Medications That Can Cause ED

Almost every medication discussed here carries some risk if stopped suddenly. Beta blockers can trigger chest pain, heart attack or dangerous heart rhythms on abrupt withdrawal. Antidepressants can cause discontinuation symptoms and a return of the depression they were treating. Opioids produce withdrawal.

The useful move is usually substitution, not cessation. Within nearly every class below there are alternatives with different sexual side effect profiles, and your prescriber can make that swap safely.

SSRIs and SNRIs are the two most commonly prescribed antidepressant classes, used for depression and anxiety. Both carry an explicit warning that they may cause ejaculatory delay or failure, reduced libido, and erectile dysfunction.

Here are the rates from their own controlled trials, drug versus placebo:

These figures likely undercount. The Zoloft prescribing information says so directly: estimates of sexual side effects cited in labeling may underestimate their actual incidence, because patients in these trials were not systematically asked.

Lower-risk alternatives exist. Bupropion (Wellbutrin) carries no sexual dysfunction warning at all and reports reduced libido at 3% versus 2% on placebo. Mirtazapine (Remeron) similarly carries no such warning and lists ED as infrequent. A 2026 review ranks SSRIs, venlafaxine and clomipramine as higher risk; duloxetine and most tricyclics as intermediate; and bupropion, mirtazapine, vortioxetine and vilazodone as more favorable.

Untreated depression is itself a cause of sexual dysfunction, so stopping without substituting usually makes things worse.

Finasteride and dutasteride belong to a class called 5-alpha reductase inhibitors. They shrink the prostate, and at a lower dose finasteride is also prescribed for male pattern hair loss. They work, and they carry the best-documented sexual side effects of any drug class here.

Both drugs carry reports of sexual dysfunction continuing after men stop taking them. These reports are uncommon and it has not been established whether the drug is responsible, but they exist and are worth knowing about before starting.

Beta blockers have a reputation as the classic cause of drug-induced ED. The evidence is weaker than the reputation.

A 2025 systematic review and meta-analysis in Endocrine found that while overall beta blocker use looked associated with increased ED risk, that association disappeared once the data was adjusted for the underlying illness being treated. Research published through the National Library of Medicine goes further, describing beta blockers as only a minor contributor. The same review found evidence that simply expecting the side effect helps produce it, a nocebo effect.

Not all agents behave the same. Nebivolol performed better than other beta blockers in studies using a standard erectile function questionnaire.

Thiazide diuretics follow a similar pattern: an old reputation that recent evidence does not support, including a network meta-analysis of nine studies that found no increased risk.

If blood pressure medication is the suspected cause, there is room to move. ACE inhibitors and calcium channel blockers are the least likely to cause ED, and alpha blockers actually improve erectile function.

Sexual side effects are a documented reason men stop taking blood pressure medication altogether, and treating the ED has been shown to improve how reliably men stay on their blood pressure drugs.

Opioids: Long-term use can suppress the hormone system that controls testosterone, which can produce low libido and erectile dysfunction. Whether the effect on fertility reverses is not known.

Antipsychotics: Some raise a hormone called prolactin, which suppresses the signals that drive testosterone production. Risperidone shows a dose-related increase in erectile dysfunction. Agents in this class differ substantially in how much they raise prolactin.

Cimetidine: A heartburn drug with a weak anti-testosterone effect. Reversible impotence has been reported at high doses taken for a year or more; at normal doses the rate is no higher than the general population.

Spironolactone: A diuretic used for heart failure and high blood pressure, which lists reduced libido and difficulty achieving or maintaining an erection.

Bring a complete medication list to your appointment, including over-the-counter drugs and anything prescribed by a different doctor.

Note the timeline. Difficulty that started within weeks of a new prescription is a different story from a gradual decline over years, and you are the only person who has that information.

Ask about substitution within the class, first, rather than about stopping.

Remember that roughly three quarters of ED is not caused by medication, so stopping a drug is not a guaranteed fix.

Prescription medication causes roughly a quarter of ED cases. The evidence is strongest for SSRIs and SNRIs, and for finasteride and dutasteride, which show first-year impotence rates of 8.1 and 4.7% against 3.7 and 1.7% on placebo. Beta blockers are a weaker cause than their reputation suggests, with the association largely disappearing once data is adjusted. Alternatives exist in every class here but stopping a prescribed medication on your own carries real risk. Bring your list, describe the timeline, and ask about substitution.