Polypharmacy Tied to Erectile Dysfunction

Risk of sexual dysfunction is higher in men taking complex medication regimens, a new study finds.

Men who take multiple medications are more likely to suffer from severe erectile dysfunction (ED), according to a Kaiser Permanente study published in the November 15 online issue of the British Journal of Urology International. The most common drugs associated with ED risk were cardiovascular medications and antidepressants, researchers reported.

The findings suggest a critical first step in managing ED may be a simple review of medications and their side effects, said lead author Diana C. Londono, MD, of the urology department at Kaiser Permanente Los Angeles Medical Center. “When appropriate, decreases or changes in the amount of or type of medication should be considered,” she noted.

For the study, Dr. Londono and colleagues examined pharmacy records of 37,712 ethincally diverse men aged 46 to 69. More than half (57%) took at least 3 medications. Self-reported survey data was used to identify the presence and severity of ED. After controlling for other ED risk factors, such as higher body mass index, diabetes, and older age, the researchers observed a direct relationship between multiple medications and ED.

Of the men included in the study, 29% reported experiencing moderate or severe ED. Across all age groups, prevalence of ED increased as the number of medications increased. Approximately 16% of men taking 2 or fewer drugs reported having erectile dysfunction, compared with 30.9% of men taking at least 10 medications.

The drugs most commonly associated with ED were antihypertensives, such as beta blockers, thiazides, and clonidine; psychogenic medications, such as selective serotonin reuptake inhibitors, tricyclic antidepressants, lithium, and monoamine oxidase inhibitors; and any medications that interfere with testosterone.

In addition to thoroughly reviewing patients’ medications and tailoring the list if possible, providers should keep ED risk in mind when prescribing complex drug regimens, according to Michael Kanter, medical director of Quality & Clinical Analysis for Kaiser Permanente Southern California. “This study highlights that while physicians still need to treat patients with medications when indicated, they should be aware that erectile dysfunction may occur,” he said.

For other articles in this issue, see:

• The Pitfalls of e-Prescribing
• 4 Drugs Cause Most Hospitalizations in Seniors