Medications that may contribute to sexual disorders: a guide to assessment and treatment in family practice

Journal of Family Practice, Jan, 1997 by William W. Finger, Margaret Lund, Mark A. Slagel

(*) Case report(s), package insert or uncertain frequency; (**) infrequent side effect; (***) frequent side effect; (****) very frequent side effect.

Note: Medications and their accompanying side effects that have been cited frequently as causing sexual disorders are in bold type

In addition to illicit drugs, nonprescription medications and homeopathic remedies also may cause or contribute to sexual dysfunction, albeit rarely (Table 6). These include common medications such as diphenhydramine (Benadryl)[49] and newer nonprescription medications such as naproxen (Aleve).[50] The use of herbal products should also be questioned, since many of these "all natural" products contain pharmacologically active ingredients. Again, patients are not likely to associate these substances with changes in sexual function. It is imperative that physicians be aware of the possible effects of these substances and structure their interview accordingly.

TABLE 6
Nonprescription Medications Associated with Sexual Disorders

Medication                  Sexual Disorder

antihistamines              erectile disorder(*)
cimetidine (Tagamet HB)     deceased desire (men or women),(*)
                            erectile disorder,(***) gynecomastia(*)
dimenhydrinate (Dramamine
Marmine, Calm-X, etc)       erectile disorder(*)
diphenhydramine (Benadryl,
Genahist, Nordryl, etc)     decreased desire, erectile disorder(*)
famotidine (Pepcid AC)      erectile disorder(**)
naproxen (Aleve)            erectile disorder, no ejaculation(*)
niacin                      decreased desire(***)
ranitidine (Zantac 75)      decreased desire, erectile disorder(*)

(*) Case report(s), package insert, or uncertain frequency; (**) infrequent side effect; (***) frequent side effect; (****) very frequent side effect.

Note: Medications and their accompanying side effects that have been cited frequently as causing sexual disorders are in bold type.

GUIDELINES FOR ASSESSMENT OF MEDICATION EFFECTS

The presentation of medication-related disorders is often similar to disorders caused by physiological factors. That is, they are likely to be consistent across time and situations, whereas disorders with psychogenic causes are likely to be situation specific. A woman who lubricates and climaxes during masturbation but not with her partner is not likely suffering the side effects of medication. Similarly, a male patient who reports regular morning erections of good rigidity and good erections during masturbation, but no erections or insufficient erections with a partner, is most likely experiencing a psychological problem.

Medication effects, however, may mimic a psychogenic problem in two ways. First, it is possible for medications to have transient effects on sexual function. For example, antihypertensive medications may cause a disruption of sexual function for a few hours after ingestion. A patient who takes one of these medications in the morning may report poor erections with his partner following ingestion but good erections masturbating at other times of the day and good morning erections before taking medication. This patient can be encouraged to modify the timing of his sexual activities, or an alternative dosing schedule may be tried. Second, medication-induced sexual disorders do not typically develop gradually as organic disorders typically do. For example, a patient who reports sudden onset of erectile disorder with a new partner may be diagnosed with a psychogenic disorder. However, if this patient began taking a new medication between relationships, it is possible that the sudden onset is caused by the medication, not the anxiety inherent in a new relationship.