Lipid Lowering Medication

Fibrates (clofibrate, gemfibrozil, and less frequently bezafibrate and fenofibrate) are lipid-lowering medications that have long been associated with medication-induced sexual dysfunction.

A case­control study of 339 age­matched men revealed that there were more impotent men in the group of patients treated with lipid-lowering medications (12% vs. 5.6%); and multivariate anal-ysis showed that fibrates and statins were independent risk factors for erectile dysfunction.

A contemporary systematic review was recently carried out by a group in England evaluating the evidence associating lipid lowering therapies, including statins, with the onset of ED. While there are multiple trials that do not show and increased rate of sexual dysfunction in patients taking lipid lowering medications versus placebo, the authors report several studies in which the initiation of clofibrate, gemfibrozil, and multiple statins was associated with ED. While it remains unclear what the true rates of sexual adverse events with hypolipidemics, the mechanism in which this occurs is thought to be through decreased synthesis of sex steroid hormones derived from cholesterol, namely, testosterone. In addition to their known effects on serum lipid levels, statins have been hypothesized to mediate anti-inflammatory effects through several different pathways, including the inhibition of NOS activity. Thus, it is possible that statins might potentiate erectile dysfunction via decreased nitric oxide levels.

Miscellaneous and Kamagra Australia

Case reports of sexual side effects from metoclopramide, baclofen, amicar (epsilon-amino-car-poic acid), disulfiram, and carbonic anhydrase inhibitors have been associated with ED. Cytotoxic drugs have also been implicated in drug­related ED include methotrexate and thalidomide. Digoxin is yet another drug that has been suggested to induce ED. The mechanism it thought to be via blockade of the Na⁺, K⁺­ATPase pump, resulting in a net increase in intracellular calcium and increased corporal smooth muscle tone. Others have also suggested that the chemical structure of digoxin is similar to sex steroids leading to antiandrogen activity.

Immunomodulators

Decreased libido and ED are commonly reported side effects experienced by male patients during antiviral therapy for chronic hepatitis C. This effect was studied in 34 male patients being treated with interferon and ribavirin. Free and total testosterone decreased significantly during antiviral therapy while depression scores increased during therapy.

Certain agents used in renal transplantation have been implicated in erectile function as well. The immunosuppressive agents’ target of rapamycin inhibitors (i.e., sirolimus and everolimus) have been shown to result in decreases in serum testosterone levels, increases in levels of luteinizing hormone, and a disruption of spermatogenesis. The impairment of gonadal function is reported to elicit ED in patients receiving these drugs.