Medications that Cause ED

Hypertension (high blood pressure) may be a risk factor for ED, and several blood pressure medications (antihypertensives) have been described as causing ED. Most notably beta-blockers, such as metoprolol, atenolol, and labetolol, and thiazide diuretics, such as hydrochlorothiazide. The only thiazide diuretic that has not been associated with ED is indapamide.

Clonidine (Catapres), another blood pressure medication, is also associated with an increased incidence of ED.

The incidence of ED in patients taking antidepressants has been reported to be as high as 35%. Tricyclic antidepressants, such as imipramine (Tofranil), amitriptyline (Elavil), protriptyline (Concordin), and clomipramine (Anafranil), have been reported to cause ED. It appears that they affect ejaculatory function more than erectile function. Selective serotonin reuptake inhibitors (SSRIs) were initially thought to have less of an effect on erectile function; however, studies suggest that 50% of men who are taking SSRIs may experience ED. There have been reports of ED being associated with fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). In rare cases, ED has improved with SSRI use. Antipsychotics such as thioridazine (Mellaril), fluphenazine (Prolixin), and thiothixene (Navane) have also been associated with ED, with up to 44% men taking thioridazine reporting ED. Benzodiazepines, used to treat such conditions as posttraumatic stress disorder, may also cause ED. Clonazepam (Klonopin) use has been associated with a 43% incidence of ED, whereas the other benzodiazepines and the tranquilizers diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax) have not been associated with ED.

Cimetidine (Tagamet), a histamine2-antagonist used for gastrointestinal irritation, has been reported to cause ED in 40% of men. It is known to prevent testosterone from functioning and may also increase prolactin levels, which can lower testosterone levels, decrease libido, and affect erectile function. The other histamine2-antago-nists, ranitidine (Zantac) and famotidine (Pepcid), do not have the same effect on testosterone and are not as frequently associated with ED.

Medications used to lower one's cholesterol (lipid) level such as clofibrate (Atromid-S), gemfibrozil (Lopid), pravastatin (Pravachol) and lovastatin (Mevacor) may also affect erectile function. Digoxin, a cardiac medication, has also been associated with ED, as have the seizure medications phenytoin (Dilantin), carbamazepine (Tegretol), primidone (Mysoline), and phenobarbitol (10 to 20% incidence).

Hormone therapies for prostate cancer, such as leuprolide (Lupron) and goserelin (Zoladex), orchiectomy, and estrogen, have a negative effect on erectile function. Recreational drugs, including alcohol, cocaine, marijuana, and heroin, may also have a negative effect on erectile function. Up to 50 to 80% of alcoholics experience ED; the ED may resolve with prolonged abstinence, but in some men it may persist. Marijuana decreases testosterone levels, and long-term marijuana use may affect erectile function. Opiate addiction is commonly associated with loss of libido (interest in sex) and ED. With abstinence from opiates, the ED improves. Anabolic steroids, used by body builders and athletes to increase their muscle mass, cause testicular atrophy and decrease testosterone production, which may decrease sperm production, decrease libido, and cause ED. If the anabolic steroids are discontinued, it may take 4 months for the testicles to start producing enough testosterone to restore erectile function to normal. The medication ketoconazole, if taken in large quantities, may also affect testosterone production and affect erectile function.