En español | Many people don’t know it, but drugs are among the most common causes of sexual problems. Indeed, studies show that prescription medications are responsible for as many as one of every four cases of sexual dysfunction — and this figure may understate the extent of the problem.
If your sex life isn’t what you think it should be — or what it used to be — talk with your physician or health care provider, even if initiating the discussion feels a little awkward or embarrassing. (If all those television ads can bring such subjects into your living room, surely you can bring them up in your doctor’s office.) At the very least, it’s helpful to rule out drugs as a cause of sexual problems before you undergo diagnostic tests that could lead to additional prescriptions.
Here’s a rundown of the major classes of drugs that can interfere with your sex life. As always, it’s important to remember that you should not discontinue drugs without consulting your doctor.
1. Statins and fibrates
Why they’re prescribed: Statins and fibrates are used to treat high cholesterol.
How they can cause sexual dysfunction: Researchers say that by limiting the availability of cholesterol, a building block of hormones, these drugs likely interfere with the production of testosterone, estrogen and other sex hormones. Additionally, statins can cause rhabdomyolysis, a breakdown of muscle tissue, leading to joint pain and fatigue.
A review of studies of statins and fibrates, published in 2002, concluded that both classes of drugs may cause erectile dysfunction (ED). And a six-month, government-funded study published in 2009 found that men and women taking statins reported increased difficulty achieving orgasm. In the study, people’s levels of sexual pleasure dropped along with their levels of LDL cholesterol.
Options: If you’re among the many millions of older Americans without known coronary disease who are taking these drugs, ask your doctor or other health care provider about treating your slightly elevated cholesterol with a combination of sublingual (under-the-tongue) vitamin B12 (1000mcg daily), folic acid (800mcg daily) and vitamin B6 (200mg daily).
2. Blood pressure medications
Why they’re prescribed: All blood pressure medications — and there are eight different categories of them — are used to lower the pressure inside blood vessels, so the heart doesn’t have to work as hard to pump blood throughout the body.
How they can cause sexual dysfunction: While high blood pressure in itself can lead to sexual dysfunction, studies show that many of the drugs used to treat this condition also can cause sexual difficulties. In men, the decreased blood flow can reduce desire and interfere with erections and ejaculation. In women, it can lead to vaginal dryness, a decrease in desire, and difficulties achieving orgasm.
Three types of blood-pressure medications — diuretics (or “water pills”), beta-blockers and alpha-blockers — have been found to have the highest incidence of sexual side effects. Some diuretics, for example, not only interfere with blood flow to the sex organs but increase the body’s excretion of zinc, which is needed to produce testosterone. And beta-blockers can sabotage a satisfying sex life at least three ways — by making you feel sedated and depressed, by interfering with nerve impulses associated with arousal and by reducing testosterone levels.
Options: Talk with your doctor or other health care provider about switching to another type of blood pressure medication. For older patients, a benzothiazepine calcium channel blocker is often the best choice, and drugs in this class have been shown to cause fewer adverse sexual effects than other antihypertensives.
Why they’re prescribed: While antidepressants are typically used to treat depression, they’re also frequently prescribed for anxiety disorders, eating disorders, obsessive compulsive disorder, chronic pain, smoking cessation and some hormone-mediated disorders, such as severe menstrual cramps.
There are many different kinds of antidepressants, including tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), selective serotonin re-uptake inhibitors (SSRIs), dopamine antagonists and lithium, among others.
How they can cause sexual dysfunction: Antidepressants cause problems in all areas of sexual function, probably by blocking the action of three brain chemicals that relay signals between nerve cells: acetylcholine, serotonin and norepinephrine.
The adverse effects of clomipramine (Anafranil), for instance, include ejaculation failure (reported by more than 40 percent of men taking the drug), impotence (reported by at least 15 percent of patients) and decreased libido (reported by at least 18 percent of patients).
Options: Talk with your doctor or other health care provider about lowering your dose (sexual side effects are often dose-related) or whether nondrug therapies might work just as well or better for you than a drug. You might also want to explore switching drugs, especially if you’re older and taking one of the tricyclic antidepressants, which are considered to be potentially inappropriate drugs for older people.
Why they’re prescribed: Antipsychotics are used to treat schizophrenia, bipolar disorder and other serious psychiatric conditions. Antipsychotics also are often prescribed “off-label” to treat agitation and depression, among other conditions.
How they can cause sexual dysfunction: All antipsychotic drugs block dopamine, a brain chemical that helps regulate emotional responses and control the brain’s reward and pleasure centers. They also increase levels of the hormone prolactin, which can lead to ED, reduced libido and difficulties achieving orgasm. And, like antidepressants, they block the action of acetylcholine, which researchers believe can lead to problems in all areas of sexual function.
The sexual side effects of these drugs have been difficult to tease out because many of the psychiatric conditions the drugs are used to treat are themselves associated with sexual problems. Nonetheless, the incidence of sexual dysfunction associated with antipsychotic drugs ranges in different studies from 45 percent to as high as 90 percent.
Options: Talk with your doctor or other health care provider about the possibility of reducing dosage or switching to another antipsychotic drug. If you or a loved one has been prescribed one of these drugs for Alzheimer’s-related depression or agitation, talk to the doctor immediately. Antipsychotics pose heightened death risks for older people with dementia.
Why they’re prescribed: Benzodiazepines, commonly known as tranquilizers, are used to treat anxiety, insomnia, agitation and muscle spasms, and to prevent seizures.
How they can cause sexual dysfunction: The sedative and muscle-relaxant properties of benzodiazepines are thought to lessen sexual interest, excitement and sensation. Benzodiazepines may also interfere with the production of testosterone, a hormone important for sexual desire in women as well as men.
The sexual problems most frequently associated with benzodiazepines are diminished orgasms, pain during intercourse, ED and ejaculation problems.
Options: Many patients with mild anxiety or insomnia don’t need benzodiazepines at all. And for all the conditions listed above, there are alternative drug and nondrug treatments. Melatonin, in doses from 3 milligrams to 10 milligrams before bedtime, for instance, sometimes helps to reestablish healthy sleep patterns. Elderly people should never use diphenhydramine (Benadryl) or any sleep aid with a name ending in “PM.” Talk with your doctor or other health care provider.
6. H2 blockers
Why they’re prescribed: H2 blockers, also called H2-receptor antagonists, are used to treat gastrointestinal disorders, including gastroesophageal reflux disease (GERD), gastric ulcers, peptic ulcers and erosive esophagitis.
How they can cause sexual dysfunction: H2 blockers can cause impotence (as well as breast enlargement in men) when taken at high doses for a long period of time.
Cimetidine (Tagamet) is associated with a wider range of sex-related side effects than other H2 blockers, including ranitidine (Zantac), famotidine (Pepcid) and nizatidine (Axid). Cimetidine’s side effects include decreased libido, reduced sperm count and ED.
Options: If you are taking an H2 blocker for GERD or other reflux problems — and H2 blockers, with the exception of cimetidine, are the treatment of choice for older people — changes in your diet and sleep habits may be helpful. Some of my patients have reported success with the home remedy of apple cider vinegar and honey (one tablespoon of each in a glass of water), taken throughout the day, along with melatonin at bedtime.
Why they’re prescribed: Anticonvulsant drugs are typically used to control seizures in people who have epilepsy. They are also used to treat some types of chronic pain, including neuropathic pain and migraines, even though they weren’t designed for that purpose. Anticonvulsants are also increasingly being used “off label” in the treatment of bipolar disorder.
How they can cause sexual dysfunction: Studies have shown that these drugs can lower testosterone levels, which can depress desire and interfere with arousal (erection problems for men, lubrication problems for women). They also can impair the ability to have orgasms.
Options: Some newer anticonvulsants like gabapentin (Neurontin) and topiramate (Topamax) may have fewer side effects than older drugs like carbamazepine (Tegretol) and phenytoin (Dilantin), so ask your doctor or other health care provider if switching medications makes sense for you — and your sex life.
"Ask the Pharmacist" is written by Armon B. Neel Jr., PharmD, CGP, in collaboration with journalist Bill Hogan. They are coauthors of Are Your Prescriptions Killing You?, to be published in July by Atria Books.