Drugs that may cause impotence
Impotence caused by medicines; Drug-induced erectile dysfunction; Prescription medicines and impotence

You're a man and unfortunately, you aren't able to get an erection at all, or, you lose your erection during intercourse before you are ready. What's a man to do? Let's talk about the causes of this condition, and the various ways to make erection problems a thing of the past. Erection problems are pretty common in adult men. Almost all men sometimes have trouble getting or keeping an erection. In many cases, the problem goes away with little or no treatment. In other cases, it can be an ongoing problem. If you have trouble getting or keeping an erection more than 25% of the time, it is a problem. An erection involves your brain, nerves, hormones, and blood vessels. So, anything that interferes with any of these normal functions can lead to problems getting or keeping an erection. Common causes of erection problems include diseases such as diabetes, high blood pressure, heart or thyroid conditions, poor blood flow, depression, or nervous system disorders like multiple sclerosis or Parkinson's disease. Medicines can also be a culprit, including those that treat high blood pressure, heart problems, sleeping pills, and antidepressants. Men who have prostate surgery may also have erection problems, but this is often only a short-term problem. For many men, lifestyle changes can help. Cut down on smoking, alcohol, and illegal drug use. Get plenty of rest and take time to relax. Exercise and eat a healthy diet to keep good blood circulation. Talk openly to your partner about sex and your relationship; if you can't do this, counseling can help. If the problem does not go away with lifestyle changes, or if it begins after an injury or prostate surgery, or if you have symptoms like low back pain, or abdominal pain, or a change in urination, you should call your doctor. If erection problems seem to be caused by a medication you are taking, talk to your doctor about that. You may need to lower the dose or change to another drug. But don't change or stop taking any medications without first talking to your doctor. Treatment may depend on the cause of your problem. Your doctor can prescribe many treatments, including medicines you take by mouth, injections into the penis, medicines inserted into the urethra, vacuum devices, surgery, and penis implants. Ask your doctor about the possible side effects and complications of each treatment. Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are popular medications called phosphodiesterase-5 (PDE5) inhibitors. They work, and they work when you are sexually aroused. These drugs can have side effects, which can range from muscle pain and flushing to heart attack. Do not use these drugs with medications such as nitroglycerin. The combination can cause your blood pressure to drop. As you see, there are several ways to treat erectile problems. Talk with your doctor to see what may be the best one for you.
Information
Many medicines and recreational drugs can affect a man's sexual arousal and sexual performance. What causes erection problems in one man may not affect another man.
Talk to your health care provider if you think that a drug is having a negative effect on your sexual performance. Never stop taking any medicine without first talking to your provider. Some medicines may lead to life-threatening reactions if you do not take care when stopping or changing them.
The following is a list of some medicines and drugs that may cause erectile dysfunction (ED) in men. There may be additional drugs other than those on this list that can cause erection difficulties.
Antidepressants and other medicines for mental health conditions:
- Amitriptyline (Elavil)
- Amoxapine (Asendin)
- Buspirone (Buspar)
- Chlordiazepoxide (Librium)
- Chlorpromazine (Thorazine)
- Clomipramine (Anafranil)
- Clorazepate (Tranxene)
- Desipramine (Norpramin)
- Diazepam (Valium)
- Doxepin (Sinequan)
- Fluoxetine (Prozac)
- Fluphenazine (Prolixin)
- Imipramine (Tofranil)
- Isocarboxazid (Marplan)
- Lorazepam (Ativan)
- Meprobamate (Equanil)
- Mesoridazine (Serentil)
- Nortriptyline (Pamelor)
- Oxazepam (Serax)
- Phenelzine (Nardil)
- Phenytoin (Dilantin)
- Sertraline (Zoloft)
- Thioridazine (Mellaril)
- Thiothixene (Navane)
- Tranylcypromine (Parnate)
- Trifluoperazine (Stelazine)
Antihistamine medicines (certain classes of antihistamines are also used to treat heartburn):
- Cimetidine (Tagamet)
- Dimenhydrinate (Dramamine)
- Diphenhydramine (Benadryl)
- Hydroxyzine (Vistaril)
- Meclizine (Antivert)
- Nizatidine (Axid)
- Promethazine (Phenergan)
- Ranitidine (Zantac)
High blood pressure medicines and diuretics (water pills):
- Atenolol (Tenormin)
- Bethanidine
- Bumetanide (Bumex)
- Captopril (Capoten)
- Chlorothiazide (Diuril)
- Chlorthalidone (Hygroton)
- Clonidine (Catapres)
- Enalapril (Vasotec)
- Furosemide (Lasix)
- Guanabenz (Wytensin)
- Guanethidine (Ismelin)
- Guanfacine (Tenex)
- Haloperidol (Haldol)
- Hydralazine (Apresoline)
- Hydrochlorothiazide (Esidrix)
- Labetalol (Normodyne)
- Methyldopa (Aldomet)
- Metoprolol (Lopressor)
- Nifedipine (Adalat, Procardia)
- Phenoxybenzamine (Dibenzyline)
- Phentolamine (Regitine)
- Prazosin (Minipress)
- Propranolol (Inderal)
- Reserpine (Serpasil)
- Spironolactone (Aldactone)
- Triamterene (Maxzide)
- Verapamil (Calan)
Thiazides are the most common cause of erectile dysfunction among the high blood pressure medicines. The next most common cause is beta blockers. Alpha blockers tend to be less likely to cause this problem.
Parkinson disease medicines:
- Benztropine (Cogentin)
- Biperiden (Akineton)
- Bromocriptine (Parlodel)
- Levodopa (Sinemet)
- Procyclidine (Kemadrin)
- Trihexyphenidyl (Artane)
Chemotherapy and hormonal medicines:
- Antiandrogens (Casodex, Flutamide, Nilutamide)
- Busulfan (Myleran)
- Cyclophosphamide (Cytoxan)
- Ketoconazole
- LHRH agonists (Lupron, Zoladex)
- LHRH antagonist (Firmagon)
Other medicines:
- Aminocaproic acid (Amicar)
- Atropine
- Clofibrate (Atromid-S)
- Cyclobenzaprine (Flexeril)
- Cyproterone
- Digoxin (Lanoxin)
- Disopyramide (Norpace)
- Dutasteride (Avodart)
- Estrogen
- Finasteride (Propecia, Proscar)
- Furazolidone (Furoxone)
- H2 blockers (Tagamet, Zantac, Pepcid)
- Indomethacin (Indocin)
- Lipid-lowering agents
- Licorice
- Metoclopramide (Reglan)
- Nonsteroidal anti-inflammatory drugs (NSAIDs, ibuprofen, etc.)
- Orphenadrine (Norflex)
- Prochlorperazine (Compazine)
- Pseudoephedrine (Sudafed)
- Sumatriptan (Imitrex)
Opiate analgesics (painkillers):
- Codeine
- Fentanyl (Innovar)
- Hydromorphone (Dilaudid)
- Meperidine (Demerol)
- Methadone
- Morphine
- Oxycodone (Oxycontin, Percodan)
Recreational drugs:
References
Burnett AL, Ramasamy R. Evaluation and management of erectile dysfunction. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 69.
Liu JL, Bivalacqua TJ. Erectile dysfunction. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 191.
Waller DG. Erectile dysfunction. In: Waller DG, ed. Medical Pharmacology and Therapeutics. 6th ed. Philadelphia, PA: Elsevier Limited; 2022:chap 16.
Version Info
Last reviewed on: 1/1/2023
Reviewed by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
