Common prescription medication use and erectile dysfunction: results from the Boston Area Community Health (BACH) survey

Abstract

Objectives To investigate the association of ED with commonly used medications including antihypertensive, psychoactive medications, and pain and anti-inflammatory medications. Subjects and Methods The Boston Area Community Health (BACH) Survey used a multistage stratified design to recruit a random sample of 2,301 men age 30-79. ED was assessed using the 5-item International Index of Erectile Function (IIEF-5). Prescription medication use, captured using a combination of drug inventory and self-report with a prompt by indication, included in this analysis were antihypertensive agents (AHT), psychoactive medications, and pain and anti-inflammatory medications. Logistic regression was used to estimate odds ratios of the association of medication use and ED and adjust for potential confounders including age, comorbid conditions, and sociodemographic and lifestyle factors. Results Multivariable analyses show benzodiazepines (adjusted OR=2.34, 95%CI:1.03, 5.31) and tricyclic antidepressants (adjusted OR=3.35, 95%CI:1.09, 10.27) were associated with ED, while no association was observed for SSNRI/SNRIs and atypical antipsychotics. AHT use, whether in monotherapy or in conjunction with other AHTs, and pain or anti-inflammatory medications were not associated with ED after accounting for confounding factors. Conclusions Results of the BACH study suggest adverse effects of some psychoactive medications (benzodiazepines and tricyclic antidepressants). No evidence of an association of AHT or pain and anti-inflammatory medication with ED was observed.

Association of Pain and Depression in Those With Chronic Low Back Pain

“…Evidence has shown clear detrimental effects of opiate and antidepressant medication on sexual function (eg, low libido for men and women, erectile dysfunction in men), but little or no effect for anti-inflammatory medication. 46,47 Added to this general pharmacological effect is the influence and interaction within pain populations that shows greater complexity; for example, a recent meta-analysis showed better sexual functioning for pain patients prescribed opiates due to the reduction in pain. 48 Medication use and influence on sexual function is an issue that further research should investigate.…”

A literature review of antithrombotic and anticoagulating agents on sexual function

“…On the other hand, the unadjusted and adjusted OR of ED with regular use of aspirin was 1.16 and 1.10, respectively, in the Prostate Cancer Prevention Trial which included 5,781 men (Patel et al., ) (LOE: 2b). In the Boston Area Community Health Survey, which included 2,301 men, benzodiazepines (OR = 2.34) and tricyclic antidepressants (OR = 3.35) but not aspirin‐containing analgesics (OR = 1.15) were associated with a higher risk of ED (Kupelian, Hall, & McKinlay, ) (LOE: 2b). However, the OR of aspirin for ED was only 0.92 in stroke male survivors (Bener et al., ) (LOE: 2b).…”

“…Taken together, clopidogrel seems to have no risk (Böhm et al., ; US‐FDA, ; Wallentin et al., ) to marginal risk (Bener et al., ) of ED (GOE: B). Aspirin has not been shown to increase the risk of ED in stroke survivors (Bener et al., ) or cardiovascular disease patients (Böhm et al., ), but there is a level of insignificant (Kupelian et al., ; Patel et al., ), marginal (Gleason et al., ) or moderate risk (Shiri et al., ) associated with the chronic use of aspirin‐containing analgesics for pain control. Aspirin may be a useful ATA to avoid ED, but the data are still preliminary (GOE: B).…”

“…The results from studies of aspirin in ED have been controversial and inconsistent, ranging from there being moderate risks (Shiri et al., ), marginal risks (Gleason et al., ), or insignificant risks (Kupelian et al., ; Patel et al., ), without deteriorating effects (Bener et al., ; Böhm et al., ) and even beneficial (Saroukhani et al., ) in some of the available studies. The inconsistencies result from different study designs, different population samples, underlying comorbidities or different dosages.…”

Erectile dysfunction in patients taking psychotropic drugs and treated with phosphodiesterase-5 inhibitors

“…Furthermore, we found significantly more improvement in the group receiving benzodiazepines, indicating their ED was due to an underlying anxiety disorder rather than to their medication. Although benzodiazepines may differ in their ED-inducing potential, results from large cohorts show benzodiazepines to be associated with ED, even after adjusting for comorbidities and health behaviors or addressing possible confounders (19). Benzodiazepine increase GABAA receptor function and GABAA receptor stimulation has been shown to reduce penile erection in rats through central mechanisms, so we could expect that people on benzodiazepines could show similar rates of ED to people taking other ED-associated psychotropic drugs (20).…”