Erectile dysfunction (ED) is something a significant percentage of the male population has to face at some point in their lives. It has many potential causes — including the use of recreational drugs or prescription medications.
This article goes over common substances that can cause ED, how they work, and treatments that can help.
Erectile dysfunction is when a man has difficulty getting or keeping a firm erection before or during sexual intercourse. Unfortunately, this condition is common, with about 10% of men ages 40–70 suffering from ED and another 25% experiencing it intermittently.
There are several causes of ED, and one of the most frequent is the use of drugs, either recreationally or for medical purposes. In fact, one fourth of ED cases are caused by prescription medications. Eight of the twelve most commonly prescribed medicines list ED as a possible side effect . The following section will explain how each group of substances can produce this condition.
|Drug Class||Drug, Generic and Trade Name|
|Antidepressants, anxiolytics, and antiepileptics||AmitriptylineAmoxapine (Asendin)Buspirone (Buspar)Chlordiazepoxide (Librium)Clomipramine (Anafranil)Clorazepate (Tranxene)Desipramine (Norpramin)Diazepam (Valium)Doxepin (Silenor, Zonalon)Fluoxetine (Prozac)Imipramine (Tofranil)Isocarboxazid (Marplan)Lorazepam (Ativan)Nortriptyline (Pamelor)OxazepamPhenelzine (Nardil)Phenytoin (Dilantin)Sertraline (Zoloft)Tranylcypromine (Parnate)|
|Antihistamines||Dimenhydrinate (Dramamine)Diphenhydramine (Benadryl)Hydroxyzine (Vistaril)Meclizine (Antivert)Promethazine (Phenergan)|
|Chemotherapy drugs||Busulfan (Busulfex, Myleran)Cyclophosphamide (Cytoxan)|
|Diuretics and high blood pressure drugs||Atenolol (Tenormin)Benazepril (Lotensin)BumetanideCaptoprilChlorthalidone (Chlorthalidone, Thalitone)Clonidine (Catapres)Enalapril (Epaned, Vasotec)Furosemide (Lasix)Guanfacine (Intuniv, Tenex)HydralazineHydrochlorothiazideLabetalol (Normodyne)MethyldopaMetoprolol (Lopressor)Nifedipine (Adalat, Procardia)PhenoxybenzaminePropranolol (Hemangeol, Inderal LA)Spironolactone (Aldactone)Triamterene (Dyrenium)Verapamil (Calan, Verelan)|
|Histamine H2-receptor antagonists||Cimetidine (Tagamet)Famotidine (Pepcid, Zantac 360)NizatidineRanitidine|
|Muscle relaxants||Cyclobenzaprine (Amrix, Flexeril)Orphenadrine|
|Non-steroidal anti-inflammatory drugs (NSAIDs)||Indomethacin (Indocin)Naproxen (Anaprox, Naprelan, Naprosyn)|
|Parkinson’s disease medications||Benztropine (Cogentin)Bromocriptine (Parlodel)Carbidopa-Levodopa (Sinemet)Trihexyphenidyl (Artane)|
|Prostate cancer medications||Carbidopa-Levodopa (Sinemet)Flutamide (Eulexin)Leuprolide (Eligard, Lupron)Trihexyphenidyl (Artane)|
|Recreative drugs and other substances||AlcoholAmphetaminesCocaineCannabisNicotineOpioids|
Antiarrhythmics are used to keep the heart’s rhythm from going too fast or irregularly. By controlling the electrical impulses, they can make the heart beat slower over time. There are several classes of antiarrhythmics, but one of the most common side effects of these drugs — especially amiodarone — is testicular dysfunction. Although this condition is not the same as ED, one of its most frequent symptoms is loss of libido and difficulty having sexual intercourse.
In a 1992 study, researchers evaluated the gonadal function in 44 men, eighteen of whom had been using amiodarone for more than a year. Most of these men presented with sexual problems, showing that prolonged use of amiodarone can lead to ED .
Most medications used to treat depression, anxiety, and epilepsy target central neurotransmitters like serotonin, norepinephrine, and dopamine.
Antidepressants can cause sex-related side effects for both males and females, such as decreased sexual desire and excitement, painful ejaculation, and decreased orgasm .
Although chemotherapy drugs do not directly affect male sexuality, they have several side effects that can affect the libido. For instance, cyclophosphamide can cause infertility, leading to various sexual function problems .
Furthermore, researchers discovered that busulfan significantly altered spermatogenesis, promoting erectile dysfunction .
Diuretics lower blood pressure by making you urinate, which gets rid of extra water. Other drugs work on different brain receptors.
Although most medications for high blood pressure have some association with erectile dysfunction, they rarely cause it. Nevertheless, diuretics can significantly decrease blood flow, making an erection difficult .
Also known as H2 blockers, these medications treat gastric or duodenal ulcers by reducing the amount of stomach acid. However, many of them can produce libido-related problems.
For instance, cimetidine blocks testosterone synthesis, which directly affects sexual desire . The same is true for other drugs, such as famotidine or ranitidine, although they are significantly less risky.
Sexual dysfunction is a common side effect of muscle relaxants due to their sedative effects. In addition, cyclobenzaprine can also produce painful ejaculations. However, these symptoms are reversible by simply discontinuing use .
Non-steroidal anti-inflammatory drugs, also known as NSAIDs, relieve pain and inflammation. They can treat headaches, flu symptoms, painful long-term conditions, and more.
NSAIDs significantly increase the risk of erectile dysfunction and other related problems. A Finnish study showed that men who use these drugs are more likely to have issues getting or maintaining an erection .
On the other hand, research also shows NSAIDs can help treat or prevent ED since they lower inflammation .
Erectile dysfunction is the most common side effect among patients taking Parkinson’s medications. Moreover, it’s also a common disease symptom, making its treatment more challenging.
Some drugs, such as benzatropine, block the action of the neurotransmitter acetylcholine. By doing so, they inhibit the cholinergic receptors that help with penile erection, resulting in ED .
Prostate cancer is driven by androgens, the hormones in charge of developing and maintaining various male characteristics. One way to treat this type of cancer is through hormonal therapy, which lowers the androgen levels.
Unfortunately, the most important androgen is testosterone, and blocking its production increases the likelihood of erectile dysfunction .
Alcohol is probably the most prevalent recreational substance in the world, but it interferes with the neurotransmitters in the brain that control blood flow to the penis. In addition, alcohol reduces testosterone production .
Amphetamines are highly effective stimulants that increase the speed at which the brain sends messages to the body. They also stimulate the release of dopamine, inducing feelings of joy and euphoria.
However, in a 2015 study, half of the male amphetamine users recruited reported having sexual problems . In addition to sexual dysfunction, amphetamines can affect ejaculatory latency time, orgasm intensity, and sexual satisfaction.
Cocaine is a potent euphoric stimulant that activates endothelin-1 release and can cause erectile dysfunction through vasoconstriction or the narrowing of blood vessels. This and other substances significantly affect pleasure, desire, arousal, and orgasm .
Cannabis can cause erectile dysfunction because there are cannabinoid receptors in the smooth muscle tissue of the penis. A recent study suggests that ED is twice as frequent in users of this substance .
However, some users claim that cannabis helps them maintain an erection, so more studies are still needed.
Nicotine is a natural alkaloid most commonly found in tobacco products. It is a potent stimulant and anxiolytic, but also highly addictive.
Opioids are synthetic substances mainly used as pain relievers and anesthetics. They are potent narcotics, and abusing them could lead to addiction.
Opioid-induced sexual dysfunction (OISD) affects half of all opioid users, and includes erectile dysfunction, decreased desire, etc. .
Another investigation demonstrated a relationship between ED and methadone. Researchers recruited 200 addicts — 53 presented problems with erectile function, libido, orgasm, and sexual pleasure .
Besides medications and drugs, there are other causes of erectile dysfunction — here are the most common ones.
This is one of the most common causes of ED — psychogenic erectile dysfunction, to be more accurate — due to problems such as stress or insecurities. Arguments, acute or chronic stress, money problems, and personality and mood disorders can significantly impair sexual life .
Because of this, it’s important to talk to your partner or try different ways to deal with stress.
People with vascular diseases, such as diabetes, hypertension, or arteriosclerosis of the larger arteries, are more likely to experience ED — also known as vascular erectile dysfunction . It is one of the first symptoms of coronary heart disease, especially in those under 60.
Neurological problems such as Parkinson’s disease, tumors, strokes, or encephalitis can affect the nervous system that controls penile erection . ED can also be caused by changes in the autonomic nerve pathways, the somatic nerve pathways, or both.
Although neurogenic erectile dysfunction is difficult to treat, oral phosphodiesterase inhibitors can slowly help.
When we talk about hormonal causes of ED, we refer to the lack of male hormones such as testosterone. Current research shows that men with ED have statistically much lower levels of total testosterone (TT), sex hormone-binding globulin (SHBG), and albumin .
People with diabetes mellitus usually present a significant shortage of these hormones, affecting their sexual life.
Treatments for erectile dysfunction depend mainly on the cause, so consult your doctor before trying any of the ones you see below. Also, we recommend that you do not stop or change your medications without consulting a professional.
Sometimes ED can be solved with a few lifestyle changes and natural alternatives. Though the research on these alternatives isn’t conclusive, there’s enough to suggest it can help some men [29, 30]. If you want to go with these treatments first, make sure you research possible drug interactions and side effects first — never use a substance, no matter how natural, before fully understanding its capabilities.
Because of the risks of drug interactions, we recommend talking to a doctor before using any of the following treatments for ED:
This amino acid helps build protein and is something your body already makes, but it’s also found in foods high in protein, such as red meat, fish, dairy products, and whole wheat.
It acts as a blood thinner, so be careful if you’re on certain medications.
Asian ginseng is a top ingredient in supplements for ED for a reason — it can help increase penile blood flow, NOS activity, and nitric oxide (NO) production.
While it is generally safe for short-term use, it can interact with certain medications like statins and antidepressants and might affect blood sugar.
Yohimbe is an African tree that’s commonly used as an aphrodisiac and treatment for ED, as well as for weight loss and high blood pressure. It blocks pre- and postsynaptic α2-adrenergic receptors, giving it great therapeutic potential.
Unfortunately, it’s linked to seizures, heart attacks, high blood pressure, and stomach problems, often due to products that aren’t properly labeled. Look for labels that state how much yohimbine is in each dose — the maximum is 30 mg per day .
It can interact with some medications, especially MAOIs.
The drugs used to treat erectile dysfunction are usually PDE-5 inhibitors, as they increase penile blood flow. Generally, these pills are taken one to two hours before intercourse.
Although PDE5s are safe, they can have side effects such as headaches, facial flushing, muscle aches, and nasal congestion.
Some PDE5 medications include:
- Cialis (tadalafil)
- Stendra (avanafil)
- Levitra (vardenafil HCl)
- Viagra (sildenafil citrate)
Surgeries have the highest success and satisfaction rates among all the treatments on this list. However, this is usually reserved for patients who don’t find success with prescription drugs.
Surgery involves implanting a device into the penis that makes it rigid, allowing the patient to have sexual intercourse without issues.
There are two kinds of penile implants:
- Semi-rigid implants — Two silicone rods that bend downward for urinating or upward for sexual intercourse.
- Inflatable implants — The surgeon places liquid-filled cylinders along the penis, which make it rigid when inflated.
The vacuum device is another effective way to treat erectile dysfunction. A plastic tube slides over the penis and generates a low-pressure vacuum to induce an erection.
Afterward, the user places an elastic ring at the base of the penis to retain blood, keeping it erect for around 30 minutes.
This therapy is implemented only when the patient has low testosterone levels and can be administered in injections, tablets, patches, or gel form. However, this isn’t as effective as the other methods, and its benefits are only noticeable in the long term.
To avoid erectile dysfunction, live a healthy life — eat healthy, exercise, and avoid alcohol, drugs, cigarettes, and junk food. Breaking bad habits can significantly reduce the likelihood of ED.
Here’s a list of steps you can take to avoid sexual problems.
1. Eat Healthily
A healthy diet reduces the risk of ED and other diseases. However, this does not mean that you have to say goodbye to your favorite foods forever — just find a balance.
The foundation of your diet should be whole foods like those in the Mediterranean Diet, such as fruits, vegetables, fish, nuts, and olive oil . Also, avoid excessive salt and saturated fats, as they can affect your blood pressure.
However, if you don’t already do this, start slowly and gradually increase the intensity. We recommend that you consult with a health professional to guide you.
As was already said, diabetes and high blood pressure are two of the most common reasons why men can’t get or keep an erection. The best way to prevent these diseases is to maintain a healthy weight and have regular check-ups.
Losing weight can significantly increase testosterone levels and improve your overall health. Metabolically unhealthy obesity (MUHO) is the biggest preventable factor in cardiovascular disease and is a known factor in ED . This condition centers around myocardial dysfunction and poor metabolic health.
Lastly, we recommend avoiding alcohol, tobacco, and illegal drugs — all are related to ED . Plus, smoking is related to diseases of the heart and blood vessels, another cause of erectile dysfunction.
Moreover, alcohol and other recreational substances can mask other psychological, emotional, or physical factors causing ED.
Erectile dysfunction is a problem that most men go through, and many drugs, even prescription drugs, are responsible for it.
Although there are multiple ways to treat ED, consult your doctor before opting for any of them. Moreover, you shouldn’t stop taking any medications without your doctor’s say on the situation.
The best way to prevent ED is simply by living a healthy lifestyle, incorporating physical activity, eating a balanced diet, and staying away from vices.
- Sooriyamoorthy, T., & Leslie, S. W. (2020). Erectile dysfunction.
- Dobs, A. S., Sarma, P. S., Guarnieri, T., & Griffith, L. (1991). Testicular dysfunction with amiodarone use. Journal of the American College of Cardiology, 18(5), 1328–1332. https://doi.org/10.1016/0735-1097(91)90557-p
- Rothmore, J. (2020). Antidepressant‐induced sexual dysfunction. Medical Journal of Australia, 212(7), 329-334.
- Cará, A. M., Lopes-Martins, R. A., Antunes, E., Nahoum, C. R., & De Nucci, G. (1995). The role of histamine in human penile erection. British journal of urology, 75(2), 220–224. https://doi.org/10.1111/j.1464-410x.1995.tb07315.x
- Ogino, MH and Tadi, P. (2022). cyclophosphamide. In StatPearls [Internet] . StatPearls Publication.
- Patel, R., & Tadi, P. (2021). Busulfan. En StatPearls [Internet]. StatPearls Publishing
- Doumas, M., & Douma, S. (2006). The effect of antihypertensive drugs on erectile function: a proposed management algorithm. Journal of clinical hypertension (Greenwich, Conn.), 8(5), 359–364. https://doi.org/10.1111/j.1524-6175.2005.05285.x
- Lardinois, C. K. (1985). Cimetidine Blocks Testosterone Synthesis. Archives of internal medicine, 145(5), 920. https://doi.org/10.1001/archinte.1985.00360050190034
- Kraus, M. B., Wie, C. S., Gorlin, A. W., Wisenbaugh, E. S., & Rosenfeld, D. M. (2015). Painful Ejaculation with Cyclobenzaprine: A Case Report and Literature Review. Sexual medicine, 3(4), 343–345. https://doi.org/10.1002/sm2.93
- Shiri, R., Koskimäki, J., Häkkinen, J., Tammela, T. L., Auvinen, A., & Hakama, M. (2006). Effect of nonsteroidal anti-inflammatory drug use on the incidence of erectile dysfunction. The Journal of urology, 175(5), 1812–1816. https://doi.org/10.1016/S0022-5347(05)01000-1
- Kaya-Sezginer, E., & Gur, S. (2020). The inflammation network in the pathogenesis of erectile dysfunction: attractive potential therapeutic targets. Current Pharmaceutical Design, 26(32), 3955-3972.
- Jacoby, H. I. (2017). Gastric Emptying. In Reference Module in Biomedical Sciences. Elsevier.
- Hyun J. S. (2012). Prostate cancer and sexual function. The world journal of men’s health, 30(2), 99–107. https://doi.org/10.5534/wjmh.2012.30.2.99
- Masuku, N. P., Unuofin, J. O., & Lebelo, S. L. (2020). Promising role of medicinal plants in the regulation and management of male erectile dysfunction. Biomedicine & Pharmacotherapy, 130, 110555.
- Li, S., Song, J. M., Zhang, K., & Zhang, C. L. (2021). A Meta-Analysis of Erectile Dysfunction and Alcohol Consumption. Urologia Internationalis, 105(11-12), 969-985.
- Chou, N. H., Huang, Y. J., & Jiann, B. P. (2015). The Impact of Illicit Use of Amphetamine on Male Sexual Functions. The journal of sexual medicine, 12(8), 1694–1702.
- Pizzol, D., Demurtas, J., Stubbs, B., Soysal, P., Mason, C., Isik, A. T., Solmi, M., Smith, L., & Veronese, N. (2019). Relationship Between Cannabis Use and Erectile Dysfunction: A Systematic Review and Meta-Analysis. American journal of men’s health, 13(6), 1557988319892464. Chattopadhyay, S. (2022). Smoking, erectile dysfunction, and its extended psychobiology.
- Chattopadhyay, S. (2022). Smoking, erectile dysfunction, and its extended psychobiology.
- Salata, B., Kluczna, A., & Dzierżanowski, T. (2022). Opioid-Induced Sexual Dysfunction in Cancer Patients. Cancers, 14(16), 4046.
- Hosseini, S. H., Isapour, A., Tavakoli, M., Taghipour, M., & Rasuli, M. (2013). Erectile dysfunction in methadone maintenance patients: a cross-sectional study in northern Iran. Iranian journal of psychiatry, 8(4), 172–178.
- Dadomo, H., Ponzi, D., Nicolini, Y., Volpi, R., Palanza, P., Pelosi, A., … & Parmigiani, S. (2020). Loss of socio-economic condition and psychogenic erectile dysfunction: the role of temperament and depression. Adaptive Human Behavior and Physiology, 6(1), 57-74.
- Ma, M., Yu, B., Qin, F., & Yuan, J. (2020). Current approaches to the diagnosis of vascular erectile dysfunction. Translational Andrology and Urology, 9(2), 709.
- Moussa, M., Papatsoris, A. G., Abou Chakra, M., Dabboucy, B., & Fares, Y. (2020). Erectile dysfunction in common neurological conditions: A narrative review. Archivio Italiano di Urologia e Andrologia, 92(4).
- Aleksandra, R., & Aleksandra, S. (2022). Erectile Dysfunction in Relation to Metabolic Disorders and the Concentration of Sex Hormones in Aging Men. International Journal of Environmental Research and Public Health, 19(13), 7576.
- Ostfeld, R. J., Allen, K. E., Aspry, K., Brandt, E. J., Spitz, A., Liberman, J., … & Freeman, A. M. (2021). Vasculogenic erectile dysfunction: The impact of diet and lifestyle. The American Journal of Medicine, 134(3), 310-316.
- Duca, Y., Calogero, A. E., Cannarella, R., Giacone, F., Mongioi, L. M., Condorelli, R. A., & La Vignera, S. (2019). Erectile dysfunction, physical activity and physical exercise: Recommendations for clinical practice. Andrologia, 51(5), e13264.
- Rastrelli, G., Lotti, F., Reisman, Y., Sforza, A., Maggi, M., & Corona, G. (2019). Metabolically healthy and unhealthy obesity in erectile dysfunction and male infertility. Expert review of endocrinology & metabolism, 14(5), 321-334.
- Sivaratnam, L., Selimin, D. S., Abd Ghani, S. R., Nawi, H. M., & Nawi, A. M. (2021). Behavior-related erectile dysfunction: A systematic review and meta-analysis. The journal of sexual medicine, 18(1), 121-143.
- Muncey, W., Sellke, N., Kim, T., Mishra, K., Thirumavalavan, N., & Loeb, A. (2021). Alternative treatment for erectile dysfunction: a growing arsenal in men’s health. Current Urology Reports, 22(2), 1-12.
- Sin, V. J. E., Anand, G. S., & Koh, H. L. (2021). Botanical medicine and natural products used for erectile dysfunction. Sexual Medicine Reviews, 9(4), 568-592.
- Ivanoval, S., Anna, M., Penka, P., & Kalin, I. (2019). Yohimbine Intake-Health Risks-Correlation Between Side Effects and The Quality of The Yohimbine Bark: A UHPLC/MS, GC/MS Screening. Biomedical research, 30(5), 810-14.