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 than first-generation agents. Selective serotonin reuptake inhibitor (SSRI) and multiple receptor reuptake inhibitor antidepressants cause less erectile dysfunction than tricyclic antidepressants. Of the SSRIs, paroxetine, sertraline, fluvoxamine, and fluoxetine cause erectile dysfunction more commonly than venlafaxine, nefazodone, trazodone, bupropion, duloxetine, mirtazapine, escitalopram, or vilazodone. Phenothiazines with less anticholinergic effect (eg, chlorpromazine) can be substituted in some patients if erectile dysfunction is a problem. |
Dopamine antagonists (eg, metoclopramide, phenothiazines) | Inhibit prolactin inhibitory factor, thereby increasing prolactin levels | Increased prolactin levels inhibit testicular testosterone production; depressed libido results. |
Estrogens or drugs with antiandrogenic effects (eg, luteinizing hormone-releasing hormone superagonists, digoxin, spironolactone, ketoconazole, cimetidine) | Suppress testosterone-mediated stimulation of libido | In the face of a decreased libido, a secondary erectile dysfunction develops because of diminished sexual drive. |
CNS 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 ... |