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    When Good Drugs Lead to Bad Sex

    Lost That Lovin' Feeling? It Could Be Your Medicine.

    Lowering pressure continued...

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    Physicians do have a good idea of how some of the blood pressure-lowering drugs affect some sexual functioning. Beta-blockers, for instance, can reduce stimulation to the erection center.

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    Studies have yielded mixed results about which antihypertensive drugs to avoid if you want to keep some romance in your life. Several have shown, for instance that diuretics and beta-blockers are associated with more sexual side effects, according to Rudd.

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    Despite that, he says, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure continues to recommend those drugs first.

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    "Those two drugs classes have been shown to reduce heart attack, stroke, and other major end points of high blood pressure," Rudd adds. But it can be a tradeoff.

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    For instance, he says, ACE inhibitors, shown in some studies to be less likely to cause sexual problems, are also more expensive.

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    Not all of the studies paint a bleak picture of the old standby drugs, however. For instance, a study published in the same issue of American Journal of Medicine that carried Rudd's editorial found no difference in sexual function between 312 men and women randomly placed on either the beta-blocker Inderal or an inactive placebo drug.

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    It's difficult to predict who will and won't notice an effect on sexual functioning after beginning blood pressure-lowering drugs, Rudd says. But one study published in the May 1999 issue of Pharmacotherapy found that nearly every first-line antihypertensive treatment (which includes diuretics and beta-blockers) has been reported to cause some degree of erectile dysfunction. But sexual problems can also increase with age and as other diseases set in, so it's even more difficult to pinpoint exactly what percent of problems can be blamed on the drugs.

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    A physician should mention the possibility of side effects when prescribing a blood pressure-lowering drug, Rudd says, but encourage a patient to try it before dismissing it because of potential effects. "The only way to be sure," he tells patients, "is to take a trial of it."

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    If sex life is affected, doctors can consider many options: reduce the dose, switch to another drug, or suggest lifestyle modifications such as exercise, which could help lower blood pressure and reduce the need for medication.

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