Which blood pressure medicines are linked to ED? Lisinopril, amlodipine, losartan and others

The short version: blood pressure medicines are on the NIH list of medicines that can play a part in erection problems (NIDDK, Symptoms & Causes of ED), but the picture is more mixed than the list suggests. The FDA labels for lisinopril, amlodipine and losartan each mention erection or sexual problems, though none lists them among its most common side effects. A 2022 network meta-analysis of randomized trials found no major blood pressure drug class with a clear effect on erectile function compared with placebo (Farmakis et al., Cardiovascular Drugs and Therapy, 2022). Beta-blockers and thiazide water pills are the classes most often named (MedlinePlus, Drugs that may cause erection problems). And high blood pressure is itself on the NIH list of conditions linked to ED, so the pill is not always the whole story. Whatever you take, the NIH guidance is the same: “Do not stop taking any medicines on your own. Talk with your health care professional first” (NIDDK, Treatment for ED). Evidence level: FDA labels plus randomized trials and reviews, many of them small, older or rated at concerning risk of bias.

Which blood pressure medicines are linked to ED?

Most blood pressure medicines have been linked to erection problems in a label, a trial or both, but the strength of the link differs a lot by class. MedlinePlus, the National Library of Medicine’s encyclopedia, ranks them: “Thiazides are the most common cause of erectile dysfunction among the high blood pressure medicines. The next most common cause is beta blockers. Alpha blockers tend to be less likely to cause this problem” (MedlinePlus, Drugs that may cause erection problems). Newer reviews are more cautious about thiazides, as the table shows.

Sources: labels on DailyMed as linked in each section below; MedlinePlus; TOMHS, Hypertension, 1997; Corona et al., Endocrine, 2024; Ko et al., JAMA, 2002.

Does lisinopril cause erectile dysfunction?

Its label lists erection problems as a possible side effect, but not a common one. The current Zestril (lisinopril) label lists “Urogenital: Impotence” among other clinical adverse reactions seen in 1% or more of patients with high blood pressure or heart failure in controlled trials, without a placebo comparison for that item. The side effects that showed up most often beyond placebo in its blood pressure trials were headache, dizziness and cough (Zestril prescribing information, DailyMed).

Trial data put ACE inhibitors, the class lisinopril belongs to, near the neutral end. In the Treatment of Mild Hypertension Study (TOMHS), a double-blind trial of 557 men and 345 women followed for about four years, new erection problems with the ACE inhibitor enalapril were similar to placebo (Grimm et al., Hypertension, 1997). In a small crossover trial of 90 men aged 40 to 49 who compared lisinopril with the beta-blocker atenolol, sexual activity dipped in the first month on both, then recovered on lisinopril but not on atenolol, and complaints of sexual dysfunction were 3% on lisinopril against 17% on atenolol (Fogari et al., American Journal of Hypertension, 1998).

Does amlodipine cause erectile dysfunction?

Its label lists sexual dysfunction as a possible side effect, but among the uncommon ones, with a causal link it calls uncertain. The Norvasc (amlodipine) label lists “sexual dysfunction (male and female)” among events reported in under 1% of patients in controlled trials or in open trials and marketing experience, where it says a causal link is uncertain, and a footnote says the rate for men was between 1% and 2% across all multiple-dose studies. The label’s most common side effect is swelling (edema) (Norvasc prescribing information, DailyMed).

In TOMHS, men on amlodipine had a rate of new erection problems similar to men on placebo (Grimm et al., Hypertension, 1997), and a 2024 review in Endocrine describes calcium channel blockers as neutral for erectile function (Corona et al., 2024).

Does losartan cause erectile dysfunction?

Its label lists impotence as a possible side effect, but among the less common ones. The current Cozaar (losartan) label includes “Reproductive system and breast disorders: Impotence” in its list of less common adverse reactions from clinical trials, without a rate, while its most common side effects were dizziness, upper respiratory infection, nasal congestion and back pain (Cozaar prescribing information, DailyMed).

The research on ARBs, losartan’s class, leans neutral to slightly favorable. A 2019 meta-analysis of four randomized trials with 2,809 men found that losartan or telmisartan did not significantly improve erectile function scores compared with control or placebo, while valsartan was associated with better reported sexual activity; the authors noted that few studies were available (Ismail et al., American Journal of Men’s Health, 2019). In a trial of 160 newly diagnosed men (120 in a crossover comparison, 40 on placebo), ED was a complaint for 13.5% on the beta-blocker carvedilol, 0.9% on the ARB valsartan and one man on placebo (Fogari et al., American Journal of Hypertension, 2001).

What about beta-blockers?

Beta-blockers are the class most often linked to ED, but the measured effect in large trials is small. The Lopressor (metoprolol) label states that “beta-blockers (including metoprolol) may cause erectile dysfunction,” based on the published literature (Lopressor prescribing information, DailyMed), and the Tenormin (atenolol) label lists impotence among postmarketing reports (Tenormin prescribing information, DailyMed).

How big is the effect? A JAMA analysis of 15 placebo-controlled trials in heart attack, heart failure and high blood pressure, with more than 35,000 people found a small but significant increase in reported sexual dysfunction: about 5 extra reports per 1,000 patients per year, or one additional report for every 199 people treated for a year. The authors concluded that the conventional wisdom of substantial risk “is not supported by data from clinical trials” (Ko et al., JAMA, 2002). A 2024 review still calls beta-blockers “the class of medications more often associated with ED,” and notes better outcomes with nebivolol (Corona et al., Endocrine, 2024). In the 2022 network meta-analysis, nebivolol did better than non-vasodilating beta-blockers but not significantly better than placebo (Farmakis et al., 2022).

Expectation matters here too. In a small study of 96 men starting atenolol, none of whom had ED at the start, reported ED after three months was 3.1% in men not told which drug they had, 15.6% in men told the name only, and 31.2% in men told the name and its possible effect on erections (Silvestri et al., European Heart Journal, 2003). Our guide on telling ED from performance anxiety covers that side.

What about water pills?

“Blood pressure medicines and diuretics, or water pills” are on the NIH list (NIDDK, Symptoms & Causes of ED), and MedlinePlus names thiazides such as hydrochlorothiazide and chlorthalidone as the most common cause among blood pressure medicines (MedlinePlus). The trial evidence is more nuanced.

In TOMHS, men on chlorthalidone reported new erection problems more often than men on placebo through 24 months (17.1% against 8.1%), but by 48 months the difference was no longer significant. The authors added that “in many cases, erection dysfunction did not require withdrawal of medication” (Grimm et al., Hypertension, 1997). The 2024 review says that, after some early negative reports, “more recent evidence does not confirm the negative impact of thiazides” (Corona et al., Endocrine, 2024).

Could high blood pressure be the cause, not the pill?

Yes, it can be either or both. High blood pressure is on the NIH list of conditions that can lead to ED (NIDDK, Symptoms & Causes of ED). In TOMHS, 12.2% of men already reported erection problems before starting any study drug, and those problems were linked to age, systolic pressure and earlier blood pressure treatment (Grimm et al., 1997).

The TOMHS authors drew a direct lesson: similar rates in the placebo group and most active drug groups “caution against routine attribution of erection problems to antihypertensive medication.” A 2023 genetic (Mendelian randomization) study reached a similar view from a different angle, finding that genetically predicted hypertension was associated with ED but finding “little evidence that antihypertensive drugs increase the risk” (Zhao et al., Frontiers in Cardiovascular Medicine, 2023). That kind of study estimates links across large populations; it cannot say what is happening for one man. Our guide to ED and heart disease explains why blood vessel health matters for erections.

Is there a blood pressure medicine with less effect on erections?

No blood pressure medicine can be promised to leave erections untouched, but the classes do differ. Reviews describe calcium channel blockers as neutral and ACE inhibitors and ARBs as neutral or even positive, beta-blockers as the class most often associated with ED (with nebivolol doing better), and alpha blockers as less likely to cause the problem (Corona et al., 2024; MedlinePlus). The pooled trial evidence is also weaker than it looks: the 2022 network meta-analysis rated the risk of bias as concerning or high in most studies and found no class clearly different from placebo (Farmakis et al., 2022).

Which medicine fits you depends on much more than erections, so it is a decision for your prescriber. The NIH says a clinician who suspects a medicine “may suggest taking a different dose of medicine or switching to another medicine” (NIDDK, Treatment for ED), and the 2024 review recommends that sexual function be assessed in everyone with high blood pressure, at diagnosis and after a new prescription (Corona et al., 2024).

Why not stop a blood pressure medicine on your own?

Because stopping can be dangerous, and it leaves the blood pressure untreated. MedlinePlus warns, “Never stop taking any medicine without first talking to your provider,” and adds that some medicines “may lead to life-threatening reactions if you do not take care when stopping or changing them” (MedlinePlus).

Beta-blockers are the clearest example. The Tenormin (atenolol) label says patients with coronary artery disease should be advised against abrupt discontinuation, and reports severe worsening of angina, heart attacks and abnormal heart rhythms after sudden stops in people with angina (Tenormin prescribing information, DailyMed), and the Lopressor (metoprolol) label carries a similar warning (Lopressor prescribing information, DailyMed). Stopping also leaves the high blood pressure itself untreated, and that is on the NIH list of conditions that can lead to ED (NIDDK, Symptoms & Causes of ED).

Can you take an ED medicine with blood pressure medicines?

That is a question for your prescriber, because the effects on blood pressure can add up. The Cialis (tadalafil) label says physicians should discuss the potential for tadalafil “to augment the blood-pressure-lowering effect of alpha-blockers and antihypertensive medications,” and notes that in its studies, taking tadalafil with blood pressure medicines produced small additional reductions in blood pressure compared with placebo (Cialis prescribing information, DailyMed). Our page on tadalafil interactions sets out what that label says, including the nitrate heart medicines that must never be combined with any ED pill.

Sources

Every clinical statement on this page traces to one of these sources:

• NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases, NIH), Symptoms & Causes of Erectile Dysfunction, last reviewed October 2024. Blood pressure medicines and diuretics on the medicines list; high blood pressure on the conditions list: niddk.nih.gov, ED symptoms and causes
• NIDDK, Treatment for Erectile Dysfunction, last reviewed October 2024. Medication review, a different dose or a different medicine, and “Do not stop taking any medicines on your own”: niddk.nih.gov, ED treatment
• MedlinePlus Medical Encyclopedia (National Library of Medicine), Drugs that may cause erection problems, review date January 2025. The thiazide, beta-blocker and alpha blocker comparison and the warning about stopping or changing medicines: medlineplus.gov/ency/article/004024.htm
• ZESTRIL (lisinopril) prescribing information, revised November 2024, DailyMed. Section 6.1, impotence among reactions seen in 1% or more of trial patients; most common reactions: dailymed.nlm.nih.gov, ZESTRIL label
• NORVASC (amlodipine besylate) prescribing information (Pfizer), revised January 2019, DailyMed. Section 6.1, sexual dysfunction in the under 1% list, with a 1% to 2% rate for men in multiple-dose studies: dailymed.nlm.nih.gov, NORVASC label
• COZAAR (losartan potassium) prescribing information (Organon), revised June 2025, DailyMed. Section 6.1, impotence among less common adverse reactions: dailymed.nlm.nih.gov, COZAAR label
• TENORMIN (atenolol) prescribing information, revised December 2025, DailyMed. Impotence in postmarketing reports; warning against abrupt cessation: dailymed.nlm.nih.gov, TENORMIN label
• LOPRESSOR (metoprolol tartrate) prescribing information, revised September 2023, DailyMed. Section 8.3, beta-blockers may cause erectile dysfunction; section 5.1, abrupt cessation of therapy: dailymed.nlm.nih.gov, LOPRESSOR label
• CIALIS (tadalafil) prescribing information (Eli Lilly), DailyMed. Sections 5.6 and 7.1, alpha blockers and other blood pressure medicines: dailymed.nlm.nih.gov, CIALIS label
• Farmakis IT, Pyrgidis N, et al. Effects of major antihypertensive drug classes on erectile function: a network meta-analysis (Cardiovascular Drugs and Therapy, 2022). 25 studies, 7,784 patients; no class significantly different from placebo; nebivolol compared with other beta-blockers: pubmed.ncbi.nlm.nih.gov/33945044
• Grimm RH Jr, et al. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment (TOMHS) (Hypertension, 1997). 557 men; chlorthalidone 17.1% vs placebo 8.1% through 24 months; acebutolol, amlodipine and enalapril similar to placebo: pubmed.ncbi.nlm.nih.gov/9039073
• Ko DT, et al. Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction (JAMA, 2002). 15 trials, more than 35,000 subjects; 5 per 1,000 per year: pubmed.ncbi.nlm.nih.gov/12117400
• Corona G, et al. Anti-hypertensive medications and erectile dysfunction: focus on beta-blockers (Endocrine, 2024). Class-by-class narrative and systematic review: pubmed.ncbi.nlm.nih.gov/39269577
• Fogari R, et al. Sexual function in hypertensive males treated with lisinopril or atenolol: a cross-over study (American Journal of Hypertension, 1998). 90 men; 3% vs 17% complaints: pubmed.ncbi.nlm.nih.gov/9799042
• Fogari R, et al. Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study (American Journal of Hypertension, 2001). 160 men; ED complaints 13.5% carvedilol, 0.9% valsartan: pubmed.ncbi.nlm.nih.gov/11206674
• Ismail SB, et al. Angiotensin receptor blockers for erectile dysfunction in hypertensive men: a brief meta-analysis of randomized control trials (American Journal of Men’s Health, 2019). 4 trials, 2,809 men: pubmed.ncbi.nlm.nih.gov/31795911
• Zhao C, et al. Genetically predicted hypertension, antihypertensive drugs, and risk of erectile dysfunction: a Mendelian randomization study (Frontiers in Cardiovascular Medicine, 2023): pubmed.ncbi.nlm.nih.gov/37363097
• Silvestri A, et al. Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo (European Heart Journal, 2003). 96 men starting atenolol: pubmed.ncbi.nlm.nih.gov/14585251

This page is general education, not medical advice. A clinician who knows your health history is the right person to judge whether a medicine is affecting your erections and what to change.