Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. While ED has various causes, certain medications have been identified as significant contributors. A detailed examination of pharmaceutical agents reveals several classes known to affect sexual function through diverse physiological pathways. **Antidepressants:** Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are linked to ED by altering neurotransmitter levels, which can disrupt the neural pathways required for erection. They may lower libido, interfere with nitric oxide signaling, and reduce blood flow to the penis. **Antihypertensives:** Blood pressure medications, notably beta-blockers (e.g., propranolol, metoprolol) and diuretics (e.g., hydrochlorothiazide), can decrease blood vessel elasticity or reduce blood flow to the pelvic region. This can impede the vascular process essential for achieving an erection. Angiotensin-converting enzyme inhibitors and calcium channel blockers have lower incidences of sexual side effects but are not entirely free from such risks. **Antipsychotics and Mood Stabilizers:** Drugs used to treat psychiatric conditions, including risperidone and other dopamine antagonists, can disrupt hormonal balance by increasing prolactin levels or interfering with dopamine pathways. Hyperprolactinemia is associated with reduced testosterone and decreased libido, contributing to ED. **Opioids and Pain Medications:** Chronic use of opioid analgesics affects the central and peripheral nervous systems, potentially lowering testosterone levels and impacting the hormonal pathways involved in sexual arousal. Long-term opioid therapy has a well-documented relationship with ED. **Hormonal Medications:** Treatments like antiandrogens or medications that modulate testosterone can directly impact libido and erectile function by reducing circulating testosterone necessary for normal sexual response. **Other Medications:** Antihistamines, antiepileptics, and medications for ulcer treatment have also been implicated. They may cause ED by altering central nervous system function, interfering with neurochemical pathways, or inducing fatigue and depression, further reducing sexual interest and performance. Clinical data supports that medication-induced ED is often underreported due to embarrassment or lack of communication. Studies suggest that adjusting medication dosages, switching to alternative drugs with fewer sexual side effects, or using adjunct therapies can alleviate symptoms. 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Aired: May 11, 2025
