Erectile dysfunction increases with use of multiple medications

This study surveyed 37,712 ethnically diverse men from Southern California and found that men taking various medications are likely to have more severe ED. This was part of the California Men's Health Study, a multiethnic cohort of men ages 46 to 69 who are members of Kaiser Permanente in California.

Information about medication use between 2002 and 2003 was obtained from pharmacy records. This study looked at men who were taking more than three medications. Survey responses about ED were used to quantify its presence and severity. Of the men included in this study, 29 percent reported moderate or severe ED. In addition to the number of medications, ED was associated with older age, higher body mass index, diabetes, high cholesterol, hypertension, depression, and being a current or past smoker. After taking these conditions into account, the relationship between multiple medications and ED persisted.

"Clinically, the findings from this study suggest that a crucial step in the evaluation of ED would be to review the current medications the patient is taking and their potential side effects. When appropriate, decreases or changes in the amount or type of medication should be considered," said study lead author Diana C. Londoño, MD, from the urology department at Kaiser Permanente Los Angeles Medical Center.

Across all age groups, ED was more prevalent as the number of medications increased.

• Medications.........Number of Men....Moderate ED
• 0 – 2...............16,126...................15.9%
• 3 - 5...............10,046...................19.7%
• 6 - 9...............6,870.....................25.5%
• _>10................4,670....................30.9%

The most common medications associated with ED include antihypertensives (beta blockers, thiazides, and clonidine) and psychogenic medications such as selective serotonin reuptake inhibitors, tricyclic antidepressants, lithium, monoamine oxidase inhibitors, and any medication which can interfere with testosterone pathways.

Researchers found that 57 percent of men in the study took more than three medications. Use of multiple medications was the greatest among older age groups, with 53 percent of men ages 50 to 59 years taking at least three medications and 66 percent men ages 60 to 70 taking at least three medications. Seventy-three percent of the men who used more than three medications had a BMI greater than 35 kg/m2 (obese). Twenty-five percent of the men used at least 10 medications.

ED is a problem that affects a significant number of men in the United States and around the world. Previous studies have shown that 35 percent of men over the age of 60 suffer from ED, a condition with multiple causes including thyroid diseases, depression, stress, medication side effects, atherosclerosis, coronary artery disease, alcoholism, smoking, trauma, and surgery. Most of these conditions decrease nitric oxide, the main neurotransmitter which initiates and maintains an erection.

"This study highlights that while physicians still need to treat patients with medications when indicated, they should be aware that erectile dysfunction may occur," said Michael Kanter, MD, regional medical director of Quality & Clinical Analysis for the Southern California Permanente Medical Group. "These men would benefit from lifestyle changes such as changes in their diet, regular exercise, and not smoking which would help control their hypertension, diabetes, and stress and reduce erectile dysfunction risk. Physicians can use this as an opportunity to talk with their patients about risks of erectile dysfunction and the underlying health conditions causing their need for multiple medications."

Provided by Kaiser Permanente