Can Spironolactone Cause Erectile Dysfunction?

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Key takeaways

• Spironolactone can cause erectile dysfunction by affecting testosterone and other hormones.
• Never stop spironolactone without medical advice, as it treats important conditions like heart failure.
• PDE5 inhibitors such as sildenafil and tadalafil can usually be used safely with spironolactone.
• Your doctor may reduce your dose, switch medicines, or treat the erectile dysfunction directly.
• Always discuss all your current medicines during your consultation to ensure safe treatment.

Does Spironolactone Cause Erectile Dysfunction?

Yes, spironolactone can cause erectile dysfunction, and it is one of the more commonly reported sexual side effects of this medicine [1][2]. Spironolactone works by blocking the action of a hormone called aldosterone, but it also affects other hormones, including testosterone and oestrogen. This hormonal effect can reduce sex drive (libido) and make it harder to get or keep an erection firm enough for sex.

The medicine can also cause gynaecomastia (breast tissue enlargement in men), which is another sign of its hormonal effects. Studies suggest that erectile dysfunction and reduced libido occur in a significant proportion of men taking spironolactone, particularly at higher doses or with longer-term use. The exact risk varies from person to person, but it is important to know that this side effect is recognised by doctors and pharmacists, and you are not alone if you experience it.

If you have noticed changes in your erections or sex drive since starting spironolactone, it is worth discussing with your prescriber. However, never stop taking spironolactone suddenly without medical advice, as it is usually prescribed for important conditions such as heart failure or high blood pressure, and stopping abruptly could be harmful.

How Does Spironolactone Affect Erections?

Spironolactone affects erections through several mechanisms, primarily by interfering with male sex hormones. It has anti-androgen properties, meaning it can block the effects of testosterone, the hormone that plays a key role in sexual desire and erectile function. Lower testosterone activity can lead to reduced libido and difficulty achieving erections.

Additionally, spironolactone can increase the levels of oestrogen (a female sex hormone) in men, which may further contribute to sexual side effects and breast tissue changes. These hormonal shifts can disrupt the delicate balance needed for normal sexual function. The medicine may also affect the blood vessels and smooth muscle tissue in the penis, although the hormonal effects are thought to be the main cause of erectile dysfunction.

The severity of these effects often depends on the dose you are taking. Men on higher doses (100 mg or more per day) are more likely to experience sexual side effects than those on lower doses. The duration of treatment also matters—some men notice changes after a few weeks, while others may not experience problems until they have been on the medicine for several months.

Why Is Spironolactone Prescribed?

Spironolactone is prescribed to treat several important medical conditions, including high blood pressure (hypertension), heart failure, and fluid retention (oedema). It is also used in some cases of primary aldosteronism, a condition where the adrenal glands produce too much aldosterone. Because it helps the body get rid of excess fluid while retaining potassium, it is a valuable medicine for people with heart or kidney problems. Your doctor has prescribed it because the benefits for your overall health are considered to outweigh the potential side effects, but that does not mean you have to live with erectile dysfunction if it occurs.

At a glance

How Common Is Spironolactone Erectile Dysfunction?

Erectile dysfunction is a relatively common side effect of spironolactone, though the exact frequency varies between studies and depends on the dose and duration of treatment. Clinical reports suggest that sexual side effects, including reduced libido and erectile dysfunction, may affect a noticeable proportion of men taking the medicine, particularly those on higher doses or long-term therapy.

Gynaecomastia (breast enlargement) is reported in up to 10% of men taking spironolactone, and sexual side effects often occur alongside this. However, not every man will experience erectile dysfunction, and some may notice only mild changes in sexual function. Individual factors such as age, overall health, other medicines, and underlying conditions (like diabetes or heart disease) can all influence whether you develop erectile problems while taking spironolactone.

If you are experiencing erectile dysfunction and you take spironolactone, it is important to discuss it with your doctor. They can assess whether the medicine is the likely cause and explore alternative treatments or adjustments to your dose. Remember, erectile dysfunction can also be caused by the conditions spironolactone is treating (such as heart disease), so a full review is important.

What Should You Do If Spironolactone Causes Erectile Dysfunction?

If you think spironolactone is affecting your erections, the most important step is to speak to your doctor or prescriber. Do not stop taking spironolactone on your own, as it is usually prescribed for serious conditions, and stopping suddenly could lead to a dangerous rise in blood pressure, worsening heart failure, or fluid retention. Your prescriber needs to review your treatment and decide on the safest course of action.

Your doctor may consider several options, depending on your individual circumstances. They might reduce your dose of spironolactone to see if a lower amount still controls your condition while causing fewer sexual side effects. Alternatively, they may switch you to a different medicine that treats your condition without the same hormonal effects—for example, other diuretics or blood pressure medicines that are less likely to cause erectile dysfunction.

Another option is to continue spironolactone (if it is the best medicine for your condition) and treat the erectile dysfunction directly with a PDE5 inhibitor such as sildenafil or tadalafil. Many men find this approach effective, and these medicines can usually be used safely alongside spironolactone, though your prescriber will need to check your full medical history and current medicines to ensure it is appropriate for you.

Never Stop Prescribed Medicines Without Advice

It is crucial to understand that spironolactone is prescribed for important medical reasons, and stopping it without guidance can have serious consequences. If you are taking it for heart failure, stopping suddenly could lead to fluid build-up in your lungs or legs, shortness of breath, and worsening heart function. If it is for high blood pressure, your blood pressure could rise to dangerous levels, increasing your risk of stroke or heart attack. Always speak to your doctor or pharmacist before making any changes to your prescribed medicines, even if you are experiencing side effects.

Can You Take Erectile Dysfunction Tablets with Spironolactone?

Yes, in most cases, erectile dysfunction tablets such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra) can be used safely alongside spironolactone [3][4][5][6]. These medicines are called PDE5 inhibitors, and they work by increasing blood flow to the penis during sexual stimulation, helping you achieve and maintain an erection. They do not interact directly with spironolactone in a way that makes them unsafe.

However, because spironolactone is often prescribed for heart or blood pressure conditions, your prescriber will need to check that your cardiovascular health is stable enough for sexual activity and that you are not taking any other medicines that could interact with PDE5 inhibitors. For example, if you take nitrates (such as GTN spray or isosorbide mononitrate) for angina, you must not use PDE5 inhibitors, as the combination can cause a dangerous drop in blood pressure.

If you are on other blood pressure medicines alongside spironolactone, your prescriber will assess whether the additional blood-pressure-lowering effect of a PDE5 inhibitor is safe for you. In most cases, it is, but you should always declare all your current medicines during your consultation. At Cured Pharmacy, our UK prescribers review your full medical history and current medicines before approving any erectile dysfunction treatment, ensuring it is safe and appropriate for you.

Treatment Options for Spironolactone Erectile Dysfunction

If you are experiencing erectile dysfunction while taking spironolactone, several treatment options are available, and the right one for you will depend on your overall health, the severity of your symptoms, and your preferences. The first step is always a conversation with your doctor or prescriber, who can review your medicines and suggest adjustments or alternatives.

PDE5 inhibitors are the most commonly used and effective treatments for erectile dysfunction, and they can help many men who experience erection problems due to spironolactone. Sildenafil (Viagra) is taken about an hour before sex and lasts for around four to six hours. Tadalafil (Cialis) can be taken on-demand (at least 30 minutes before sex, with effects lasting up to 36 hours) or as a low daily dose for continuous readiness. Vardenafil (Levitra) and avanafil (Spedra) are also effective options, with avanafil working particularly quickly (in as little as 15 to 30 minutes) [3][4][5][6].

If PDE5 inhibitors are not suitable or effective for you, other treatments such as vacuum erection devices, alprostadil (a prescription medicine applied as a cream or injection), or psychological support may be considered. Your prescriber can discuss these options with you. At Cured Pharmacy, we offer a confidential online consultation service, where a UK prescriber reviews your health and current medicines to recommend the most suitable erectile dysfunction treatment for you.

How Cured Pharmacy Can Help

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering discreet, convenient access to erectile dysfunction treatments after a clinical consultation with a UK prescriber. We stock a range of PDE5 inhibitors, including sildenafil from £0.45 per tablet (£0.36 with code Ednew on your first order) and tadalafil from £7.95 (£6.36 with code Ednew). Our prescribers review your medical history and current medicines, including spironolactone, to ensure any treatment is safe and appropriate for you. Your medicines are delivered discreetly to your door, and our pharmacist-led team is available to answer any questions you may have.

When to get urgent help

• Erection lasting more than 4 hours (priapism) — go to A&E immediately
• Sudden loss of vision or hearing after taking erectile dysfunction medicine — seek urgent medical help
• Chest pain during or after sex — stop activity and call 999 if severe or not relieved by your usual angina medicine
• Severe dizziness, fainting, or very low blood pressure after taking erectile dysfunction tablets — seek same-day medical advice
• Sudden shortness of breath, chest pain, or swelling in your legs (possible signs of worsening heart failure) — contact your doctor urgently or call 999

Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.