Although the attention of subjects suffering from impotence is mainly focused on the choice of effective drugs for the treatment of erectile dysfunction, we must not forget that there are also medicines that can cause or aggravate this disorder.
There is talk of erectile dysfunction of an iatrogenic nature when the disorder follows medical or pharmacological therapies. There are many commonly used drugs involved in the onset or worsening of erectile dysfunction; some examples are grouped by therapeutic categories and listed by active principle in the table below. It is important to underline that erectile dysfunction does not represent the automatic consequence of taking these drugs, but a side effect that occurs in a generally minority percentage of patient users, perhaps amplifying other possible underlying causes.
| Drugs for the Treatment of Arterial Hypertension | diuretic drugs (thiazides, spironolactone), centrally acting antihypertensives (methyldopa, clonidine, reserpine), α-blockers (prazosin, terazosin), β-blockers (propanolol, metoprolol, atenolol) |
| Drugs for the treatment of dyslipidemia (high triglycerides, high cholesterol) | gemfibrozil, clofibrate | Drugs for the treatment of heart failure | digoxin, chlorthalidone, amiodarone, disopyramide |
| Drugs for the treatment of neurological and psychiatric diseases | amitriptyline, clomipramine, imipramine, desipramine, tiotixene, lithium salts, tranylcypromine, isocarboxazide, phenelzine, haloperidol, chlorpromazine, fluphenazine, pimozide, primidone, carbamazepine, amoxapine, doxepine, sertraline, paroxetine, benzodiazepines, barbiturates |
| Drugs for the treatment of prostatic and endocrinological diseases | cyproterone acetate, medrogestone, megesterol acetate, flutamide, finasteride, GnRH analogues, corticosteroids |
| Drugs for the treatment of gastroenterological diseases | cimetidine, ranitidine, metoclopramide, famotidine, nizatidine, propantheline bromide |
| Drugs for the treatment of inflammatory and degenerative pathologies of the osteo-articular apparatus | indomethacin, naproxen |
| Drugs | cocaine, marijuana, amphetamines, codeine, methadone, heroin, meperidine, LSD, cannabis |
These substances can alter both the function of the hypothalamic-pituitary system and testicular steroidogenesis, or act by antagonizing the peripheral action of androgens. If an iatrogenic origin of erectile dysfunction is suspected, it is important not to suspend drug therapy spontaneously; rather it is necessary to talk about it with the doctor, who may eventually prescribe an alternative therapy.
Beyond drugs and drugs that can cause or at least promote erectile dysfunction, we remind you that alcohol abuse and cigarette smoking can also aggravate the disorder. Alcoholism, for example, causes a decrease in libido, premature ejaculation, testicular hypotrophy, increase in prolactin and gynecomastia.
Cigarette smoking is a documented risk factor for erectile dysfunction as it causes peripheral vascular disease, reduces penile blood pressure and inhibits neurogenic vasodilation. Nicotine reduces blood flow and induces vasoconstriction of cavernous bodies even in the absence of systemic vascular anomalies
