Best Blood Pressure Medications for Erectile Dysfunction: Here’s What Works Best, and Why

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High blood pressure is sneaky. Most people don’t have any symptoms. Even though you can’t feel it, it can still raise your risk for heart problems and stroke. But did you know that it can also affect your sex life?

High blood pressure can affect blood flow to your genitals and cause problems such as erectile dysfunction (ED). And if you’re already experiencing ED, that could be an early sign that you’re having high blood pressure.

It makes sense that treating high blood pressure should resolve ED. But it’s not so simple. Certain blood pressure medications can improve ED, while others may make it worse. If this sounds confusing, read on to dive deeper into how certain blood pressure medications can affect ED symptoms.

What are the best blood pressure medications for erectile dysfunction?

There are several types of blood pressure medications that can manage your blood pressure without worsening ED. Some blood pressure medications may even improve ED symptoms.

1. ARBs such as losartan

Angiotensin II receptor blockers (ARBs) — including losartan (Cozaar), valsartan (Diovan), and olmesartan (Benicar) — are common blood pressure medications. They lower blood pressure by blocking a hormone called angiotensin II from attaching to its receptor. Angiotensin II normally tells your blood vessels to squeeze tighter. Blocking this hormone allows blood vessels to relax.

This relaxation may also increase blood flow to the penis and improve ED. Researchers aren’t certain if this is the reason they help, but a collection of studies found that people who took ARBs for high blood pressure noticed an improvement in ED and an increased desire to have sex. 

Sometimes people need to take blood pressure medications for other reasons, such as heart failure or kidney problems. However, if high blood pressure is your only issue, ARBs seem to be the best option for people with ED since they may actually improve its symptoms.

2. ACE inhibitors such as lisinopril

Like ARBs, angiotensin-converting enzyme (ACE) inhibitors such as lisinopril (Zestril), benazepril (Lotensin), and ramipril work by blocking angiotensin II. But they work a little differently than ARBs do. They prevent your body from making angiotensin II rather than blocking it from attaching to its target. Even though their actions are different, their end results are the same — blood vessel relaxation.

ACE inhibitors typically don’t worsen ED. In fact, some may improve sexual function. A study from 2005 found that quinapril improved genital blood flow, sexual activity, and erectile function after 6 months of regular use. Another study compared lisinopril to a beta blocker called atenolol. Although both medications caused an initial decrease in sexual activity, this improved after the first month in people taking lisinopril. 

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Overall, ACE inhibitors are another beneficial option for people living with both high blood pressure and ED.

3. Calcium channel blockers such as amlodipine

Calcium channel blockers (CCBs) such as amlodipine (Norvasc), felodipine ER, and nifedipine ER (Procardia XL) work by preventing calcium from doing its job in your blood vessels and heart. Calcium normally causes muscles to tighten up, so blocking its activity causes blood vessel relaxation and a decrease in how hard your heart is pumping.

CCBs rarely affect erections. But CCBs could make it harder to ejaculate. Although this is different from ED, it could still impact your sex life. What’s more, both amlodipine and nifedipine have sexual dysfunction or sexual difficulties listed as rare side effects in their labeling. 

Since these issues aren’t common, CCBs are good options to consider for those with ED.

Which blood pressure medications worsen erectile dysfunction?

Beta blockers and certain diuretics are the blood pressure medications most likely to worsen ED. Read on to understand why these medications might be contributing to the problem.

1. Beta blockers such as carvedilol

Beta blockers can cause or worsen ED. They work by decreasing how hard your heart is pumping and by relaxing your blood vessels. This is good for lessening high blood pressure. But decreasing the amount of blood pumped around the body and making the blood vessels wider can actually decrease blood flow to the penis.

This effect tends to be more pronounced with nonselective beta blockers such as labetalol and carvedilol (Coreg). These medications block receptors in both the heart and blood vessels throughout the body, including those that supply blood to the penis. Selective beta blockers, such as atenolol (Tenormin), primarily act on the heart’s beta-1 receptors, so they may be less likely to interfere with sexual function. 

Still, some research suggests that all beta blockers — even selective ones — can contribute to sexual side effects including ED.

Keep in mind: One possible exception is nebivolol (Bystolic). It may improve ED symptoms by increasing the release of nitric oxide, which causes blood vessels to dilate.

2. Diuretics such as hydrochlorothiazide

Several types of diuretics (“water pills”) are available. They each affect erections differently.

Thiazide diuretics such as hydrochlorothiazide and thiazide-like diuretics such as chlorthalidone can worsen ED. Some studies show that people who take thiazides are more than twice as likely to struggle with ED compared with people with high blood pressure who don’t take them.

There isn’t much data about the effects on ED of loop diuretics such as furosemide (Lasix). But one older study suggests that both thiazide and nonthiazide diuretics can contribute to ED. 

Aldosterone antagonists such as spironolactone (Aldactone) and eplerenone (Inspra) block testosterone and could potentially decrease sexual function, too.

3. Alpha agonists such as clonidine

Clonidine (Catapres-TTS) and methyldopa are alpha agonists. They attach to a protein in the brain to decrease hormones that contribute to your “fight-or-flight” response. This is beneficial for blood pressure, but like beta blockers, alpha agonists can dull your response to sex and interfere with signals that cause an erection.

ED is common with these medications. These medications aren’t regularly prescribed for blood pressure except in special situations.

How to treat erectile dysfunction caused by medications

If you’re only taking medication for blood pressure, one option is to switch to a different medication that has a neutral or beneficial effect on ED symptoms. However, it’s not always possible to stop your blood pressure medicine or switch to an alternative. Beta blockers, diuretics, and alpha agonists have beneficial effects for many other conditions.

Phosphodiesterase 5 (PDE5) inhibitors such as sildenafil (Viagra) and tadalafil (Cialis) relax the blood vessels in the penis and are an effective treatment for ED. They’re typically safe to pair with most blood pressure medications. Your prescriber can help determine whether a PDE5 inhibitor might be a safe option for you. 

If you’re new to taking a PDE5 inhibitor, make sure to ask your pharmacist to check for interaction risks. Some blood pressure medications — such as diltiazem and verapamil — can interact with PDE5 inhibitors by preventing them from being broken down in the body efficiently. This can lead to higher amounts of medication in your system and increased risk of side effects.

Important: If you remember one thing about interactions with Viagra and Cialis, it’s this: You shouldn’t take nitrates or riociguat (Adempas) with these medications. Nitrates and Adempas relax blood vessels, too, and using them with PDE5 inhibitors can cause a serious drop in blood pressure. Common nitrates include nitroglycerin (Nitrostat) and isosorbide mononitrate (Imdur).

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Written by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Austin Ulrich, PharmD, BCACP

​​Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. Ulrich’s experience includes direct patient care in hospital and community pharmacies.

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