Can Losartan (Cozaar) Treat Erectile Dysfunction?

Losartan, sold under the brand name Cozaar, among others, is a prescription angiotensin receptor blocker (ARB) medication used primarily to treat hypertension.

There are a lot of similarities in how losartan and ED medications like tadalafil and sildenafil affect the body. Unsurprisingly, certain studies show that losartan can aid in the treatment of ED-related symptoms.

But what does the research say? PDE-5 inhibitors are the type of medication traditionally used to treat ED, but is losartan a better option?

We’ll dive into these questions so you can make an informed decision that best suits your individual needs.

Losartan (Cozaar) & Erectile Dysfunction

Losartan displays a high degree of similarity when compared to ED medications (PDE-5 inhibitors). These drugs don’t have the same mechanism of action, but both improve blood flow by relaxing the vessels, so it’s only natural they would share this effect.

How do they work?

Sexual stimulation triggers the release of nitric oxide (NO), the primary vasoactive neurotransmitter in the corpora cavernosa. NO diffuses across the smooth membrane, causing the production of guanosine monophosphate (cGMP). This action makes the vascular smooth muscle relax, allowing blood to flow into the penis, causing an erection.

PDE-5 inhibitors work by inhibiting phisohidiesterase type 5 (PDE-5), an enzyme that breaks down cGMP. Doing this raises the cGMP levels, enhancing the vasodilatory effect of nitric oxide (NO).

Losartan is an angiotensin II receptor blocker and keeps blood vessels from constricting.

Studies show that combining losartan with PDE-5 inhibitors yields more positive results for treating ED than using losartan alone [1].

However, combining these medications could cause a dangerous decrease in blood pressure, so we don’t recommend trying it unless you’re under the guidance of a doctor.

What can losartan do on its own? Here’s a look at the research.

Study #1

Studies show that losartan has a significantly positive impact on treating sexual dysfunction. For example, a 2001 study examined 82 men with uncontrolled hypertension.

They found the following results after a 12-week losartan regimen [2]:

Losartan treatment improved sexual satisfaction from an initial score of 7.3 to 58.5%.
Subjects reporting a high frequency of sexual activity improved from 40.5% initially to 62.3% after drug treatment, whereas the number of patients with a low or very low frequency of sexual activity decreased significantly.
Improvement in quality of life was demonstrated in 73.7% of subjects medicated with losartan, 25.5% reported no changes, and only 0.8% felt worse.
In the group without sexual dysfunction, losartan had a non-significant effect on sexual function.

Study #2

A 2012 study examined a total of 124 diabetic patients and concluded that losartan considerably improved scores in the International Index of Erectile Function (IIEF-5), the percentage of successful penetrations (SEP2), and successful intercourse completions (SEP3) [1].

The general conclusion was that losartan was well tolerated and effective in diabetic ED patients, especially those with only mild to moderate symptoms.

Overall, the data is quite clear — losartan can help patients with ED achieve erections. We should also note that losartan also appears to improve sex drive, though we need more research.

What Is Losartan (Cozaar)?

Patented in 1986 and approved for medical use in 1995, losartan is an angiotensin II receptor blocker, the first medication of its kind.

Losartan is indicated by the FDA for treating the following conditions:

Hypertension: Losartan is used to lower blood pressure in adults and children greater than six years old, reducing the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.
Left ventricular hypertrophy: This condition is a thickening of the wall of the heart’s main pumping chamber. It often results in elevated blood pressure, but losartan effects can help to reduce this.
Diabetic kidney disease: Losartan is also effective in delaying the progression of kidney disease (the loss of function) induced by diabetes.

What Does Losartan Do?

Erections involve a complex series of bodily mechanisms that must work together. One of the most important parts of this process is the engorging of the penis through the widening (dilating) of blood vessels. According to the CDC, hypertension affects nearly half of American adults and can severely impair erections.

This effect can come about through two main pathways [3]:

Over time, hypertension hardens artery walls, including those in the penis, making them less able to dilate.
Hypertension can stiffen smooth muscles inside the penis and make it harder for blood flow to reach it.

Losartan counters hypertension’s effects, preventing blood vessels from constricting and allowing blood flow to reach the penis unimpeded. This action allows for a successful erection.

How Does Losartan Work?

Angiotensin II antagonists like losartan work by exerting an antagonist function at angiotensin receptors, which are located in the walls of blood vessels.

Normally, the angiotensin hormone binds to these receptors in order to “switch on” vasoconstriction [4], but losartan blocks these receptors and prevents angiotensin action.

This dampening effect prevents blood vessels from dilating and constricting and has several beneficial effects, like reducing blood pressure, lowering heart strain, and increasing blood supply and oxygen.

Losartan Side Effects

However, like most other drugs, losartan does have its share of side effects, although the overall incidence is low and similar to that of a placebo.

According to the FDA, here’s a list of the adverse effects associated with losartan use:

Abdominal pain
Anemia
Arthralgia
Atrial fibrillation
Constipation
Depression
Dyspnea
Edema
Headaches
Impotence
Migraine
Myalgi
Nausea
Palpitations
Paresthesia
Photosensitivity
Pruritus
Rash
Sleep disorders
Somnolence
Syncope
Tinnitus
Urticaria
Vertigo
Vomiting

Final Thoughts: Losartan & Erectile Dysfunction

Studies show that losartan is well suited for the treatment of ED symptoms and is well tolerated. However, the treatment of ED is not an FDA-approved indication for losartan, which means you might have a tough time getting a losartan prescription to treat your ED. In this sense, the beneficial effects of losartan act mostly as a sort of bonus to those with cardiovascular issues who need losartan treatment.

If you don’t have cardiovascular problems and don’t need losartan, we recommend sticking with the traditional range of ED-related medications. You’ll need a prescription to access these, but PDE-5 inhibitors are generally safe and well tolerated.

What’s important is making sure to find the PDE-5 inhibitor that works best for you and to make sure it does not interact with any other medication.

References Used

Chen, Y., Cui, S., Lin, H., Xu, Z., Zhu, W., Shi, L., … & Dai, Y. (2012). Losartan improves erectile dysfunction in diabetic patients: a clinical trial. International journal of impotence research, 24(6), 217-220.
Caro, J. L. L., Vidal, J. V. L., Roca, M. A., Bravo, C. P., Vicente, J. A., Ferrario, C. M., & Zamorano, M. A. S. (2001). Sexual dysfunction in hypertensive patients treated with losartan. The American journal of the medical sciences, 321(5), 336-341.
Hernández-Cerda, J., Bertomeu-González, V., Zuazola, P., & Cordero, A. (2020). Understanding erectile dysfunction in hypertensive patients: the need for good patient management. Vascular Health and Risk Management, 16, 231.
Ismail, S. B., Noor, N. M., Hussain, N. H. N., Sulaiman, Z., Shamsudin, M. A., & Irfan, M. (2019). Angiotensin receptor blockers for erectile dysfunction in hypertensive men: A brief meta-analysis of randomized control trials. American journal of men’s health, 13(6), 1557988319892735.