|Anticholinergic agents (antihistamines, antiparkinsonian agents, tricyclic antidepressants, phenothiazines) ||Anticholinergic activity || |
Second-generation nonsedating antihistamines (eg, loratadine, fexofenadine, or cetirizine) are associated with less erectile dysfunction (ED) than first-generation agents.
Selective serotonin reuptake inhibitor (SSRI) antidepressants cause less ED than tricyclic antidepressants. Of the SSRIs, paroxetine, sertraline, and fluoxetine cause ED more commonly than venlafaxine, nefazodone, trazodone, or mirtazapine.
Phenothiazines with less anticholinergic effect (eg, chlorpromazine) can be substituted in some patients if ED is a problem.
|Dopamine antagonists (eg, metoclopramide, phenothiazines) ||Inhibit prolactin inhibitory factor, thereby increasing prolactin levels || |
|Estrogens, antiandrogens (eg, luteinizing hormone–releasing hormone superagonists, digoxin, spironolactone, ketoconazole, cimetidine) ||Suppress testosteronemediated stimulation of libido || |
|Central nervous system depressants (eg, barbiturates, narcotics, benzodiazepines, short-term use of large doses of alcohol, anticonvulsants) ||Suppress perception of psychogenic stimuli || |
|Agents that decrease penile blood flow (eg, diuretics, peripheral β-adrenergic antagonists, or central sympatholytics [methyldopa, clonidine, guanethidine]) ||Reduce arteriolar flow to corpora || |
Any diuretic that produces a significant decrease in intravascular volume can decrease penile arteriolar flow.
Safer antihypertensives include angiotensin-converting enzyme inhibitors, postsynaptic α1-adrenergic antagonists (terazosin, doxazosin), calcium channel blockers, and angiotensin II receptor antagonists.