Although the attention of subjects suffering from erectile deficit is mainly focused on the choice of specific medicines that can improve their performance, one should not forget that there are also drugs that can cause or aggravate this disorder. It is important to emphasize that erectile dysfunction does not represent the automatic consequence of taking these drugs, but a side effect that occurs in a generally minority percentage of patient users.

Here are some classes of drugs that cause problems with sexual function:

• antihypertensive drugs: diuretics (thiazides, spironolactone), centrally acting (methyldopa, clonidine, reserpine), a-blockers (prazosin, terazosin), ß-blockers (propanolol, metoprolol, atenolol).
• medications for the treatment of dyslipidaemias (hypertriglyceremia, hypercholesterolaemia): gemfibrozil, clofibrate
• heart failure medications: digoxin, chlortalidone, amiodarone, disopyramide
• neurological and psychiatric drugs: benzodiazepines, amitriptyline, clomipramine, imipramine, desipramine, tiotixene, lithium salts, tranylcypromine, isocarboxazide, phenelzine, haloperidol, chlorpromazine, flufenazine, pimozide, primidone, carbamurepepine,
• urological and endocrinological drugs: cyproterone acetate, flutamide, finasteride, analogues of GnRh, cortisone.
• gastroenterological drugs: cimetidine, ranitidine, metoclopramide, famotidine, nizatidine, propantheline bromide
• recreationally used substances (drugs of various kinds): cocaine, marijuana, amphetamines, codeine, methadone, heroin, meperidine, LSD, hashish

If an iatrogenic origin of erectile dysfunction is suspected, it is important not to spontaneously discontinue drug therapy; rather it is necessary to talk to the doctor, who may eventually prescribe alternative therapy.

Beyond the drugs and drugs that can cause or otherwise promote erectile dysfunction, we remember that alcohol abuse and cigarette smoking can also aggravate the disorder. Alcohol, for example, causes a drop in libido, premature ejaculation, testicular hypotrophy, increased prolactin and gynecomastia.

These substances can alter both the function of the hypothalamic-pituitary system and testicular steroidogenesis, or act by antagonizing the peripheral action of androgens. If an iatrogenic origin of erectile dysfunction is suspected, it is important not to spontaneously discontinue drug therapy; rather it is necessary to talk to the doctor, who may eventually prescribe alternative therapy.

Beyond the drugs and drugs that can cause or otherwise promote erectile dysfunction, we remind you that alcohol abuse and cigarette smoking can also aggravate the disorder. Alcoholism, for example, causes a drop in libido, premature ejaculation, testicular hypotrophy, increased prolactin and gynecomastia.

Cigarette smoking is a documented risk factor for erectile dysfunction as it results in peripheral vasculopathy, reduces penile blood pressure and inhibits neurogenic vasodilation. Nicotine reduces blood flow and induces vasoconstriction of the corpora cavernosa even in the absence of systemic vascular anomalies.