Erectile dysfunction, or ED, means regularly having difficulty getting or maintaining an erection firm enough for sex. Diabetes, cardiovascular disease, low testosterone, depression, nerve damage, smoking, and other health conditions can contribute to ED. Medications are another possible cause.
The National Institute of Diabetes and Digestive and Kidney Diseases lists antidepressants, blood pressure medicines, diuretics, hormone treatments, certain pain medicines, sedatives, and ulcer medicines among the drugs that may contribute to erectile dysfunction.
Below are 20 drugs that may cause erectile dysfunction, organized by medication class. Some drugs have a clear hormonal or neurological effect that can interfere with erections. Others have been associated with ED in clinical trials and safety reports, but the underlying illness may also contribute.
Antidepressants
Antidepressants can affect sexual function at several stages. They may reduce sexual desire, delay orgasm or ejaculation, decrease genital sensation, or make it harder to achieve an erection.
Serotonin is involved in mood regulation, but increased serotonin activity can suppress dopamine and other pathways involved in sexual excitement. Some antidepressants may also interfere with nitric oxide signaling, which helps the smooth muscle inside the penis relax so blood can enter.
In a prospective study conducted by Montejo and colleagues, of 1,022 people who had normal sexual function before starting an antidepressant, 59.1% developed some form of sexual dysfunction. The researchers assessed libido, orgasm, ejaculation, erectile function, and sexual satisfaction. Only 20.2% of affected patients spontaneously reported the problem, showing why clinicians often need to ask directly about sexual health.
A separate systematic review of randomized trials found that antidepressants were associated with higher odds of erectile dysfunction than placebo.
1. Paroxetine
Paroxetine (Paxil) is a selective serotonin reuptake inhibitor, or SSRI. It is commonly prescribed for depression, panic disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and generalized anxiety disorder.
Among SSRIs, paroxetine has one of the clearest associations with sexual side effects. Its strong serotonin effects can reduce desire, interfere with erection-related nerve signaling, and substantially delay ejaculation.
In the 1,022-patient prospective study, 70.7% of people taking paroxetine reported some form of treatment-related sexual dysfunction.
2. Citalopram
Citalopram (Celexa) is an SSRI used primarily to treat depression. It is also sometimes prescribed for anxiety-related conditions.
Citalopram increases serotonin activity, which can reduce sexual excitement and weaken the neurological signals involved in erection and orgasm. Some men maintain normal sexual desire but find that physical arousal or erection firmness changes after treatment begins.
In the Montejo study, 72.7% of citalopram users developed at least one type of sexual dysfunction. This was the highest reported percentage among the commonly used SSRIs evaluated in that study, although the result included decreased libido and orgasm or ejaculation problems as well as erectile dysfunction.
3. Sertraline
Sertraline (Zoloft) is prescribed for depression, panic disorder, obsessive-compulsive disorder, social anxiety disorder, post-traumatic stress disorder, and premenstrual dysphoric disorder.
Like other SSRIs, sertraline can reduce dopamine-mediated sexual motivation and interfere with arousal, erection, ejaculation, and orgasm. Ejaculatory delay is especially common, but erection problems can occur as part of the same treatment-related sexual response.
In the prospective antidepressant study, 62.9% of sertraline users reported some form of sexual dysfunction.
4. Fluoxetine
Fluoxetine (Prozac) is an SSRI used for depression, obsessive-compulsive disorder, panic disorder, bulimia nervosa, and certain other psychiatric conditions.
Fluoxetine has a long half-life, so sexual side effects may take time to improve after the dose is changed or the medication is discontinued under medical supervision. Increased serotonin activity can reduce libido, dampen physical arousal, and interfere with erections or orgasm.
In the Montejo study, 57.7% of fluoxetine users experienced at least one type of sexual dysfunction. The rate refers to the broader category of sexual problems, but erectile function was one of the areas assessed.
5. Venlafaxine
Venlafaxine (Effexor XR) is a serotonin-norepinephrine reuptake inhibitor, or SNRI. It is used for depression, generalized anxiety disorder, social anxiety disorder, and panic disorder.
At lower doses, venlafaxine acts mainly through serotonin. Its norepinephrine effect becomes stronger at higher doses. Serotonin-related suppression of sexual response can reduce desire and interfere with erection, ejaculation, or orgasm.
The prospective study reported treatment-related sexual dysfunction in 67.3% of venlafaxine users.
Antipsychotic drugs
Antipsychotic medications can interfere with erections through several mechanisms. Blocking dopamine may raise prolactin, a hormone that can reduce testosterone production and sexual desire. Some antipsychotics also block alpha-adrenergic or cholinergic receptors involved in normal arousal and blood-flow regulation.
Psychiatric illness itself can affect sexual function, so studies do not always separate the effect of the drug from the effect of the underlying condition.
A 2026 analysis of the World Health Organization’s VigiBase safety database examined 5,195 reports involving sexual adverse effects from antipsychotics. Erectile dysfunction accounted for 3,487 male reports and was reported about 2.5 times more frequently in connection with antipsychotics than with other medications in the safety database.
6. Risperidone
Risperidone is used to treat schizophrenia, bipolar disorder, irritability associated with autism, and certain other psychiatric symptoms.
Risperidone strongly blocks dopamine D2 receptors and commonly raises prolactin. Elevated prolactin can reduce testosterone, lower sexual desire, and make erections more difficult. Alpha-adrenergic blockade may also interfere with erection and ejaculation.
In a study of 100 men receiving antipsychotic treatment, 43% to 50% of those taking risperidone met criteria for erectile dysfunction, depending on the assessment scale used.
7. Haloperidol
Haloperidol is a first-generation antipsychotic used for schizophrenia, severe agitation, psychosis, and some movement or behavioral disorders.
Its strong dopamine-blocking effect can raise prolactin and reduce sexual desire. Reduced testosterone signaling, emotional blunting, sedation, muscle stiffness, and autonomic effects may also make sexual activity and erections more difficult.
Reviews comparing antipsychotics generally place first-generation drugs such as haloperidol among the medications with a relatively high burden of sexual adverse effects. The current haloperidol prescribing information also recognizes sexual and reproductive adverse reactions associated with treatment.
8. Olanzapine
Olanzapine is used to treat schizophrenia and bipolar disorder. It may also be combined with fluoxetine for certain forms of depression.
Olanzapine usually raises prolactin less dramatically than risperidone, but it can still affect dopamine, sexual desire, and arousal. Sedation, weight gain, insulin resistance, and worsening metabolic health can add to the problem over time.
In the 100-man antipsychotic study, 16% of olanzapine users met erectile dysfunction criteria on one validated scale. Depending on the scale, 16% to 34% reported some form of sexual dysfunction. The rate was lower than with risperidone but remained clinically meaningful.
Diuretics
Diuretics help the body remove sodium and water. They are widely used to treat high blood pressure, swelling, heart failure, and other cardiovascular conditions.
Some diuretics may reduce circulating blood volume and penile blood flow. Certain drugs in this group also affect hormones. High blood pressure and vascular disease independently cause ED, which makes careful assessment important.
9. Chlorthalidone
Chlorthalidone is a thiazide-like diuretic used mainly to treat high blood pressure. It may also be prescribed for fluid retention.
In the randomized Treatment of Mild Hypertension Study, 557 men received placebo or one of five blood pressure medicines. During the first 24 months, erection problems were reported by 17.1% of men taking chlorthalidone, compared with 8.1% taking placebo. The difference was statistically significant.
Chlorthalidone may contribute to ED by lowering blood volume and changing vascular responsiveness. Changes in potassium, sodium, or general energy levels may also affect sexual function in some patients.
10. Hydrochlorothiazide
Hydrochlorothiazide, or HCTZ, is a thiazide diuretic used for high blood pressure and fluid retention. It is often combined with another blood pressure medicine. The drug’s current DailyMed prescribing information lists impotence as a possible urogenital adverse reaction.
However, clinical trial results are mixed. A pooled analysis of randomized, blinded trials involving 1,251 men found no statistically significant difference in impotence, libido problems, or overall sexual dysfunction between hydrochlorothiazide and several comparison treatments during six to 14 weeks of treatment.
Longer exposure, dose, underlying vascular disease, and the use of multiple blood pressure medicines may explain why some patients report ED even when short-term trials do not show a clear average effect.
11. Spironolactone
Spironolactone (Aldactone) is a potassium-sparing diuretic used for heart failure, resistant hypertension, fluid retention, and conditions involving excess aldosterone.
Spironolactone also has antiandrogen effects. It can block androgen receptors and interfere with testosterone production. These hormonal effects may lower libido and make it harder to achieve or maintain an erection.
The current spironolactone prescribing information lists decreased libido and an inability to achieve or maintain an erection among reported reproductive adverse effects. Hormonal adverse effects tend to become more likely as the dose and duration of treatment increase.
Beta blockers
Beta blockers slow the heart and reduce the effects of adrenaline. They are used for high blood pressure, angina, heart rhythm disorders, heart failure, migraine prevention, tremor, and recovery after a heart attack.
Older beta blockers may reduce penile blood flow, blunt sympathetic nervous system activity, and cause fatigue. Expectations can influence symptoms as well. Men who are warned that a beta blocker may cause ED sometimes report the problem more often, an example of a nocebo effect.
A 2025 meta-analysis covering 18 epidemiological studies and 21 randomized trials did not find a statistically significant increase in ED with beta blockers as a class. However, beta blockers reduced the reported frequency of intercourse, and results differed among individual drugs. Nebivolol generally performed better than older beta blockers on validated erectile-function measures.
12. Atenolol
Atenolol (Tenormin) is used for high blood pressure, angina, and heart-rate control. It is also prescribed after certain heart attacks.
In a study of 90 men with high blood pressure, sexual dysfunction symptoms were reported by 17% during atenolol treatment and 3% during lisinopril treatment. Monthly sexual intercourse declined from 7.8 episodes at baseline to 4.5 after one month of atenolol and remained lower during continued treatment.
Another randomized study found that successful intercourse declined from 7.0 to 3.7 episodes per month with atenolol. The decline was much smaller with nebivolol.
13. Metoprolol
Metoprolol is used for high blood pressure, angina, heart failure, and heart-rate control. It is also prescribed after a heart attack.
Metoprolol blocks beta-1 receptors and can reduce heart rate and cardiac output. In some men, reduced vascular responsiveness, fatigue, and decreased sympathetic activity can weaken sexual arousal or erectile firmness.
In the randomized MR NOED study, men receiving metoprolol had poorer erectile-function outcomes than men receiving nebivolol, a beta-blocker that also promotes nitric oxide-mediated blood-vessel relaxation.
The difference between these drugs suggests that sexual side effects are not the same with every beta-blocker. A clinician may be able to adjust the specific medication while continuing necessary cardiovascular treatment.
Prostate and hair-loss drugs
Finasteride and dutasteride are 5-alpha-reductase inhibitors. They block the conversion of testosterone into dihydrotestosterone, or DHT.
Lowering DHT shrinks the prostate and slows androgen-related hair loss. The same hormonal change can reduce libido, alter ejaculation, or affect erections in some men.
A meta-analysis of 17 randomized trials involving 17,494 men found that those taking 5-alpha-reductase inhibitors for an enlarged prostate were about 55% more likely to develop erectile dysfunction than those in the comparison groups.
14. Finasteride
Finasteride is used at a lower dose for male-pattern hair loss and at a higher dose for an enlarged prostate.
In a 4-year study, impotence during the first year was reported by 8.1% of men taking finasteride and 3.7% taking placebo. Decreased libido occurred in 6.4% and 3.4%, respectively. During years two through four, impotence was reported by 5.1% in both groups.
In the longer MTOPS prostate study, impotence was reported by 18.5% of men taking finasteride and 12.2% taking placebo. The rate reached 22.6% when finasteride was combined with doxazosin.
Sexual symptoms often improve after treatment is adjusted or discontinued, but persistent symptoms have been reported. The frequency and cause of persistent symptoms remain uncertain.
15. Dutasteride
Dutasteride is used to treat benign prostatic hyperplasia. It blocks both major forms of the 5-alpha-reductase enzyme and produces a substantial reduction in DHT.
Clinical trials and postmarketing reports have linked dutasteride with impotence, decreased libido, ejaculation disorders, and breast changes. More than 4,300 men participated in the three placebo-controlled trials summarized in the drug’s prescribing information.
The current dutasteride label notes that some sexual adverse reactions may continue after treatment is stopped. Available evidence does not establish how frequently this happens or prove that dutasteride is responsible for every persistent case.
Prostate cancer hormone treatments
Hormone therapy for prostate cancer lowers testosterone or prevents testosterone from stimulating cancer cells. Sexual side effects are common because testosterone supports libido, arousal, erectile signaling, and the maintenance of sexual tissues.
16. Leuprolide
Leuprolide is a gonadotropin-releasing hormone agonist used in the treatment of advanced prostate cancer. It is also used for some gynecological and pediatric hormonal conditions.
After an initial hormonal surge, continued leuprolide treatment suppresses signals from the pituitary gland and reduces testosterone to castration levels. The prescribing information states that castrate testosterone concentrations are generally reached within about four weeks.
The National Cancer Institute identifies loss of libido and erectile dysfunction as common effects of androgen-deprivation therapy. ED medicines such as sildenafil may be less effective during treatment because they improve penile blood flow but do not restore testosterone-related sexual desire.
Sexual function may improve after hormone therapy ends and testosterone recovers. Recovery can be slow or incomplete in older men and in people who receive treatment for a long time.
Opioid pain medicines
Opioids can suppress the hypothalamic-pituitary-gonadal axis. This reduces the release of reproductive hormones and can lead to low testosterone. Sedation, depression, chronic pain, and reduced physical activity can add to the effect.
An Endocrine Society scientific statement cited a meta-analysis of 15 studies involving 3,250 chronic opioid users, almost all of whom were men. The estimated prevalence of hypogonadism was 63%. Hypogonadism is a condition in which the body produces too little testosterone or does not produce enough sperm. In men, it can cause low sexual desire, erectile dysfunction, fatigue, reduced muscle mass, infertility, and loss of body or facial hair.
Risk is more relevant with regular, long-term, or high-dose use than with a short course taken after an injury or procedure.
17. Methadone
Methadone is used to treat opioid use disorder and certain forms of severe chronic pain. Its long duration of action makes it effective for maintenance treatment, but prolonged exposure can strongly suppress testosterone production.
A 2024 systematic review and meta-analysis found that men receiving methadone had significantly lower total International Index of Erectile Function scores than control participants. Methadone was also associated with poorer sexual desire, intercourse satisfaction, and overall satisfaction.
A clinician may check morning testosterone and related hormones when a man taking long-term methadone develops ED, low libido, fatigue, infertility, or loss of body hair.
18. Oxycodone
Oxycodone is prescribed for moderate to severe pain. Extended-release formulations may be used when continuous opioid pain control is considered necessary.
Long-term oxycodone can suppress gonadotropin-releasing hormone, luteinizing hormone, and testosterone. The resulting androgen deficiency can reduce sexual desire and impair erections.
The Endocrine Society review found that oral oxycodone was among the opioids associated with higher odds of androgen deficiency when compared with hydrocodone. The NIDDK also specifically includes oxycodone among medicines that may contribute to ED.
Stomach-acid and antifungal drugs
Some drugs outside the major psychiatric, cardiovascular, and hormonal categories can affect androgen signaling. Cimetidine and oral ketoconazole are two important examples.
19. Cimetidine
Cimetidine is an H2-receptor blocker used to reduce stomach acid. It may be used for ulcers, gastroesophageal reflux disease, and conditions that cause excessive acid production. Other H2 blockers and proton-pump inhibitors have reduced its routine use.
At very high doses (>5 g per day), cimetidine can interfere with male sex hormones. Its antiandrogenic activity reduces the effects of testosterone, while increased prolactin may further suppress sexual function. This can cause temporary erectile dysfunction, breast enlargement called gynecomastia, or, rarely, milk-like nipple discharge called galactorrhea.
20. Oral ketoconazole
Oral ketoconazole is an antifungal medicine reserved for serious systemic fungal infections when safer alternatives are unavailable or unsuitable. This concern applies to ketoconazole tablets, rather than ketoconazole creams or shampoos.
Oral ketoconazole directly inhibits enzymes needed for testosterone synthesis. Its prescribing information states that high doses can impair or abolish testosterone production. Impotence is among the possible clinical effects.
An early clinical investigation also documented impaired testosterone responses during high-dose ketoconazole treatment (800 to 1,200 mg/day).
How can a medication cause erectile dysfunction?
A medication can interfere with erections through one or more pathways:
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- Reduced penile blood flow: Diuretics, older beta blockers, and some other cardiovascular drugs may decrease circulating volume or change blood-vessel responsiveness.
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- Changes in brain signaling: Antidepressants and antipsychotics can alter serotonin, dopamine, norepinephrine, and other chemical signals involved in sexual desire and arousal.
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- Lower testosterone: Opioids, leuprolide, oral ketoconazole, and some antipsychotics can reduce testosterone directly or disrupt the hormones that control its production.
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- Androgen blockade: Spironolactone and cimetidine can interfere with androgen receptors. Finasteride and dutasteride reduce DHT.
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- Sedation and fatigue: Antipsychotics, opioids, and some cardiovascular medicines may reduce energy, alertness, and physical arousal.
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- Reduced libido: A man may have healthy penile blood vessels but receive weaker sexual-arousal signals because of hormonal or neurological changes.
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- Metabolic changes: Weight gain, elevated blood sugar, and worsening cholesterol can gradually damage vascular health.
How do you know whether a medication is causing ED?
Medication-related ED becomes more likely when:
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- The problem began soon after starting a medication.
- Symptoms appeared after a dose increase.
- Sexual function was stable before treatment.
- Libido, ejaculation, or orgasm changed at the same time.
- Symptoms improve after a clinician safely reduces the dose or changes the medication.
- No major new vascular, neurological, hormonal, or psychological condition explains the change.
The underlying illness still matters. Depression can reduce sexual desire. High blood pressure can damage arteries. Diabetes can injure blood vessels and nerves. Chronic pain can reduce activity and testosterone. Prostate cancer treatment may affect erections through surgery, radiation, and hormone therapy at the same time.
According to the NIDDK’s diagnostic guidance, an ED evaluation may include a medical and sexual history, medication review, physical examination, blood tests, and additional testing when vascular, neurological, or hormonal problems are suspected.
What to do if a medication appears to be causing ED?
If you suspect a medication has caused unwanted sexual side effects, here’s what you need to do:
Do not stop the medication on your own
Abrupt medication changes can trigger antidepressant withdrawal, psychiatric relapse, uncontrolled blood pressure, rapid heart rate, opioid withdrawal, worsening pain, or interruption of cancer treatment.
Make a symptom timeline
Write down when the problem began, when each medication was started, and whether any doses changed. Include nonprescription drugs, supplements, alcohol, cannabis, and other substances.
Record whether the change involves erection firmness, sexual desire, morning erections, ejaculation, orgasm, or several areas.
Ask for a complete medication review
A clinician may be able to:
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- Reduce the dose when medically appropriate.
- Change the time the medication is taken.
- Replace the drug with an option that has fewer sexual effects.
- Simplify a combination of medications.
- Treat a related problem such as low testosterone or elevated prolactin.
For example, some patients may tolerate a different antidepressant or blood pressure medicine better. The safest alternative depends on the condition being treated and the person’s medical history.
Check for other causes
A clinician may evaluate blood pressure, blood glucose or A1C, cholesterol, testosterone, thyroid function, prolactin, kidney function, and cardiovascular risk. The appropriate tests depend on the symptoms and medical history.
Discuss ED treatment
The NIDDK’s treatment guidance includes oral phosphodiesterase-5 inhibitors, vacuum erection devices, injectable medicines, urethral medicines, counseling, and penile implants.
Sildenafil (Viagra) has specifically been studied for antidepressant-associated sexual dysfunction. In a randomized trial of 90 men, 54.5% receiving sildenafil reported being much or very much improved, compared with 4.4% receiving placebo. Erectile function, arousal, ejaculation, orgasm, and satisfaction all improved.
Sildenafil, tadalafil, and similar drugs must not be combined with nitrate medicines because the combination can cause a dangerous drop in blood pressure. Extra caution may also be needed with alpha blockers and some other cardiovascular treatments.
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