Fifty percent of men over age 40 have some degree of erectile dysfunction (ED) and many of these cases are probably made worse by the patient’s medications. Erectile dysfunction is a type of sexual dysfunction that occurs in men.
Erectile dysfunction is “the consistent or recurrent inability to achieve or sustain an erection of sufficient rigidity and duration for sexual intercourse”.
Many commonly prescribed medications list erectile dysfunction as a side effect. Examples of medications that disrupt normal male sexual function include antipsychotics, antidepressants and antihypertensives. Treatment options for drug-induced male sexual dysfunction include decreasing the dosage of the offending drug or replacing it with another agent with no sexual adverse effect when possible. If these measures fail, therapies for erectile dysfunction such as Viagra and similar medications, yohimbine tablets, and vacuum pump devices are used.
Antidepressants are used to treat moderate to severe depression and are the third most common prescription drug taken by Americans. Sexual dysfunction is a common adverse effect of antidepressants. This side effect has been reported with tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and monoamine oxidase inhibitors (MAOIs).
In a survey of 6,297 patients taking a range of antidepressants 37% experienced sexual dysfunction. The lowest rates occurred with Wellbutrin (bupropion) and Wellbutrin SR (bupropion sustained-release). Celexa (citalopram), Prozac (fluoxetine), Effexor (venlafaxine), Effexor XR (venlafaxine extended-release), and Zoloft (sertraline) caused moderate rates of sexual dysfunction. The highest rates of sexual dysfunction occurred with clomipramine (Anafranil) and paroxetine (Paxil).
Antipsychotics are used to treat mental disorders such as schizophrenia, bipolar disorder, depression, and personality disorders. Sexual dysfunction is a common condition in patients taking antipsychotics, resulting in a decrease in medication adherence.
The first generation or typical antipsychotics include chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), mesoridazine (Serentil), thioridazine (Mellaril), thiothixene (Navane) and trifluoperazine (Stelazine). Amongst the first generation antipsychotics, thioridazine (Mellaril) is associated with the highest risk of erectile dysfunction with up to 60% incidence reported.
Second generation or atypical antipsychotics include clozapine (Clozaril), olanzapine (Zyprexa), paliperidone (Invega), quetiapine (Seroquel), and risperidone (Risperdal). Amongst the second generation antipsychotics, risperidone (Risperdal) is associated with the highest risk of erectile dysfunction due to hyperprolactinemia. First generation antipsychotics have a higher incidence of ED than second generation antipsychotics.
Erectile dysfunction is a common condition in men taking high blood pressure medications. A study showed that the risk of ED in men treated for hypertension was significantly higher than the risk of ED in men with untreated hypertension.
Beta-blockers are commonly used to treat high blood pressure. Sexual dysfunction is more likely to be associated with lipid soluble beta-blockers such as propranolol. Sexual dysfunction has also been reported with ophthalmic timolol.
Centrally acting antihypertensive agents such as clonidine (Catapress) and methyldopa (Aldomet) are associated with erectile dysfunction in up to 20% to 30% of patients. Studies suggest that methyldopa has the highest incidence of ED amongst centrally acting antihypertensives.
Spironolactone (Aldactone) is a potassium-sparing diuretic used for treating high blood pressure and it is associated with ED. The reported rate of ED is 4% to 30% in patients using spironolactone.
Thiazide diuretics are another class of drug used to treat high blood pressure and edema (fluid build up). Erectile dysfunction has been reported in 10% to 20% of patients taking this class of drugs. Loop diuretics such as furosemide or torsemide have a lower risk of ED.
Anticonvulsants are widely used as long-term adjunctive therapy or as monotherapy for seizure treatment. Anticonvulsants that increase the activity of liver enzyme may alter sex hormone metabolism, which may cause ED in patients. Patients should consider switching to an anticonvulsant that does not affect liver enzymes that breakdown sex hormones.
Erectile dysfunction is a side of effects of many medications. Some members of a drug class have higher rates of ED compared to other members of the class. It is important to select medications with lower rates of erectile dysfunction for patients with risk of ED. In general, sexual dysfunction increases with age and is associated with physical and emotional symptoms. Sexual dysfunction is associated with impairment in quality of life and reduced medication adherence. Therefore, risks of erectile dysfunction should be discussed with patients and patients should inform their healthcare providers about any changes in sexual function associated with their medications.
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