Have you lost interest in sex seemingly out of nowhere, even though this was never an issue before? Or has achieving an erection suddenly become considerably more difficult? If you are experiencing a reduced libido or struggling with erectile dysfunction, you are likely searching for answers. Stress, performance anxiety, and declining testosterone levels are well-known culprits. But there is another very common cause that is frequently overlooked: your medicine cabinet.

It is estimated that 25% of all cases of erectile dysfunction are caused - at least in part - by medication use. In this article, we discuss which medications in each category can affect your erection and libido, and what you can do about it.

Please note: this guide contains a great deal of terminology and technical language. You can use the table of contents to jump directly to the medication most relevant to you.

Are you taking antidepressants? Please refer to our comprehensive guide on antidepressants and erectile function.

Table of contents

The relationship between blood pressure, libido, and erections

Your libido depends on healthy blood pressure. Elevated blood pressure can reduce your desire for sex. A good circulation not only ensures that blood is pumped towards the genitals, but also that sex hormones are transported more effectively. When blood pressure is too high, the blood vessels can sustain damage. This impairs blood flow through the arteries, reduces the efficiency with which sex hormones are carried around the body, and decreases blood supply to the genitals.

High blood pressure is commonly treated with antihypertensive medication. This brings your blood pressure down - which is beneficial. However, despite feeling well in yourself, your libido may not improve and an erectile problem may persist. How is this possible, given that your blood pressure is back to a healthy level? The answer lies in the side effects of the medications themselves.

Research shows that men with high blood pressure experience erectile difficulties twice as often as men with normal blood pressure. And unfortunately, certain blood pressure medications list erectile problems as a side effect - meaning the situation may worsen rather than improve.

Beta-blockers: the most well-known culprit

A reduced libido or erectile difficulties are well-recognised side effects of beta-blockers. They feature prominently in virtually every list of 'libido killers'. That said, not all beta-blockers are equally problematic.

Non-selective beta-blockers: the greatest risk

Non-selective beta-blockers - such as propranolol, pindolol, and sotalol - block both the beta-1 and beta-2 receptors in the body. This produces a broad effect: blood pressure is reduced, but blood flow to the penis is also diminished at the same time. Furthermore, these medications can disrupt the hormonal balance, which has a negative impact on both sexual desire and the ability to achieve and maintain an erection.

Selective beta-blockers: lower risk

Selective (cardioselective) beta-blockers - such as metoprolol, atenolol, and bisoprolol - act specifically on the beta-1 receptors in the heart. The risk of erectile difficulties is lower with these, though it remains possible. Interestingly, research suggests that simply knowing that erectile problems can be a side effect may itself be enough to trigger anxiety - which can in turn cause erectile difficulties.

Nebivolol: the favourable exception

Nebivolol occupies a distinctive position among beta-blockers. In addition to its blood pressure-lowering effect, this medication also has a vasodilatory action, as it stimulates the release of nitric oxide (NO) - the same mechanism involved in achieving an erection. According to recent scientific research, nebivolol has a neutral to mildly beneficial effect on erectile function. If you are taking a beta-blocker and experiencing erectile difficulties, it may be worth discussing with your doctor whether nebivolol could be a suitable alternative for you.

Diuretics (water tablets): an underestimated threat to libido

Diuretics, commonly known as water tablets, are the most frequent cause of erectile problems among all blood pressure medications. Thiazide diuretics in particular deserve special attention. The names, it must be said, are not of our making.

Thiazides: hydrochlorothiazide and chlortalidone

Hydrochlorothiazide and chlortalidone are widely used water tablets for high blood pressure. The well-known TOMHS study (Treatment Of Mild Hypertension Study) found that 17% of men taking chlortalidone developed erectile problems, compared with just 8% in the placebo group - more than double the rate.

Spironolactone: doubly problematic

A particularly notable case is spironolactone. This medication not only promotes fluid excretion, but also blocks the action of testosterone. This so-called anti-androgenic effect can lead to a reduced libido, erectile difficulties, and in some cases even breast development in men. If you are taking spironolactone and experiencing these symptoms, speak with your doctor about whether an alternative such as eplerenone might be possible.

Alternatives with a lower risk profile

ACE inhibitors (such as enalapril and lisinopril) and angiotensin II receptor blockers, or ARBs (such as losartan and valsartan), generally have a neutral to beneficial effect on erectile function. For men with high blood pressure and erectile difficulties, ARBs are therefore often considered the preferred option by urologists.

Illustratie bij informatief artikel over medicijnen gids erect bij De Paarse Keizerin met medisch advies

Are you taking antidepressants?

Antidepressants, and SSRIs in particular - such as paroxetine, fluoxetine, and sertraline - are among the most common causes of erectile difficulties and reduced libido. At least one in three men taking SSRIs experiences sexual side effects. We have written a comprehensive, dedicated guide on this topic, covering alternatives and practical advice.

Read the antidepressants guide

Cholesterol-lowering medications (statins)

Statins such as atorvastatin (Lipitor) and simvastatin (Zocor) are among the most widely prescribed medications in the world, particularly for men over 50. They are essential for reducing cholesterol levels and preventing cardiovascular disease. However, there is a drawback worth knowing about.

Statins inhibit the production of cholesterol, which is beneficial in itself. But cholesterol is also the raw material from which testosterone is produced. Research shows that men taking statins have an elevated risk of erectile difficulties (OR 1.51 in comparative studies). The relationship is nuanced, however: the same statins that lower cholesterol also improve the condition of the blood vessels - which can actually benefit erectile function.

If you are taking statins and experiencing erectile problems, there is no need to panic. Discuss it with your doctor. A lower dose or a different type of statin can sometimes make a real difference. Under no circumstances should you stop taking your statins of your own accord - the protection they provide for your heart and blood vessels is too important to forgo.

Prostate medications: the quiet frontrunner

Perhaps surprisingly, prostate medications top the list of medications with the highest number of reported erectile dysfunction cases in the American FDA adverse event database. Two groups in particular deserve attention.

5-alpha-reductase inhibitors: finasteride and dutasteride

Finasteride (Proscar) and dutasteride (Avodart) are prescribed for an enlarged prostate (BPH) and for male pattern baldness. They inhibit the conversion of testosterone into dihydrotestosterone (DHT). The sexual side effects - reduced libido, erectile difficulties, and ejaculation disorders - can be considerable. In the FDA database, 5-alpha-reductase inhibitors accounted for 46% of all reported cases of erectile dysfunction. In some men, the symptoms persist even after discontinuing the medication.

Alpha-blockers: tamsulosin and doxazosin

Tamsulosin (Omnic) and doxazosin (Cardura) improve urinary flow in men with an enlarged prostate by relaxing the muscles around the bladder neck. Erectile function is generally less affected by these medications, but ejaculation disorders are common - with tamsulosin in particular, ejaculation may be absent or may flow back into the bladder (retrograde ejaculation).

Antacids and stomach acid suppressants

Medications used to reduce stomach acid come in several forms, and not all of them have the same effect on erectile function.

Cimetidine: a well-known culprit

Cimetidine (Tagamet) is an older H2-receptor blocker known for its anti-androgenic properties. It can block the action of testosterone and raise oestrogen levels, which may lead to a reduced libido, erectile difficulties, and in rare cases breast development in men. Famotidine (Pepcid) and other H2-blockers present this problem to a lesser degree.

The newer proton pump inhibitors (PPIs) - such as omeprazole and pantoprazole, which are now prescribed far more frequently - generally have no direct effect on erectile function. If you are taking cimetidine and experiencing sexual side effects, switching to a PPI is often a straightforward solution worth discussing with your doctor.

Anti-inflammatory painkillers (NSAIDs)

Painkillers such as diclofenac, ibuprofen, and naproxen are widely used for joint complaints, back pain, and osteoarthritis - conditions that are particularly common in those over 50. Occasional use is rarely a concern, but chronic use of NSAIDs can disrupt the hormonal balance.

NSAIDs inhibit the enzyme cyclooxygenase, which not only reduces pain and inflammation but can also affect the production of sex hormones. They can also raise blood pressure and reduce the effectiveness of blood pressure medications - potentially requiring your doctor to increase the dose of your antihypertensive, which may worsen the situation further.

If you are taking painkillers on a daily basis and experiencing erectile difficulties, discuss with your doctor whether an alternative approach - such as paracetamol or physiotherapy - might be a suitable option.

What you can do - and what to avoid

If you suspect that your medications are contributing to your erectile difficulties or reduced libido, there are several steps you can take:

Check the patient information leaflets. Read through the listed side effects of all your medications. If you see terms such as 'impotence', 'erectile dysfunction', 'sexual dysfunction', or 'decreased libido', the medication in question may be playing a role.

Keep a diary. Note down when you started taking each medication and when the symptoms first appeared. This is enormously helpful to your doctor when trying to establish a connection.

Speak with your GP. Many men find it embarrassing to bring up erectile problems with their doctor. Consider this: nearly half of all men with high blood pressure experience the very same difficulties. You are far from alone. Your doctor can explore whether a different dosage or a replacement medication with fewer side effects might be better suited to you.

Ask about erection-friendly alternatives. When it comes to blood pressure medication, ACE inhibitors and ARBs are generally the most favourable options for erectile function. Among beta-blockers, nebivolol may be a better alternative. For prostate complaints, alpha-blockers tend to be gentler than 5-alpha-reductase inhibitors.

Important: never make changes to your medication use on your own initiative. Your medications were prescribed for good reason. Leave it to a medical professional to judge the appropriate dosage. Stopping or reducing medications without guidance can have serious health consequences.

Once your doctor has adjusted your dosage or prescribed an alternative medication, you will often find that your libido begins to recover before long. A fulfilling intimate life is, in turn, very beneficial for your circulation - so it really can be a win on both fronts.

Overzicht: medicijnen met invloed op erectie en libido

CategorieVoorbeeldenRisico op EDTip
Bètablokkers (niet-selectief)propranolol, sotalol, pindololHoogVraag arts naar nebivolol
Bètablokkers (selectief)metoprolol, atenolol, bisoprololMatigNebivolol als alternatief
Thiazidediureticahydrochloorthiazide, chloortalidonHoogACE-remmer of ARB als alternatief
SpironolactonspironolactonHoog (anti-androgeen)Eplerenon als alternatief
5-alfa-reductaseremmersfinasteride, dutasterideHoogBespreek alternatieven met uroloog
Alfa-blokkers (prostaat)tamsulosine, doxazosineLaag (ejaculatieproblemen)Milder dan 5-alfa-remmers
Statinesatorvastatine, simvastatineMatigNiet stoppen; bespreek dosering
Maagzuurremmers (H2)cimetidine, famotidineMatig (cimetidine hoog)Overstap naar PPI (omeprazol)
NSAID's (chronisch)diclofenac, ibuprofen, naproxenMatigParacetamol of fysiotherapie
ACE-remmers / ARB'senalapril, losartan, valsartanLaag (erectievriendelijk)Vaak beste keuze bij hypertensie + ED
Bètablokkers (niet-selectief)
Voorbeeldenpropranolol, sotalol, pindolol
RisicoHoog
TipVraag arts naar nebivolol
Bètablokkers (selectief)
Voorbeeldenmetoprolol, atenolol, bisoprolol
RisicoMatig
TipNebivolol als alternatief
Thiazidediuretica
Voorbeeldenhydrochloorthiazide, chloortalidon
RisicoHoog
TipACE-remmer of ARB als alternatief
Spironolacton
Voorbeeldenspironolacton
RisicoHoog (anti-androgeen)
TipEplerenon als alternatief
5-alfa-reductaseremmers
Voorbeeldenfinasteride, dutasteride
RisicoHoog
TipBespreek alternatieven met uroloog
Alfa-blokkers (prostaat)
Voorbeeldentamsulosine, doxazosine
RisicoLaag
TipMilder dan 5-alfa-remmers
Statines
Voorbeeldenatorvastatine, simvastatine
RisicoMatig
TipNiet stoppen; bespreek dosering
Maagzuurremmers (H2)
Voorbeeldencimetidine, famotidine
RisicoMatig
TipOverstap naar PPI (omeprazol)
NSAID's (chronisch)
Voorbeeldendiclofenac, ibuprofen, naproxen
RisicoMatig
TipParacetamol of fysiotherapie
ACE-remmers / ARB's
Voorbeeldenenalapril, losartan, valsartan
RisicoLaag (erectievriendelijk)
TipVaak beste keuze bij hypertensie + ED

Bronnen: Cureus review 2025, FDA FAERS database (2010-2020), TOMHS-studie, Tijdschrift voor Cardiologie, Farmacotherapeutisch Kompas

Veelgestelde Vragen

Kan mijn medicijn erectieproblemen veroorzaken?

Ja, naar schatting wordt 25% van alle erectiestoornissen mede veroorzaakt door medicijngebruik. Bloeddrukmedicijnen, prostaatmedicijnen, cholesterolverlagers, maagzuurremmers en pijnstillers kunnen allemaal invloed hebben op uw erectie en libido.

Welke bloeddrukmedicijnen geven de meeste erectieproblemen?

Thiazidediuretica zoals hydrochloorthiazide en chloortalidon zijn de meest voorkomende oorzaak, gevolgd door niet-selectieve bètablokkers zoals propranolol en sotalol. ACE-remmers en ARB's hebben juist een neutraal tot gunstig effect.

Is nebivolol beter voor mijn erectie dan andere bètablokkers?

Ja, uit onderzoek blijkt dat nebivolol een neutraal tot licht gunstig effect heeft op de erectiefunctie, in tegenstelling tot andere bètablokkers. Dit komt door het vaatverwijdende effect via stikstofmonoxide. Bespreek met uw arts of nebivolol een optie is.

Mag ik zelf stoppen met mijn medicijnen als ik erectieproblemen krijg?

Nee, stop nooit op eigen houtje met voorgeschreven medicijnen. Dit kan ernstige gezondheidsgevolgen hebben, vooral bij bloeddrukmedicatie. Bespreek uw klachten altijd eerst met uw huisarts, die kan beoordelen of een ander medicijn of een andere dosering mogelijk is.

Kan finasteride tegen prostaatvergroting erectieproblemen geven?

Ja, finasteride en dutasteride staan bovenaan de lijst van medicijnen met de meeste meldingen van erectiestoornissen. Bij sommige mannen houden de klachten zelfs aan na het stoppen. Bespreek met uw uroloog of een alfa-blokker een alternatief kan zijn.

Kunnen pijnstillers zoals ibuprofen erectieproblemen geven?

Bij incidenteel gebruik is het risico klein. Maar bij dagelijks of langdurig gebruik van NSAID's zoals diclofenac, ibuprofen of naproxen kan de hormonale balans verstoord raken. Bovendien kunnen NSAID's de bloeddruk verhogen, wat het probleem kan verergeren.

Welke medicijnen zijn het meest erectievriendelijk bij hoge bloeddruk?

ACE-remmers zoals enalapril en lisinopril, en ARB's zoals losartan en valsartan hebben over het algemeen een neutraal tot gunstig effect op de erectiefunctie. Voor mannen met hoge bloeddruk én erectieproblemen worden deze middelen vaak als beste keuze beschouwd.

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