Polypharmacy Linked to Erectile Dysfunction
November 15, 2011 — Erectile dysfunction (ED) rises in likelihood and severity as the number of medications a man takes increases, according to new research. This is true even after accounting for the underlying medical conditions for which these medications are used.
Diana C. Londoño, MD, from the Department of Urology at the Kaiser Permanente Los Angeles Medical Center, California, and colleagues from Kaiser Permanente published their findings online November 15 in the British Journal of Urology International.
According to the researchers, several medications have been linked to ED, including antihypertensives and psychogenic medications, but few studies have examined the role of polypharmacy as an "aggravating component for worsening degrees of ED," they write. The current study, therefore, sought to evaluate whether polypharmacy use increases the severity of ED and whether these effects can be explained by the medical conditions themselves.
Results from a cross-sectional study of questionnaire responses from 37,712 men in the California Men’s Health Study (CMHS), ranging in age from 45 to 69 years, were evaluated. The number of drugs taken was determined from the year before enrollment through electronic pharmacy records and questionnaire responses.
Of the respondents, 10,717 (29%) reported having moderate or severe ED. Among the 37,712 respondents identified, 21,586 (57%) took more than 3 medications in the year before completing the baseline survey.
Regardless of age, an increasing number of medications was linked to an increasing prevalence of ED; in men taking 0 to 2, 3 to 5, 6 to 9, and 10 or more medications, the percentages of men reporting moderate ED were 15.9%, 19.7%, 25.5%, and 30.9%, respectively (P < .001).
With adjustment for age, race, smoking, diabetes, hypertension, hyperlipidemia, peripheral vascular disease, coronary artery disease, and body mass index, men taking more than 10 medications were more likely to have ED (odds ratio, 1.65; 95% confidence interval, 1.52 – 1.80) than those taking fewer than 3 medications.
There was also evidence of a dose-response relationship "that persisted even in subsets of men with specific underlying conditions," the authors note.
The study has several potential limitations, including reliance on self-reported information and the cross-sectional design, which precludes conclusions about causality.
"Despite these potential limitations," write the authors, "these data help emphasize the importance of assessing medication use as part of the evaluation of ED. The presence of ED may signal the use of duplicate or non-essential medications. It may also trigger an assessment of current medications and their potential side effects, and a tailoring of regimens to maximize the treatment effects, while diminishing potential unwanted side effects. Decreases or changes in the amount of or type of medication may significantly improve a man’s health-related quality of life because his ED may improve from moderate to mild."
"The present research shows a new association between polypharmacy and worsening degrees of erectile function, even when individual medical conditions and other risk factors have been accounted for," Dr. Londoño and colleagues conclude.
"[P]olypharmacy itself should be part of the differential diagnosis in the evaluation of ED when other causes have been accounted for and investigated by the treating physician," they suggest.
"This study highlights that while physicians still need to treat patients with medications when indicated, they should be aware that erectile dysfunction may occur," noted Michael Kanter, MD, regional medical director of Quality & Clinical Analysis for the Southern California Permanente Medical Group in a written release.
"These men would benefit from lifestyle changes such as changes in their diet, regular exercise, and not smoking, which would help control their hypertension, diabetes, and stress and reduce erectile dysfunction risk," Dr. Kanter said. "Physicians can use this as an opportunity to talk with their patients about risks of erectile dysfunction and the underlying health conditions causing their need for multiple medications."
The authors have disclosed no relevant financial relationships.
BJU Int. Published online November 15, 2011.
