As you may already know, no medication is side effects free. Drugs such as antidepressants, antihistamines (for allergies), antihypertensives, and antiparkinsonian (for Parkinson's disease) are some of the main causes of drug-induced erectile dysfunction (ED)

Male erectile function, as well as female sexual performance, is highly vulnerable to any medication. Countless drugs influence sexual function, some leading to more marked symptoms than others regarding side effects.

High blood pressure often coexists with erectile dysfunction, as ED is arguably an early indicator of future cardiovascular problems. Many men with high blood pressure also have erectile dysfunction, but certain antihypertensive drugs to improve blood pressure may worsen their ability to obtain an erection instead of improving it.

Erectile Dysfunction

Erectile dysfunction, also misnamed impotence, is the inability to obtain an erection firm enough for truly pleasurable sexual intercourse.

Forty percent of men admit to having some level of sexual dysfunction in their 40s, while 10% admit to experiencing a decline in sexual ability or interest as they age. ED is likely to be more prevalent as you get older because high blood pressure is also common, and both conditions are closely related.

The symptoms are very clear:

  • You have erections only occasionally, but not every time you want to have sex.

  • Because of the above, you are constantly afraid of failing during sex, so you avoid sexual intercourse.

  • Erections do not last as long as you expect them to, and you find it tough to have sex because of this.

Although failing to get an erection from time to time is normal due to tension or anxiety, if your symptoms go from occasional to regular, you are likely experiencing erectile dysfunction.

ED is more common than it may seem. About 8% of men between 20-30s and 37% of 70-75s have trouble getting an erection, but many do not recognize it yet.

Erectile dysfunction and blood pressure

Arterial hypertension consists of a high pressure within the blood vessels that compromises the blood flow and damages the vessel's walls, causing less blood to reach the rest of the body.

During an erection, the penile muscles relax to allow blood to inflow the penis while the arteries dilate, and thus, the penis becomes longer and stiffer. So the arterial walls must be unimpaired for a proper erection.

Although high blood pressure can cause erectile dysfunction, men treated to improve their blood pressure often still report problems achieving an erection with two important groups of pills: thiazide diuretics and beta-blockers.

High blood pressure medications that cause erectile dysfunction

Beta-blockers are widely prescribed to treat hypertension and reduce the risk of death in heart failure. The same is for diuretics, which are broadly used in heart failure.

Apparently, these drugs lead to erectile dysfunction as part of their side effect mechanism, from which no drug is spared. 


Of all the beta-blockers, the ones most linked to erectile dysfunction are the first-generation ones, such as propranolol and atenolol. Both have one thing in common: they do not act only on the heart, so their effects can touch anywhere in the body.

According to studies, these beta-blockers hinder erection because they prevent the relaxation of the muscle responsible for erection, the corpus cavernosum.

Thiazide diuretics

These drugs lower blood pressure by stimulating diuresis (i.e., they make you pee). Like beta-blockers, they are non-specific and lead to erectile dysfunction as a side effect.

This does not mean that if you take antihypertensives because of high blood pressure, you will also have erectile dysfunction. The problems in achieving and maintaining an erection resulting from these drugs depend more on the dosage than on the drug itself.

In fact, there is also an important psychological component, where the patients with high blood pressure who are informed about the possible side effects tend to experience ED compared to those who have no idea of it.

It is possible that just knowing that such drugs cause ED as a side effect may be a psychological trigger for it. 

What blood pressure medication does not cause erectile dysfunction?

Fortunately, as science advances, new drugs have been developed to avoid this problematic side effect. 

These include new antihypertensives such as Nebivolol, which has a unique working mechanism different from the rest of the beta-blockers and induces vasodilatation of the penile arteries and thus does not prevent erection.

According to one study, patients who took Nevibolol for their high blood pressure did not experience erectile dysfunction and had an active sex life throughout treatment, compared to those who took atenolol with decreased monthly sexual intercourse.

Another alternative for those who cannot change their usual medication includes adding erectile dysfunction drugs such as sildenafil or tadalafil to their treatment regimen. The antihypertensive will lower blood pressure, and the phosphodiesterase-5 inhibitor will maintain penile dilation whenever you want to have sex.

Other drugs that produce ED

Low hormone levels, diabetes, depression, multiple sclerosis, and spinal cord injuries are closely related to erectile dysfunction, either because of the condition itself or because its medications affect libido or erectile function.

At least 25% of erectile dysfunctions are caused by medications, among them:

  • Amitriptyline 

  • Diazepam

  • Sertraline

  • Phenytoin

  • Anti-androgens

  • Diphenhydramine 

  • Ketoconazole

  • Ranitidine 

  • Codeine

  • Cyproterone

Fortunately, the sexual function returns to normal when the medication is changed, or the dose is decreased.

When to consult a doctor?

It is time to consult a specialist when the erection difficulty becomes more persistent than you would like. 

Many men expect it to resolve itself or think it is temporary at the time of sexual intercourse. By not accepting or acknowledging that you have ED, you delay treatment and allow the condition to worsen. 

Remember that erectile dysfunction is a treatable condition with excellent results nowadays. You just have to take the first step to improve your quality of life. 

Don't let it pass you by, and ask for your first consultation now. 

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