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Possible causes - Medication

Although some drugs can directly cause erection problems (iatrogenic cause), many of the drugs shown in the table below are used to treat diseases that are themselves associated with EPs. Recreational drugs, including alcohol, can also cause erection problems.

Which medications can cause erection problems?

Medications that can cause ED
Therapy area Drug class or drug Impact on ED
Cardiovascular Diuretics Not determined, but believed to interfere with smooth muscle relaxation
ACE and ARB inhibitors Interferes with smooth muscle relaxation
Aldosterone antagonists An anti-adrenergic action
Beta-blockers Affects sex hormones, impairs vasodilation of the corpora cavernosa
Clonidine Depresses adrenergic output
Psychotropic Anti-depressants, e.g. selective seretonin reuptake inhibitors, tricyclics, monoamine oxidase inhibitors, lithium Decreases arousal and desire
Anti-psychotics, e.g. phenothiazines, butyrophenones Increases prolactin levels
Anti-epileptics Carbamazepine
Affects sex hormone levels
Endocrine drugs
Endocrine drugs Testosterone antagonists/ oestrogen agonists
Anabolic steroids
Luteinising hormone-releasing
hormone analogues
Affects androgen receptors, reducing sexual desire
Recreational drugs
Recreational drugs Alcohol, heroin, cocaine, marijuana, methadone  
Other H2 antagonists, ranitidine and cimetidine Increases prolactin levels,
reducing sexual desires
Cytotoxics, e.g. cyclophosphamide The effect of nausea and general malaise associated with such drugs often diminish libido

The link between EPs and cardio-metabolic disease

The onset of EPs in men can be an early warning sign of underlying cardiovascular and metabolic conditions, including coronary artery disease and diabetes. EPs in men can be associated with a significantly increased risk of future cardiac events.

Studies have shown that EPs can be an early marker of undiagnosed diabetes, especially in middle-aged men.2

With increasing rates of obesity and diabetes in younger men, [reference to be added] pharmacists can play an essential role in the early detection of cardio-metabolic risk factors among those presenting to the pharmacy with concerns about EPs. 

It is important that all men with EPs are advised to consult their doctor within six months of receiving Viagra Connect, for a clinical review of potential underlying conditions and risk factors associated with EPs.