Gabapentin, pregabalin and ED: what the labels say
The short answer
It can for some people. Impotence appears among the reported side effects on the gabapentin (Neurontin) and pregabalin (Lyrica) labels, though in the trials only a small share of patients reported it. Diabetes and nerve damage can also lead to ED. Talk to your prescriber before changing or stopping either medicine.
Status: FDA-approved for another condition, not for ED (gabapentin for nerve pain after shingles and as add-on seizure treatment; pregabalin for several nerve pain conditions, fibromyalgia and as add-on seizure treatment). Source: NEURONTIN and LYRICA prescribing information, DailyMed, checked 2026-10-17.
The short version: gabapentin (Neurontin) and pregabalin (Lyrica) are related medicines, often called gabapentinoids, used for nerve pain and seizures. Both labels list impotence among side effects reported in clinical trials, and both list other sexual effects such as changes in desire and difficulty reaching orgasm. The numbers on the labels are small, and the conditions these medicines treat can affect erections on their own. This page sets out what the labels and studies actually show, and what to raise with your prescriber before changing anything.
Can gabapentin affect erections?
Yes, it can for some people, though the labels suggest it is not common. In the pooled placebo-controlled epilepsy trials on the NEURONTIN label, impotence was reported by 2% of patients on gabapentin and 1% on placebo (NEURONTIN prescribing information, DailyMed). The pregabalin label also lists impotence as a frequent reaction across its clinical trials (LYRICA prescribing information, DailyMed). The NIH says ED can be a side effect of many common prescription and over-the-counter medicines (NIDDK, Symptoms and Causes of ED).
What do the gabapentin labels list?
The NEURONTIN label lists impotence in its trial table and other sexual effects in its postmarketing reports. The table below shows each entry and where it comes from.
| What the label lists | Where it comes from | What it shows |
|---|---|---|
| Impotence: 2% on gabapentin, 1% on placebo | Pooled placebo-controlled add-on trials in epilepsy patients older than 12 (543 on gabapentin, 378 on placebo) | A small difference from placebo |
| Changes in libido, ejaculation disorders and anorgasmia (difficulty reaching orgasm) | Postmarketing reports | Effects reported after approval, with frequency and cause not established |
| Decreased libido, more often at the higher dose tested | HORIZANT (gabapentin enacarbil) restless legs trials | A related extended-release medicine, with the effect described as dose-related |
Sources: NEURONTIN label, sections 6.1 and 6.2; HORIZANT label, section 6.1.
The label is careful about the postmarketing list. It says these reactions “are reported voluntarily from a population of uncertain size,” so it is not always possible “to reliably estimate their frequency or establish a causal relationship to drug exposure” (NEURONTIN label). The trial percentages also count all patients in those trials, not only men.
What does the pregabalin (Lyrica) label list?
The LYRICA label lists anorgasmia and impotence as “frequent” reactions in its list of other reactions reported across all clinical trials, and decreased libido as frequent too. The label defines “frequent” as reported by at least 1 in 100 patients, and it lists abnormal ejaculation as infrequent (LYRICA prescribing information, DailyMed). That list is not a comparison with placebo, so it shows the effect was reported, not how much of it was due to the medicine.
The extended-release version gives one placebo comparison. In the double-blind phase of the LYRICA CR study in nerve pain after shingles, erectile dysfunction was reported by 1 man on the medicine and none on placebo (LYRICA CR prescribing information, DailyMed). Numbers that small cannot show a real difference either way.
What have studies found outside the label trials?
Smaller studies suggest sexual effects may be reported more often in everyday practice than the trial tables imply, but none of them can give a reliable rate. The main ones:
- A pregabalin case series. In 75 patients treated with pregabalin for pain, headache or anxiety conditions, 31 developed sexual side effects, and erectile dysfunction was the most common among them. They began within weeks of starting, and improved within weeks of stopping (Hamed, Clinical Neuropharmacology, 2018).
- A comparison study in men with nerve pain. Among 102 men, those taking pregabalin for nerve pain had lower erectile function scores than men with nerve pain who were not taking it (Bozkurt et al., Journal of Sexual Medicine, 2014). The authors advised checking erectile function before and during treatment.
- Gabapentin case reports. One report found that 3 of 15 patients newly started on gabapentin at one clinic, all men in their 70s, had difficulty reaching orgasm, which returned to normal when the medicine was reduced or stopped (Perloff et al., American Journal of Geriatric Pharmacotherapy, 2011). Another described one patient whose loss of desire, orgasm and erections tracked with the dose (Kaufman and Struck, Epilepsy and Behavior, 2011).
- A review of seizure medicines. A 2016 review concluded that pregabalin and gabapentin “may cause” sexual dysfunction, and that switching to another seizure medicine may be an option (Yang and Wang, Expert Opinion on Drug Safety, 2016).
Case series and case reports describe what happened to specific patients. They cannot show how often it happens to everyone who takes the medicine, and they often lack a comparison group.
Why is it hard to tell whether the medicine is the cause?
Because the conditions these medicines treat are linked to ED themselves. The NIH lists diabetes and nerve damage among the most common conditions that can lead to ED (NIDDK, Symptoms and Causes of ED), and pregabalin is approved for nerve pain caused by diabetes. In the Bozkurt study, men with untreated nerve pain also scored lower than healthy men on overall sexual function, though not on the erectile function score itself (Bozkurt et al., 2014).
Both labels also warn about depression and suicidal thoughts, and the NIH lists depression among the emotional issues that can cause ED or make it worse (NIDDK, Symptoms and Causes of ED). Our guides to nerve conditions and ED and ED and diabetes explain how those conditions affect erections. A change in erections that lines up with starting a medicine is worth raising, but the timing alone does not prove the medicine is the reason.
What can a prescriber change?
A prescriber can review the medicine and suggest a different dose or a different medicine. The NIH says a health care professional “may suggest taking a different dose of medicine or switching to another medicine,” and adds: “Do not stop taking any medicines on your own” (NIDDK, Treatment for ED). The 2016 review also names switching to another seizure medicine as one option (Yang and Wang, 2016). They may also treat the ED directly, which our page on medicines that can affect erections covers alongside the medication review.
Useful questions to bring:
- Timing. “My erections changed around when I started or increased this. Could the two be linked?”
- The reason I take it. “What happens to my pain or seizure control if we change this?”
- Alternatives. “Is there another option for my condition with a different side-effect profile?”
- Other causes. “Should we check blood sugar, blood pressure or hormones as well?”
- ED treatment. “If this medicine is the right one for me, can we treat the ED alongside it?”
Our guide to talking to a doctor about ED covers how to raise the subject if it feels awkward. A similar pattern, a labeled side effect alongside a condition that matters, comes up with finasteride and ED and with ADHD stimulants.
Why should you not stop gabapentin or pregabalin suddenly?
Because stopping suddenly carries its own risks, and the labels tell prescribers to reduce these medicines gradually. The NEURONTIN label says abrupt or rapid discontinuation “may increase the risk for seizures,” and that withdrawal symptoms and suicidal thoughts and behavior have been seen after stopping (NEURONTIN label). The LYRICA label says some patients who stopped abruptly reported insomnia, nausea, headache, anxiety, sweating and diarrhea, and tells prescribers to taper rather than stop at once (LYRICA label). Any change should be planned with the person who prescribed it.
When to talk to a clinician
Book a conversation with your prescriber if erection changes started after beginning or increasing gabapentin or pregabalin. Keep taking the medicine as prescribed until you have spoken with them. Seek help right away for low mood or any thoughts of self-harm, which are listed on both labels.
If you are unsure whether it is time to book that visit, our guide on when to see a doctor about ED sets out the signs that mean sooner rather than later.
Sources
Every clinical statement on this page traces to one of these sources:
- NEURONTIN (gabapentin) prescribing information, DailyMed, Viatris. Indications; impotence 2% vs 1% on placebo in pooled add-on epilepsy trials; postmarketing changes in libido, ejaculation disorders and anorgasmia; voluntary-report caveat; gradual discontinuation, seizure risk and withdrawal warnings: dailymed.nlm.nih.gov, NEURONTIN label
- LYRICA (pregabalin) prescribing information, DailyMed, Pfizer. Indications; anorgasmia, impotence and decreased libido as frequent reactions across clinical trials, with the label’s frequency definitions; abrupt discontinuation symptoms and tapering: dailymed.nlm.nih.gov, LYRICA label
- LYRICA CR (pregabalin extended-release) prescribing information, DailyMed. Erectile dysfunction in the double-blind phase of the postherpetic neuralgia study: dailymed.nlm.nih.gov, LYRICA CR label
- HORIZANT (gabapentin enacarbil) prescribing information, DailyMed. Decreased libido in restless legs trials, described as dose-related: dailymed.nlm.nih.gov, HORIZANT label
- NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases, NIH), Treatment for Erectile Dysfunction. Different dose or different medicine; “Do not stop taking any medicines on your own”: niddk.nih.gov, ED treatment
- NIDDK, Symptoms and Causes of Erectile Dysfunction. Diabetes and nerve damage among common causes; ED as a side effect of many prescription and over-the-counter medicines; depression among emotional causes: niddk.nih.gov, ED symptoms and causes
- Hamed SA. Sexual dysfunctions induced by pregabalin. Clinical Neuropharmacology, 2018: pubmed.ncbi.nlm.nih.gov/30001248
- Bozkurt M, et al. Association between neuropathic pain, pregabalin treatment, and erectile dysfunction. Journal of Sexual Medicine, 2014: pubmed.ncbi.nlm.nih.gov/24612455
- Yang Y, Wang X. Sexual dysfunction related to antiepileptic drugs in patients with epilepsy. Expert Opinion on Drug Safety, 2016: pubmed.ncbi.nlm.nih.gov/26559937
- Perloff MD, et al. Anorgasmia with gabapentin may be common in older patients. American Journal of Geriatric Pharmacotherapy, 2011: pubmed.ncbi.nlm.nih.gov/21602106
- Kaufman KR, Struck PJ. Gabapentin-induced sexual dysfunction. Epilepsy and Behavior, 2011: pubmed.ncbi.nlm.nih.gov/21612983
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