A Review Of The Positive And Negative Effects Of Cardiovascular Drugs On Sexual Function: A Proposed Table For Use In Clinical Practice

So, traditional risk factors such as hypertension, diabetes, and hyperlipidemia could contribute for ED development or worsening even in situations where psychological etiology seems more likely. 89 in the placebo group, 5. Losartan, Cozaar, DiovanConsider this list to be the start of your research to figure out which medications work best for you. Other risk factors have been related to ED. Impotence may be a manifestation of a poor relationship, or a problematic time in a relationship.

Combining losartan or other ARBs with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients who are elderly, fluid-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. If the person experiences no problems on the initial dosage, a doctor may increase the dosage to a maximum of 200 mg per day. They confirmed ED as a clinical independent marker of increased cerebral vascular disease risk [65]. Antipsychotics are used to treat schizophrenia, bipolar disorder and other serious psychiatric conditions.

Journal of Urology.

Find Out Which Drugs Might Have A Negative Effect On Your Sex Life

Sexual dysfunction associated with 5-HTactivity is completely dose-related. Lower high blood pressure for better overall health, the study group of men without sexual dysfunction, the drug did not produce changes in sexual function or satisfaction. Because there are so many potential culprits, one important aspect of diagnosing and treating ED is figuring out the underlying cause. The claims of the lawsuit advise that the manufacturers violated antitrust and consumer protection law. Impotence that’s triggered by psychological factors is more common in men who are sexually inexperienced.

Several drugs can produce erectile difficulties, but blood pressure drugs are near the top. Men should discuss any concerns with their doctor. An experimental study and an RCT showed reduced testosterone in men using a statin although the average effect is modest [64, 65]. Keep reading to learn about treatment options. Metabolic syndrome and waist-to-rip ratio have been associated to more severe ED among those over 50 years old [31]. Hypertension is associated with severe erectile dysfunction. But the impact on your sex life may be obvious.

After 8 weeks of treatment, the patients were investigated according to the following schedule: If there's any doubt about your safety, your doctor will order a stress test to measure the effects of exercise on your heart. An ignoble prize for real research, a lack of communication is the primary barrier for seeking treatment and can prolong the suffering. Like men, women can experience anxiety and relationship issues due to sexual dysfunction.

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Tell your doctor if you’re pregnant or plan to become pregnant while taking this medicine. Co-located with the Shands Jacksonville Hospital, the Jacksonville Health Science Center excels in education, research and patient care that expresses our abiding values of compassion, excellence, professionalism and innovation. In contrast, continuous use of PDE5 inhibitors proved to reverse endothelial dysfunction with positive impact on sexual function and even on blood pressure control. After cardiovascular risk stratification and adequate control of modifiable risk factors, ED patients should be oriented about the right way of sexual medication usage. It affects men of all ages but becomes increasingly prevalent with age. One reason erectile dysfunction (ED) becomes more common with age is that older men are more likely to be on medication, and ED is often a side effect of many common drugs. In men, “the pathways that lead to arousal and orgasm have been mapped,”but this information is lacking for the female body. Most common mistakes include high fat meal near intake, lack of sexual stimulation after intake, short time before sexual intercourse, and low number of attempts [84].

In many cases, psychological issues develop into performance anxiety which, in and of itself, becomes a self-fulfilling prophecy. Unfortunately, this does not guide treatment options in one specific direction. Your doctor can usually solve the problem by simply changing the prescription. In a pathological condition causing the absence of stimulated or physiological erections and abolishing such stimulus, there would be a structural change in tissue composition with deleterious consequences on erectile capacity [24]. If I take Viagra, would this be harmful?

In fact, Viagra slightly lowers the blood pressure – though only for a short time.

High blood pressure and sex: Overcome the challenges

Since the pioneering work of Jeremy et al. Penis exercises, relax and be patient with yourself. In the Trial of Antihypertensive Interventions and Management (TAIM), erection-related problems worsened in 28 % of patients receiving chlortalidone, in 11 % of patients receiving atenolol and in 3 % of patients receiving placebo [15]. Student's paired t-test for parametric data and the χ2 test for categorial data were used.

02), while, with nebivolol the PSV did not show a significant change (P = 0. An academically affiliated tertiary care Veterans Affairs medical center study found that atenolol-induced loss of libido could be reversed with lowering of the dose. What are the types of sexual dysfunction? Laryngospasm, respiratory distress. TOPROL-XL use was associated with a higher incidence of bradycardia (6. )In atherosclerosis, the arteries are clogged and narrowed, resulting in reduced blood flow.

2 % of the propranolol group and in 22. Mostly metabolized by the liver (primarily by CYP2D6; the CYP2D6 enzyme system exhibits genetic polymorphism); ~7% of population may be poor metabolizers and may have significantly ↑ metoprolol concentrations and an ↑ risk of adverse effects. Taking certain medications is also associated with causing or exacerbating ED. Among men, high blood pressure can cause erection problems by slowing the supply of blood to the penis. In contrast, in other more recent trials no significant adverse effects on sexual function were found with metoprolol [12], propranolol [13], acebutulol [14] and atenolol [15]. Why they’re prescribed:

  • Hard made easy.
  • This can sometimes cause dizziness.

Side Effects

Finasteride and dutasteride, 5-alpha reductase inhibitors for the treatment of benign prostate hyperplasia (BPH), decrease dihydrotestosterone levels, the active metabolite of testosterone. 05 was considered statistically significant. A brief list of these medications and brand names include: Find out how you can improve your erections. Consuming alcohol while taking metoprolol may cause mild body rashes and is not advised. Sedentarism, obesity, and smoking have been implicated in the etiology of ED, and an approach of these risk factors has been able to reverse ED and restore normal erectile function [30]. Multiple sclerosis (MS) and other degenerative diseases of the nervous system, such as Parkinson’s disease, can damage the nerves involved in erections. 5%, regardless of the assessment of causality.

When Are Phosphodiesterase-5 Inhibitors Appropriate In Patients With Cardiovascular Disease?

Which ED drug is the best for me? Study data suggests it affects 18 million men over the age of 20 in the United States. Duncan LE at al. IV (Adults) MI– 5 mg every 2 min for 3 doses, followed by oral dosing.

Those numbers were similar in more recent publications over the world [5] and also in developing countries [6], projecting the assumption that over 30 million American citizens suffer from some level of sexual dysfunction [5]. How long does it work? Oral therapy failure could represent a deeper vascular damage and worst cardiovascular risk and generally requires the aid of the urologist in order to restore hypertensive man sexual life. The UFHSC-J is a clinical teaching site for the Gainesville-based College of Nursing. Male pattern baldness overview, , Creutzig, A. Students rotate through the various clinical settings on the campus, and primary care centers and specialty care centers located throughout Jacksonville. Beta-blockers, alpha-adrenergic agonists, and thiazide diuretics are associated with libido changes. In fact, erection problems may be the first sign that you are at risk of coronary heart disease. The list of possible offenders is long, so check with your doctor regarding medications you are taking to rule out any as a cause of, or contributor to, ED.

It can be beneficial for a patient with pretreatment complaints of decreased libido to start on a medication that clinical studies support as having little to no effect on libido. As the pressure builds, the blood becomes trapped in the corpora cavernosa, keeping the penis erect. The following is a list of some medicines and drugs that may cause erectile dysfunction (ED) in men. I presume you have erection problems – and I'm sorry to hear that. Improving arousal and lubrication can help. Clinical trials, while subluxations are the main cause of sciatica, there are other potential causes as well. If you experience sudden vision loss, stop using Viagra and seek emergency medical help.

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Several hypotheses try to explain the pathophysiology of ED in hypertensive individuals. The different salt versions of metoprolol, metoprolol tartrate and metoprolol succinate, are approved for different conditions and are not interchangeable. It’s important to understand that oral ED drugs are not aphrodisiacs. After 5 weeks, the patients were investigated according to the same protocol as described above. If you experience ED and think that it may be a result of medication, do not stop taking the drug without first consulting your doctor.

Recent guidelines establish that patients without obvious etiology for ED, such as anatomical disorders, neurological disease, or endocrine causes, should be evaluated for cardiovascular risk factors, arterial hypertension, and arterial disease [91]. PDE5 inhibitors, ED’s first line therapy, present a mechanism of action based on NO bioavailability. Impotence was mentioned in 10. It would seem reasonable to manage these patients in the same way as those with heart failure with reduced ejection fraction (HF-REF), while noting that patients with HF-PEF may be more “brittle”. Knudsen is an assistant professor at Midwestern University College of Pharmacy, in Glendale, Arizona. Even a single episode of erectile dysfunction can cause anxiety. Although aging and atherosclerosis are recognized risk factors for ED development, according to some experimental studies the mechanism under those situations is distinct [57]. As reported in the journal, sex really can be dangerous for people with severe hypertension that isn't under control.

Thus, ED could offer the opportunity to implement adequate therapeutic efforts to minimize the burden of major cardiovascular disease such as myocardium infarction and stroke [4].


Ketoconazole and aminoglutethimide actually reduce the production of testosterone. They found that vasodilation of the brachial artery by both mechanisms, endothelium-dependent and independent, was significantly compromised in the group suffering from ED, which illustrates that vascular alterations involved in ED are a generalized process [67]. While ED isn’t necessarily a severe medical disease itself, it can certainly have profound psychological and emotional effects. These clinical manifestations rarely are symmetrical in the same patient, probably due to different sizes of arterial tree that irrigate territories such as penile, heart, brain, and legs [20], and different needs of blood supply and vasodilation of each structure [67]. On the other hand, statins have been reported to improve erectile function when the cohorts had no other cardiovascular risk factors accept for untreated ED [70–72]. However, if you develop any sexual side effects while taking metoprolol, make sure to talk with the doc. Trending topics, a penile prosthesis may be an appropriate option, and requires surgery under general anesthetic for implantation. Cold extremities, arterial insufficiency (usually of the Raynaud type), palpitations, peripheral edema, syncope, chest pain and hypotension.


If you have high blood pressure but aren't receiving treatment -- or if your blood pressure is soaring despite treatment -- your doctor may ask you to abstain from sex or other strenuous activity until your pressure is under control. Thus, knowledge of cardiovascular risk of men with ED is essential, since it could help to identify hidden risk factors and also to evaluate the existence of any contraindication for ED therapy as detailed in the second Princeton consensus [73]. In this way, search for new data on basic mechanism under ED development in hypertensive individuals is an actual need. Fortunately, there are several ways to manage and treat ED. Clinical laboratory findings may include elevated levels of serum transaminase, alkaline phosphatase, and lactate dehydrogenase.

Whatever medicine your doctor prescribes, be sure to follow the instructions to the letter. What is Erectile Dysfunction Exactly? Revatio is given to improve exercise ability and slow down worsening changes in people with this condition. Ed affects up to 40% of men by age 40. We were unable to find the requested page. In this trial the prevalence of impotence was measured by questionnaires after 2 years of treatment with propranolol, bendroflumethiazide or placebo.

Probably this aspect is one among others to explain the lack of additional contribution of ED over traditional risk factors (Framingham score) during cardiovascular evaluation in some reports [29].

Who should not take oral ED drugs?

Men who fail to seek treatment for erectile dysfunction often feel as though they are alone in their suffering, but nothing could be further from the truth. Due to the lack of large clinical trials with long followup period designed for ED identification and with cardiovascular morbidity and mortality as endpoints, it is premature to assure that ED identifies an increased cardiovascular risk among hypertensive patients that extends beyond the risk represented by blood pressure elevation [62]. Sexual function knowledge by general practitioners and cardiologists is relevant and should be ideally accessed before starting therapy for hypertension. Main menu, physical and psychological exams are a key part of diagnosing ED. Some medicines can affect libido (desire) and others can affect the ability to become aroused or achieve orgasm. Unfortunately, many of the emotional outcomes of ED further contribute to the psychological causes of ED, resulting in a discouraging cycle. Millions of men struggle with it, but shockingly few ever seek treatment. The next most common cause is beta blockers. It could be something as simple as a run away script or learning how to better use E-utilities, http:

2 mg if BP was >160/100 mmHg. July 20, 2020. – An alternative to oral medications, vacuum constriction devices can create an erection using vacuum pressure — once an erection develops, a constriction band is placed around the base of the penis to maintain the erection. Lemonaid’s ED service https: These adverse effects are due to binding of spironolactone to progesterone and androgen receptors and represent a substantial reason for drug discontinuation [36]. Read more about erectile dysfunction, between 14,000 and 19,000 babies were born with low birthweight because their parents smoked, he said, which meant that not only were they small, but they were likely to be sickly and have continuing health problems. Asking your doctor for treatments for depression may help alleviate your erection problems as well. Also, for some of these medicines ED is a very rare side effect.

For Patients

However, among those without treatment or with inadequate blood pressure control or with severe hypertension, it is recommended the cardiologic approach and initial cardiovascular therapy before the prescription of specific drugs to improve erectile function [74]. Does masturbation ever cause ed?, [25] Medications to treat ED may cause a side effect called priapism. At baseline subjects are randomized to either nebivolol 5 mg once daily or metoprolol succinate 100 mg once daily. The TOMHS trial (The Treatment Of Mild Hypertension Study), a 4-year follow-up, double-blind RTC in 557 men and 345 women, showed that chlortalidone at a dose of 15 mg/day may also be suspected to negatively affect sexual function in men [30].

Importantly, the heart conditions should be carefully clarified before initiation of medical treatment, as PDE5 inhibitors must not be used in certain cardiovascular conditions or at least require special precaution.

What are my options for ED treatment?

Losartan seemed to have positive effects on erectile function as well [58]. Alprazolam and male sex problems, if you use any of these drugs for too long, you can experience symptoms of withdrawal if you suddenly stop. Initial efforts should identify and treat all modifiable risk factors. The fact that ACE inhibitors work through other channels than the sympathetic nervous system in lowering blood pressure might in part explain their reduced impact on sexual function. Or, a combination of medications might work better to control high blood pressure and lower the risk of erectile dysfunction. Left untreated, ED can contribute to worsened stress and anxiety as well as low self-esteem, relationship problems, and impotence. So can I take Viagra with my heart medications?

After a short washout period (1–3 days) all patients started moxonidine at 0. If you still have side effects, talk to your doctor about other possible medications that may have fewer side effects. Low testosterone levels may be the result of a condition called hypogonadism, in which the testicles don’t produce enough testosterone. Women should talk to their doctor if they experience these difficulties. Self-help resources:, think about something that turns you on. Accessed online 28 August 2020. When you become aroused, your brain sends chemical messages to the blood vessels in the penis, causing them to dilate or open, allowing blood to flow into the penis. Sometimes a particular combination of medications or supplements contributes to sexual problems. A doctor will usually advise people to lower the dosage gradually over 2 weeks.

If you have experienced erectile issues or you have some of the risk factors mentioned above, it may be worth making a trip to your doctor’s office. Erectile dysfunction following radical prostatectomy, 24 However, long-term use of the vacuum erection device for penile rehabilitation is questionable because of the theoretical risk of potentiating cavernosal fibrosis from prolonged ischaemia, acidosis and lack of smooth muscle relaxation. However, doctors prescribe only metoprolol tartrate to prevent further heart attacks in people who have already experienced a heart attack. (03); however, the annual absolute increase in risk of withdrawal was only 2 per 1000 patients (95 % CI 0–5) [19].

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ED isn’t a natural part of aging, but the risk of experiencing it does increase as men get older. If a problem develops with any of these things, erectile dysfunction could be the consequence. Cholesterol is the biochemical precursor for testosterone. The effects of hypertension and its pharmacotherapy on sexual function are well known in men,although this topic remains unexplored in women. Am J Health Syst Pharm. There is evidence suggests that some classes of antihypertensive drugs such as diuretics and beta-blockers have more negative impact on male sexual function than other classes such as calcium channel blockers(CCBs) and angiotensin-converting enzyme inhibitors(ACEI). Always consult with your doctor first!


Men with certain medical histories – like diabetes or past prostate surgery – may not respond to oral ED drugs. Another theory proposed is the digoxin-associated inhibition of the corpus cavernosum smooth muscle sodium pump activity, which promotes corporeal contraction and impedes nitric oxide induced relaxation, leading to ED [41]. 89; 95 % CI 2. Water pills (diuretics).

These evidences allowed the consideration of ED as a clinical manifestation of a functional (lack of vasodilation) or structural abnormality in penile circulation as component of a systemic vasculopathy [20]. Although beta-blockers are generally safe and effective drugs, they may cause unwanted side effects in some people. Because the arteries to the penis are narrower than those to the heart, you may develop symptoms of erectile dysfunction before you experience any symptoms of heart disease, such as angina.