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Are your medicines disrupting your sex life?
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Many medicines are suspected to interfere with sexual function, and about 25 per cent of cases of erectile dysfunction (impotence) seen in clinics result from the side effects of medicines.

However, it is relatively difficult to determine whether a particular medicine can cause impotence or disrupt sexual function in other ways, for one of two reasons. Firstly, many diseases themselves often affect sexual function, so it can be difficult to establish if the dysfunction is a result of the disease or the medicine used to treat it. Secondly, side effects that involve sexual issues are frequently not reported to doctors because of embarrassment. So, the actual rate of sexual dysfunction caused by medicines might be higher than reported.

How can medicines affect sexual function?
The mechanism of sexual function is not fully understood. It involves a complex co-ordination of hormones, chemical messengers in the brain (neurotransmitters such as dopamine and serotonin) and the actual sexual organs themselves. However, in general, the neurotransmitter dopamine increases sexual function, whereas the neurotransmitter serotonin inhibits sexual function. The hormone testosterone is important, as are the blood vessels involved in producing an erection. A medicine may therefore affect sexual function in several ways.

Libido or sex drive Sex drive is influenced by reproductive hormones, particularly testosterone, which is required for sexual arousal. Medicines that reduce testosterone levels are likely to reduce sex drive. Libido is also affected by your general emotional and physical health. Therefore, medicines that affect any of these aspects, even indirectly by causing drowsiness, lethargy, weight gain or confusion, have the potential to reduce your sex drive.

Arousal and erection
An erection occurs as a result of a co-ordination between nerves, hormones, blood vessels and psychological factors. There are therefore many areas where this can go wrong! Impotence (inability to get or sustain an erection) is not just caused by medicines that have a physical effect on the blood vessels in the penis but also those that act on the brain, or interfere with hormone levels (particularly testosterone), or affect the transmission of nerve messages.

Ejaculation
This occurs after stimulation of alpha receptors in the prostate gland and seminal vesicles. Medicines that block alpha receptors can therefore prevent or delay ejaculation. Various chemicals in the brain are also involved in orgasm and ejaculation, and medicines that affect these chemicals can also cause ejaculatory disturbances.

Medicines that may affect sexual function
Antidepressants, particularly SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine, are the medicines most frequently implicated in causing sexual dysfunction. This is because they work by altering levels of chemicals in the brain. In particular, SSRIs increase serotonin levels, which inhibits sexual function. Blood pressure lowering (antihypertensive) medicines are the other key culprit, most probably causing sexual problems by their effect on the smooth muscle and blood vessels in the penis.

The following table lists medicines that have had sexual side effects reported in some people during their use. It is important to remember that not everyone experiences side effects with medicines. If you are at all worried that your medicine may be affecting your sexual function, it is important to discuss this with your doctor.

PRESCRIBED MEDICINE MAIN USE EFFECT ON SEXUAL FUNCTION
Antidepressants
MAOI antidepressants (eg moclobemide, phenelzine) Depression Decreased sex drive Impotence Delayed orgasm Ejaculatory disturbances
SSRI antidepressants (eg fluoxetine) Depression Decreased sex drive Impotence Delayed orgasm Ejaculatory disturbances
Tricyclic antidepressants (eg amitryptiline) Depression Decreased sex drive Impotence Ejaculatory disturbances
Antiepileptics
Carbamazepine Epilepsy Impotence
Antihypertensives
Alpha blockers (eg prazosin, doxazosin) High blood pressure Enlarged prostate Impotence
Beta blockers (eg atenolol, propranolol and including timolol eye drops) High blood pressure Angina Glaucoma Impotence
Calcium channel blockers (eg verapamil) High blood pressure Angina Impotence
Clonidine High blood pressure Impotence Decreased sex drive Delayed or failure of ejaculation
Methyldopa High blood pressure Impotence Decreased sex drive Ejaculatory failure
Thiazide diuretics (eg bendrofluazide) High blood pressure Decreased sex drive Impotence Ejaculatory disturbances
Antipsychotics
Phenothiazines (eg chlorpromazine, thioridazine) Psychotic illness Ejaculatory disturbances Decreased sex drive Impotence
Risperidone Psychotic illness Impotence Ejaculatory disturbances
Cholesterol lowering medicines
Fibrates (egclofibrate, gemfibrozil) High cholesterol Impotence
Statins (eg simvastatin) High cholesterol Impotence
Other
Benzodiazepines Anxiety and insomnia (sleeplessness) Decreased sex drive
Cimetidine Peptic ulcers Acid reflux disease Impotence
Cyproterone acetate Prostate cancer Decreased libido Impotence
Disulfiram Alcohol withdrawal Decreased sex drive
Finasteride Enlarged prostate Impotence Decreased sex drive Ejaculation disorders Reduced volume of ejaculation
Omeprazole Peptic ulcers Acid reflux disease Impotence
Opioid painkillers (eg morphine) Severe pain Decreased sex drive and potency
Propantheline Gut spasm Impotence
Spironolactone Heart failure Fluid retention Impotence Decreased sex drive
What should you do if you think that your medicine is affecting your sexual function?

  • Do not stop taking your medicine without first discussing it with your doctor.
  • Do not be put off seeking help. Remember that your quality of life is important, particularly if you are being treated for something like high blood pressure, which often has no symptoms and can require lifelong treatment.

    • What can your doctor do?
    There may not always be a solution. Your doctor may try transferring you to another medicine in the same class, in the hope that the new one will not cause your side effects. Alternatively your doctor may try a different class of medicine altogether, providing it is suitable for you to take. Sometimes there may be no suitable alternatives. However:

    Treatment of high blood pressure

  • ACE inhibitors such as enalapril do not seem to cause erectile dysfunction.
  • Calcium channel blockers and alpha blockers cause fewer sexual problems than diuretics (water tablets) or beta blockers.
  • Loop diuretics such as frusemide have a lower risk of impotence than thiazide diuretics.

    • Treatment of depression

  • SSRIs cause the highest frequency of sexual dysfunction, followed by MAOIs (monoamine oxidase inhibitors) and then tricyclic antidepressants.

    • Treatment of high cholesterol levels

  • Statins have a lower risk of impotence than fibrates.


    • So it may be possible for your doctor to try you on a different medicine, providing it is safe for you to take.

    Treatment of sexual dysfunction due to a side effect of a medicine by giving another drug is rarely recommended, as this increases the likelihood of further side effects and drug interactions.

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    • The documents contained in this web site are presented for information purposes only. The material is in no way intended to replace professional medical care or attention by a qualified practitioner. The materials in this web site cannot and should not be used as a basis for diagnosis or choice of treatment. Conditions for use
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