ERECTILE DYSFUNCTION: CARDIOVASCULAR MEDICATIONS
When hypertension is present, blood pressure stays elevated all the time at 140 millimeters of mercury (mm Hg) over 90 mm Hg or higher, putting extra pressure on the heart and arteries. In turn, the pressure can damage the surface of blood vessels and may lead to cholesterol deposition, thereby further narrowing pathways and blocking blood flow to the spongy tissue of the penis. And if a man has a high cholesterol count, the risk of penile blockage is increased because plaque will form where an artery has been damaged by high blood pressure.
Almost every antihypertensive medication is linked to some form of sexual disorder, but some are more likely than others to cause specine problems. I often use diuretics, such as chlorthalidone and hydrochlorothiazide, as a first line of attack to lower blood pressure. In my practice, three quarters of the men taking these medications do not experience ED. However, for the quarter who do, I may prescribe an ACE (angiotensin-converting enzyme) inhibitor, such as Accupril or Vasotec, or possibly a calcium channel blocker, such as Norvasc or Procardia XL. I would tend to shy away from medications such as clonidine (Catapres), methyldopa (Aldomet), or reserpine (Hydropres). These drugs are known to have more significant ED effects.
Beta-blocker medications, which include atenolol (Tenormin), bi-soprolol (Ziac), metoprolol (Lopressor), nadolol (Corgard), propranolol (Inderal), and timolol (Blocadren) reduce the workload on the heart and, therefore, the arteries. I commonly prescribe these drugs for the treatment of a variety of cardiac problems, from coronary artery disease to hypertension. However, I’ve found that patients often complain of ED after using these drugs. If that’s the case, I’ll switch them to either a calcium channel blocker or an ACE inhibitor.
If a man has already developed ED due to an underlying medical condition, such as diabetes, or had instances of ED because of a diuretic medication he may have taken, then I will not recommend a beta-blocking drug as a first-line treatment or even as an alternative. Again, it’s the ACE medication or calcium channel blocker that I would prescribe. ACE inhibitors are one of the most commonly used classes of antihypertensives although, to date, no one is quite sure exactly how they work. It is suspected that they block an enzyme that is required for blood vessels to constrict. As a result, the vessels relax, which is favorable to erectile function. Of the heart medications, the ACE inhibitors—benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Zestril), quinapril (Accupril), and ramipril (Altace)—are least likely to create ED problems.
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