Erectile dysfunction (ED) affects more than 320 million men worldwide. ED is the inability to get or maintain an erection, and as many as 25% of cases are caused by medications.
If you take lisinopril for blood pressure or Ozempic for weight loss or type 2 diabetes, you may have wondered whether your prescription is the culprit. The short answer is that lisinopril isn’t linked to ED, though older blood pressure drugs can affect erections. And Ozempic has shown a correlation with ED in some research, but it’s not yet clear if it helps or hurts erectile function.
Understanding what drugs can cause ED and why can help you address this condition and improve your sexual health.
Why Do Certain Drugs Cause Erectile Dysfunction?
Medications that cause or worsen ED typically affect nerves, hormones, or blood flow.
- Nerves: Your nerves send and receive signals to get and maintain an erection. Medications, such as some antidepressants, can affect the chemicals in the brain that are part of normal nerve signaling.
- Hormones: Medications that impact testosterone and other hormones, such as some prostate cancer treatments, can disrupt how your body gets and maintains an erection.
- Blood flow: During an erection, the penis fills with blood. Drugs that reduce blood flow, such as beta blockers for high blood pressure, can cause ED.
By treating one health condition, some medications can lead to ED. But even within a single drug class, the risk can vary.
Blood Pressure Medications
Blood pressure medications help lower blood pressure by relaxing blood vessels, reducing heart workload, or removing excess fluid from the body. While they are important for cardiovascular health, some types may affect erectile function differently.
Beta blockers, such as metoprolol (Toprol XL) and bisoprolol (Zebeta), help lower blood pressure by slowing heart rate and reducing the effects of adrenaline. In some people, this change in blood flow and energy levels can affect sexual drive and erectile function. However, many people take beta blockers without experiencing any sexual side effects.
Diuretics, or water pills, treat high blood pressure by removing salt and water from your body, reducing overall blood volume. This can sometimes affect erectile function through changes in blood flow and vascular tone. Hydrochlorothiazide (HCTZ) and chlorthalidone (Thalitone) are common examples of diuretics that have been associated with erectile dysfunction. Spironolactone (Aldactone), another diuretic, may have hormonal effects that block the action of testosterone in the body, worsening or causing ED.
Other types of blood pressure medications, on the other hand, can improve blood flow by widening blood vessels, making them less likely to cause ED. These types of drugs include:
- Angiotensin-converting enzyme inhibitors (ACE inhibitors), like lisinopril (Zestril)
- Angiotensin II receptor blockers (ARBs), like losartan (Cozaar)
- Calcium channel blockers (CCBs), like amlodipine (Norvasc)
Mental Health and Anxiety Prescriptions
Medications for anxiety and other mental health conditions can affect different chemicals in the brain, such as serotonin or dopamine. In the process, these drugs may also impact sexual desire (libido), erections, and ejaculation.
The following antidepressant drugs are known to impact sexual function, including causing ED:
- Escitalopram (Lexapro)
- Citalopram (Celexa)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Fluvoxamine (Luvox)
- Fluoxetine (Prozac)
- Duloxetine (Cymbalta)
However, not all antidepressants carry the same risk. Bupropion (Wellbutrin) is less likely to cause ED, and research has found it may even improve sexual health for some people. Mirtazapine (Remeron) and vortioxetine (Trintellix) are other antidepressants that are less likely to cause sexual problems.
Anxiety medications, including benzodiazepines like alprazolam (Xanax), may also cause ED and reduced libido by slowing activity in the nervous system. Stimulant medications for ADHD, such as dextroamphetamine/amphetamine (Adderall), don’t affect everyone in the same way. For some, they can lead to ED by causing blood vessels to tighten, reducing blood flow to the penis.
Hair Loss and Prostate Treatments
Erectile dysfunction can be a side effect of medications used for hair loss and prostate problems.
Finasteride (Proscar, Propecia) is used to treat both male pattern baldness and enlargement of the prostate (benign prostate hyperplasia, or BPH). It alters the production of male hormones, which can lead to ED, reduced libido, and difficulty ejaculating. Tamsulosin (Flomax) is another drug used to treat BPH by relaxing muscles in the prostate and bladder. It is most likely to cause abnormal ejaculation, but it can also affect libido and erections.
Weight Loss and Diabetes Medications
Before assuming a diabetes or weight loss drug is the reason for ED, consider the condition it’s treating. Obesity and type 2 diabetes can cause ED because of their effects on metabolism, hormones, and blood circulation.
By treating diabetes, drugs like empagliflozin (Jardiance) and metformin (Glucophage) may improve sexual health. However, some research has found that metformin has a risk of lowering testosterone levels, which can affect libido and erections.
The effect of the popular weight loss drug semaglutide (Ozempic, Wegovy) on ED remains unclear. Some studies have found correlations (but not causality) with ED, while other research suggests it could help address ED, especially for people also taking metformin.
Pain & Dependency Drugs
Some pain and neurologic medications can affect sexual function. For example, long-term use of opioid pain medications may lower testosterone levels, which can lead to reduced sex drive, ED, or difficulty achieving orgasm. Medications used to treat opioid dependence, such as buprenorphine-naloxone (Suboxone), may have similar effects in some people.
Gabapentin (Gralise, Horizant), used for nerve pain and seizures, is not directly associated with ED, but it may affect sexual function in some people. Reported effects include reduced libido, difficulty achieving orgasm, and changes in ejaculation.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, have limited evidence of a connection to ED. While they are not commonly associated with hormonal changes, long-term use may be discussed as a possible contributing factor in some cases, but the relationship is not well established.
Drug Myths: Common Misconceptions Without Evidence of ED Impact
With a topic as sensitive as erectile dysfunction, misinformation can run rampant. Luckily, despite what you may have heard, the following drugs do not have established evidence of ED impact.
- Cholesterol treatments: Statin medications are used to treat high cholesterol, and studies show that their effect on ED is mixed. For most people, these drugs have a neutral-to-beneficial effect on ED. The benefits of treating high cholesterol and improving overall cardiovascular health can help with erectile function.
- Allergy medications: Allergy medications do not have reported side effects of ED. While common side effects of allergy medications, such as drowsiness, may temporarily impact libido, this is not a direct link to ED.
- Antibiotics: Antibiotics treat bacterial infections and do not have reported links to ED. Common side effects may temporarily impact sexual function, but this effect is not specific to antibiotics.
Drug Swaps & Side Effect Management for Improving ED
Sometimes, switching medications can help improve ED side effects. However, not all drugs that treat the same condition are interchangeable, and stopping or switching a prescription on your own is risky. Your doctor considers many factors when prescribing a medication, including its expected effectiveness and potential side effects.
If you have ED or are worried about ED, ask your doctor to walk you through everything, including any risk of ED. Use the table below to discuss your options.
| Medication Type | Higher Risk of ED | Lower Risk of ED |
| Blood pressure medications |
|
|
| Mental health and anxiety medications |
|
NDRIs, like bupropion (Wellbutrin) |
| Hair loss and prostate medications | Systemic hair loss treatments, like oral finasteride | Topical hair loss treatments, like topical minoxidil (Rogaine) |
Other ED Management Techniques
If you are struggling with medication-related ED, there are different steps that may help.
- Take a drug holiday: A drug holiday is a temporary break from taking the medication causing ED. This should only be done under your doctor’s supervision because suddenly stopping a medication can pose serious health risks.
- Add an ED-specific treatment: Medications like sildenafil (Viagra), tadalafil (Cialis), and certain penile injections can make it easier to get and maintain an erection. While these drugs are generally well-tolerated, always talk with your doctor before using them to make sure they won’t interact with other medications you take.
- Utilize a vacuum erectile device: These devices use vacuum pressure to draw blood into the penis with a ring that fits around the base of the penis to help maintain an erection. Although the technique can take some getting used to, a vacuum erectile device can be a drug-free way of addressing ED.
Your Next Steps
Millions of men experience erectile dysfunction from medications they take for other health issues. The drugs that can affect erections are easy to overlook, especially because they include well-known blood pressure pills, antidepressants, antihistamines, and pain medications. Knowing what’s on that list can be a first step in improving your sexual health.
Many men are hesitant to bring up ED, but a conversation with your doctor about adjusting your medications or starting treatment for ED can open up paths you didn’t know were available.
Our experts
Written by
Eric Suni is a health writer and editor with over 15 years of experience. For more than seven years, he worked at Fred Hutch, Seattle's prestigious cancer research center, as a Science Writer and Information Specialist for the National Cancer Institute's Cancer Information Service. His work has been cited in more than 45 published medical journal articles and has been referenced by the CDC, FDA, The New York Times, and numerous state and local health departments.
Reviewed by
Ashley Robinson, PharmD
Ashley Robinson oversees daily operations at TelyRx's Clearwater pharmacy location, optimizes workflow efficiency, and ensures compliance with regulatory standards while maintaining a strong focus on patient safety and quality of care. She collaborates closely with clinical and operations teams to evaluate new medications, support formulary development, and implement process improvements that enhance both patient outcomes and team performance.
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