine.

By altering the action of these neurotransmitters, the excitatory nerves in the penis may be impaired. At the same time, a lack of acetylcholine can prevent the dilation (widening) of blood vessels, making it difficult to achieve an erection.

The medications that can cause ED in people with Parkinson's include:

  • Akineton (biperiden)
  • Artane (trihexyphenidyl)
  • Cogentin (benztropine)
  • Kemadrin (procyclidine)
  • Levodopa
  • Parlodel (bromocriptine)

Over-the-Counter Drugs

Several over-the-counter drugs can cause or contribute to erectile dysfunction. Chief among these are antihistamines.

These not only include antihistamines used specifically to treat allergies but those classified as H2 blockers that function as antacids. Antihistamines block the action of histamine, a chemical in the body that is involved both in allergic reactions and the regulation of stomach acid.

What many people do not realize is that histamine also helps relax smooth muscles, allowing the blood vessels in the penis to engorge. The overuse of antihistamines may lead to erection problems, particularly in those with other risk factors for ED.

OTC antihistamines and H2 blockers closely associated with ED include:

In addition to OTC antihistamines, prescription antihistamines like Phenergan (promethazine) and Vistaril (hydroxyzine) are also linked to ED.

Sudafed and Erectile Dysfunction

The OTC decongestant Sudafed (pseudoephedrine) can also cause ED by increasing adrenaline levels in the blood. When this happens, blood vessels will constrict (narrow) rather than dilate (widen), making it harder for the penis to fill with blood.


Recreational Drugs

Recreational drugs, both legal and illegal, can cause erectile dysfunction in different ways. Some impair signals to and from the brain that facilitate erections. Others affect blood pressure or cause the narrowing of blood vessels, both of which restrict the flow of blood to the penis.

Recreational drugs that increase the risk of ED include:

Other Drugs

The National Institutes of Health lists other common and uncommon drugs linked to ED. These include prescription medications and certain supplements that can reduce testosterone levels when overused.

In addition to the above-listed drugs, there are other medications that can potentially cause erection problems, including:

Summary

A wide variety of drugs can increase the risk of erectile dysfunction. Among prescription drugs, antidepressants, anxiolytics, antipsychotics, opioids, blood pressure medications, Parkinson's disease medications, chemotherapy agents and hormonal medications may lead to ED.

OTC medications linked to ED include antihistamines, H2 blockers, and Sudafed. Recreational drugs that may increase the risk of ED include alcohol, amphetamines, barbiturates, cocaine, heroin, marijuana, and nicotine.

A Word From Verywell

Although erectile dysfunction is something you may face as you get older, you shouldn't necessarily consider it "one of those things" over which you have no control. Before jumping online to buy ED drugs like Viagra or Cialis, speak with your doctor or a urologist to pinpoint the possible causes. There may be more than you think.

In some cases, things like weight loss, exercise, smoking cessation, or psychotherapy can treat the underlying causes of ED. Or, you may find that certain medications are at the heart of the problem. This is especially true if you are younger and are at a lesser overall risk of ED.

Alternately, you may find that you have an undiagnosed health condition that requires immediate medical treatment.

By taking a measured approach and working with a specialist, you may find that ED is one of those things that you can address and, in some cases, resolve.

Frequently Asked Questions

  • Can antibiotics cause erectile dysfunction?

    There is no evidence of this. Some antibiotics like erythromycin can slow the breakdown of the erectile dysfunction (ED) drug Viagra (sildenafil), allowing the drug to accumulate and increasing the risk of side effects. The prolonged use of antibiotics can lead to delayed ejaculation in some people but not ED.

  • What is the safest drug for erectile dysfunction?

    PDE5 inhibitors are a class of drugs used in the first-line treatment of erectile dysfunction. A 2013 review of studies in European Urology reported that the drug Cialis (tadalafil) appeared slightly more effective in treating ED but was no more or less safe than any of the other ED medications.

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