SexRx: Calcium Channel Blockers and Your Sex Life
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SexRx: Calcium Channel Blockers and Your Sex Life

sex rx

Medications and Their Commonly Used Brand Names

MedicationBrand names
amlodipineNorvasc
bepridilVascor
diltiazemCardizem
felodipinePlendil
flunarizineSibelium
isradipineDynaCirc
nicardipineCardene
nifedipineAdalat, Procardia
nimodipineNimotop
nisoldipineSular
nitrendipineBaypress
verapamilCalan, Isoptin

How They Work:

Calcium channel blockers (CCBs) affect the movement of calcium into the cells of your heart and blood vessels. As a result, CCBs relax blood vessels and increase the supply of blood and oxygen to the heart, which reduce the heart's workload.

Possible Sexual Side Effects:

Compared to most other blood pressure drugs (antihypertensives), CCBs seem to cause fewer sexual problems. However, several case reports have shown that CCBs have the potential to cause sexual dysfunction in both men and women. Specific effects include:

  • Decreased desire (in both men and women)
  • Decreased erectile rigidity, and in some cases impotence
  • Retarded ejaculation
  • Gynecomastia—breast enlargement in men
  • Galactorrhea—abnormal discharge of milk from the nipple

On a positive note, calcium channel blockers may help reduce premature ejaculation.

How They Cause Sexual Problems

CCBs block calcium activity, which causes blood vessels to dilate and lowers blood pressure. The same mechanism that causes this decrease in blood vessel constriction can also decrease the contractions essential for penile rigidity and orgasmic sensation.

Other possible mechanisms by which CCBs may affect sexual activity include:

  • Decreasing dopamine activity, which can lead to an increase in prolactin. Increased prolactin can have the following effects:
    • Reduced sex drive
    • Impotence
    • Galactorrhea
    • Gynecomastia
  • Blocking the actions of excitatory peptides that are involved in genital sensation

CCBs potentiate the effects of alcohol; therefore a few drinks combined with a CCB could possibly decrease sexual desire and function in both sexes.

Few sexual effects from CCBs have been reported in women with normal sexual functioning. However, for women who already have sexual difficulties, side effects of CCBs that indirectly affect sexual function may worsen the problem. For example, headache, flushing, swelling, bloating, dizziness, and weakness can dampen sexual desire and response for many women.

Treatment Options

Wait It Out

As you adjust to your new medication, the sexual side effects may go away.

Change the Drug or Dose

There are many CCBs, and some may be more likely to affect sexual function than others. Among those that less commonly cause erectile problems are:

  • Isradipine
  • Nicardipine
  • Nimodipine
  • Nisoldipine

Ask your doctor if you should try a different CCB. You might also discuss the option of lowering the dosage with your doctor. Never change the dose or stop taking your medication without guidance from your doctor.

Switch Medications

Depending on your condition, there may be other medications that can manage your medical symptoms without affecting sexual function. For example, ACE inhibitors can sometimes be used in place of CCBs. However, the use of ACE inhibitors may require the simultaneous use of a diuretic (water pill). Diuretics also have the potential to cause sexual dysfunction, so this option may not work for everyone.

Try an Antidote

This involves maintaining your current level of CCB while adding a second medication to offset the sexual side effects. This option is generally less desirable since antidotes frequently have their own side effects and may adversely interact with the primary medication you are taking. Drugs that have shown some promise as antidotes are:

  • Bupropion (Wellbutrin)—This is not recommended for people with eating disorders, panic disorders, seizure disorders, or obsessive compulsive disorder. Possible side effects include:
    • Anxiety
    • Delirium
    • Myoclonus (irregular involuntary contraction of a muscle)
    • Uncontrolled hypertension
    • Nausea
    • Headache
    • Dizziness
    • Fatigue
    • Constipation
    • Diarrhea
    • Drowsiness
    • Low blood pressure
  • Sildenafil (Viagra)—Commonly known as a treatment for male impotence, sildenafil may also help women with sexual dysfunction. However, if insurance doesn't cover the cost, the expense may stop people from using it. Also, sildenafil is contraindicated in people who take nitrates.

Consider Herbal Supplements

The efficacy of herbal supplements to treat the sexual side effects of CCBs is not clear. Care should also be taken with herbal products because, unlike medications, they are not strictly regulated. Two herbs commonly used to resolve the sexual dysfunction associated with medications are:

RESOURCES:

American Heart Association
http://www.americanheart.org

National Institutes of Health
http://www.nlm.nih.gov

CANADIAN RESOURCES

Canadian Urological Association
http://www.cua.org/

SexualityandU.ca
http://www.sexualityandu.ca/home_e.aspx/

References:

Crenshaw TL. Sexual Pharmacology: Drugs That Affect Sexual Function. WW Norton & Company; 1996.

Grimm RH Jr, Grandits GA, Prineas RJ, et al. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS) Hypertension. 1997;29(1 Pt 1):8-14.

Yohimbe. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=114. Updated July 2008. Accessed August 14, 2008.



Last reviewed June 2008 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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