Dozens of commonly prescribed medications can cause or worsen erectile dysfunction, and several over-the-counter drugs can too. Blood pressure medications, antidepressants, antipsychotics, and hormonal treatments are the most frequent culprits, but the risk varies widely depending on the specific drug within each class. In many cases, switching to a different medication in the same category can reduce or eliminate the problem.
Antidepressants, Especially SSRIs
SSRIs are among the most widely prescribed drugs linked to erectile dysfunction. In one study of men being treated for depression, roughly 37% reported erectile problems. The mechanism is straightforward: SSRIs work by increasing serotonin levels in the brain, and while that helps with mood, elevated serotonin interferes with the signaling pathways that trigger arousal and erection, including the release of nitric oxide, the molecule that relaxes blood vessels in the penis.
Not all antidepressants carry the same risk. Bupropion (Wellbutrin), mirtazapine (Remeron), vilazodone (Viibryd), and vortioxetine (Trintellix) have the lowest rates of sexual side effects, according to the Mayo Clinic. Some doctors add bupropion alongside an SSRI specifically to counteract the sexual side effects. SNRIs like desvenlafaxine (Pristiq) and duloxetine (Cymbalta) also tend to cause fewer problems than traditional SSRIs, though they’re not risk-free.
Blood Pressure Medications
Thiazide diuretics, loop diuretics, and beta-blockers can all decrease blood flow to the penis and make erections harder to achieve. But the psychological dimension matters here too. In one study published in the European Heart Journal, men who were told their beta-blocker could cause sexual side effects reported ED at nearly one-third the rate, while only 3% of men who weren’t told about this side effect experienced it. That doesn’t mean the drug effect isn’t real, but it suggests that expectation plays a significant role.
Among beta-blockers, the differences are meaningful. A meta-analysis of six studies covering over 1,500 men found that nebivolol had the lowest risk of ED, while bisoprolol carried the highest risk. Atenolol and metoprolol fell in between. Nebivolol works differently from older beta-blockers because it also promotes nitric oxide release, which supports blood flow rather than restricting it.
ACE inhibitors and angiotensin-receptor blockers (ARBs) rarely cause erectile dysfunction. If you’re on a blood pressure medication and experiencing problems, these classes are often reasonable alternatives to discuss with your prescriber.
Finasteride and Dutasteride
These drugs, used to treat hair loss (at lower doses) and enlarged prostate (at higher doses), block the conversion of testosterone into its more potent form. Both are linked to decreased libido and erectile dysfunction. What makes them particularly concerning is that for some men, sexual side effects persist even after stopping the medication.
The UK’s Medicines and Healthcare products Regulatory Agency has received over 400 reports of sexual dysfunction associated with finasteride. In nearly half of those reports, the patient’s symptoms were recorded as “not recovered” or “not resolved.” This persistent pattern, sometimes called post-finasteride syndrome, remains a subject of ongoing debate, but it’s now acknowledged in the drug’s official prescribing information.
Antipsychotics
Many antipsychotic medications cause ED through an indirect route: they block dopamine receptors in the brain, which triggers a rise in the hormone prolactin. Elevated prolactin suppresses libido, impairs erection, and can lower testosterone levels over time. Older antipsychotics (phenothiazines, butyrophenones) and risperidone are the most common offenders. Men on these drugs may also experience breast tissue growth and reduced fertility.
Some newer antipsychotics have less effect on prolactin, so if sexual side effects are a concern, there may be alternatives within this drug class worth exploring.
Hormone Therapies for Prostate Cancer
Androgen deprivation therapy, which suppresses testosterone to slow prostate cancer growth, has the most severe and lasting impact on erectile function of any medication class. Even three to four months of treatment can cause permanent changes to the smooth muscle tissue inside the penis, making erections structurally harder to achieve. In one study tracking men over nine months of therapy, only 13% remained sexually active.
Recovery is possible but slow and incomplete. Among men who stopped treatment, about half resumed sexual activity, but it took 9 to 12 months off therapy to reach their best recovery. When additional anti-androgen drugs like bicalutamide are layered on top, the risk of irreversible ED increases further because these drugs can directly damage penile tissue.
Over-the-Counter Medications
Several drugs you can buy without a prescription are linked to erectile problems. Antihistamines are the most common category, including diphenhydramine (Benadryl), dimenhydrinate (Dramamine), meclizine (Antivert), and hydroxyzine (Vistaril). These work by blocking acetylcholine, one of the chemical messengers involved in arousal.
Heartburn drugs known as H2 blockers also appear on the list. Cimetidine (Tagamet) is the most studied offender, with additional reports involving ranitidine and nizatidine. Proton pump inhibitors like omeprazole are not associated with the same risk, making them a practical alternative for chronic heartburn. NSAIDs like ibuprofen and naproxen, as well as the decongestant pseudoephedrine (Sudafed), are also listed among medications that may contribute to erection problems.
Statins Do Not Cause ED
Cholesterol-lowering statins are sometimes blamed for erectile dysfunction, but the evidence points in the opposite direction. A meta-analysis of randomized trials involving over 700 patients found that statins actually improved erectile function scores by a clinically meaningful amount, roughly one-third to one-half the benefit seen with drugs like Viagra. Statins improve the health of blood vessel linings and boost nitric oxide production, which directly supports the mechanism behind erections. If you’re taking a statin and experiencing ED, the cause is likely something else.
What You Can Do
If you suspect a medication is affecting your erections, the single most useful step is identifying which drug class is responsible. Many of the worst offenders have alternatives within the same category that carry lower sexual side effect risks: nebivolol instead of atenolol for blood pressure, bupropion instead of an SSRI for depression, a proton pump inhibitor instead of an H2 blocker for heartburn. In some cases, adding a medication that improves erections (such as sildenafil or tadalafil) can work alongside the original prescription without requiring a switch.
Timing matters too. Some medication-related ED improves within weeks of switching or stopping the drug, while hormonal therapies may take many months to recover from, and finasteride-related changes may not fully resolve at all. Knowing the expected timeline helps set realistic expectations for any change you and your doctor decide to try.