Drugs that cause erectile dysfunction
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 medications that can directly or indirectly affect a person’s ability to get or keep an erection.
This article explores the long list of prescription, over-the-counter (OTC), recreational, and other medications that can cause or contribute to erectile dysfunction.
There are five categories of prescription drugs that have an increased potential to cause erectile dysfunction, either alone 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 serotonin, the “feel good” hormone, 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 (anxiolytics) and antipsychotics.
Among the psychiatric drugs that can cause erectile dysfunction are:
Medicines for high blood pressure
Erectile dysfunction in people with hypertension (high blood pressure) can be a “catch-22” situation. High blood pressure can lead to erectile dysfunction by causing the arteries to harden and narrow, which restricts blood flow to the penis. But treating it with antihypertensive drugs can affect erections by lowering blood pressure and the volume of blood entering the penis.
There are several classes of drugs used to treat hypertension, including ACE inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, calcium channel blockers, and diuretics (“diuretics”).
ED and blood pressure medications
While most high blood pressure medications have the potential to cause erectile dysfunction, the two commonly linked to erection problems are thiazide diuretics and, to a lesser extent, beta-blockers. In contrast, some ARBs may actually improve symptoms of erectile dysfunction.
Blood pressure medications most commonly linked to erectile dysfunction include:
- Aldactone (spironolactone)
- Aldomet (methyldopa)
- Apresolin (hydralazine)
- 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)
- Regitin (phentolamine)
- Serpasil (reserpine)
- Tenex (guanfacine)
- Tenormin (atenolol)
- Vasotec (enalapril)
- Wytensin (guanabenz)
Chemotherapy and hormonal agents
There are chemotherapy drugs and other anticancer agents that can cause erectile dysfunction.
These include hormonal drugs used to slow the progression of prostate cancer. These drugs have anti-androgenic effects, that is, they block the action of testosterone or decrease testosterone. Although this can slow the growth of a cancerous tumor, it can also lead to loss of erectile function and fertility.
Common medications linked to this include:
- Casodex (bicalutamide)
- Cytoxane (cyclophosphamide)
- Firmagon (degarelix)
- Eulexin (flutamide)
- Lupron (leuprorelin)
- Myleran (busulfan)
- Nilandron (nilutamide)
- Nizoral (ketoconazole)
- Zoladex (goserelin)
Opioids are strong narcotics used to treat pain. One of the common side effects of opioid medications is erectile dysfunction. This is caused when the drug impairs the signals between the testicles (testicles), the pituitary gland, and the hypothalamus of the brain. Communication blockage can lead to a sharp drop in testosterone and an increased risk of erection problems or reduced fertility.
The most common opioids linked to erectile dysfunction are:
Medicines for Parkinson’s disease
Parkinson’s disease is treated with drugs known as anticholinergics which block the acetylcholine and dopamine agonists which increase the effects of dopamine. Parkinson’s disease is thought to be caused by an imbalance of acetylcholine and dopamine.
By modifying the action of these neurotransmitters, the excitatory nerves of the penis can be altered. At the same time, a lack of acetylcholine can prevent the dilation (widening) of blood vessels, making it difficult to achieve an erection.
Drugs that can cause erectile dysfunction in people with Parkinson’s disease include:
- Akineton (biperiden)
- Artane (trihexyphenidyl)
- Cogentine (benztropine)
- Kemadrin (procyclidine)
- Parlodel (bromocriptine)
Several over-the-counter medications can cause or contribute to erectile dysfunction. Chief among these are antihistamines.
These include not only antihistamines used specifically to treat allergies, but also those classified as H2 blockers that work like antacids. Antihistamines block the action of histamine, a chemical in the body involved in both allergic reactions and the regulation of stomach acid.
What many people don’t realize is that histamine also helps relax smooth muscles, allowing blood vessels in the penis to become engorged. Excessive use of antihistamines can cause erection problems, especially in people with other risk factors for erectile dysfunction.
Over-the-counter antihistamines and H2 blockers closely associated with erectile dysfunction include:
In addition to over-the-counter antihistamines, prescription antihistamines like Phenergan (promethazine) and Vistaril (hydroxyzine) are also linked to erectile dysfunction.
Sweat and erectile dysfunction
The over-the-counter decongestant Sudafed (pseudoephedrine) can also cause erectile dysfunction by increasing levels of adrenaline in the blood. When this happens, the blood vessels constrict (narrow) instead of dilate (widen), making it more difficult for blood to fill the penis.
Recreational drugs, both legal and illegal, can cause erectile dysfunction in different ways. Some alter the signals to and from the brain that facilitate erections. Others affect blood pressure or cause blood vessels to narrow, which restricts blood flow to the penis.
Recreational drugs that increase the risk of erectile dysfunction include:
The National Institutes of Health lists other common and rare drugs linked to erectile dysfunction. These include prescription drugs and certain supplements that can lower testosterone levels if overused.
In addition to the drugs listed above, there are other drugs that can potentially cause erection problems, including:
A wide variety of drugs can increase the risk of erectile dysfunction. Among prescription medications, antidepressants, anti-anxiety drugs, antipsychotics, opioids, blood pressure medications, Parkinson’s disease medications, chemotherapy agents, and hormonal medications can cause erectile dysfunction.
Over-the-counter medications linked to erectile dysfunction include antihistamines, H2 blockers, and Sudafed. Recreational drugs that can increase the risk of erectile dysfunction include alcohol, amphetamines, barbiturates, cocaine, heroin, marijuana, and nicotine.
A word from Verywell
While erectile dysfunction is a problem you might face as you age, you shouldn’t necessarily think of it as “one of those things” over which you have no control. Before jumping online to buy erectile dysfunction drugs like Viagra or Cialis, talk to your doctor or urologist to identify possible causes. There may be more than you think.
In some cases, things like weight loss, exercise, quitting smoking, or psychotherapy can address the underlying causes of erectile dysfunction. Or, you may find that certain medications are at the root of the problem. This is especially true if you are younger and have a lower overall risk of erectile dysfunction.
Alternatively, 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 erectile dysfunction is one of those issues that you can and, in some cases, fix.
Frequently Asked Questions
Can antibiotics cause erectile dysfunction?
There is no proof of this. Certain antibiotics like erythromycin can slow the breakdown of erectile dysfunction (ED) drug Viagra (sildenafil), allowing the drug to build up and increasing the risk of side effects. Prolonged use of antibiotics can cause delayed ejaculation in some people, but not erectile dysfunction.
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 to be slightly more effective in treating erectile dysfunction, but was no more or less safe than other erectile dysfunction drugs.