Does lisinopril cause erectile dysfunction?

Lisinopril does not usually cause lasting erectile dysfunction. It is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure (hypertension) and as add-on therapy in heart failure (lisinopril label). A 16-week double-blind crossover trial in 90 men aged 40-49 found that sexual activity fell in the first month on lisinopril 20 mg, then returned toward the pretreatment rate, while atenolol 100 mg kept it lower (Fogari 1998). Erectile dysfunction is more common in men with high blood pressure, whether or not they take lisinopril.

Lisinopril at a glance

Lisinopril blocks ACE, the enzyme that converts angiotensin I to the vasoconstrictor angiotensin II. That drop in angiotensin II lowers vasopressor activity and is the main way the drug reduces blood pressure (lisinopril label). In men with hypertension, the blood-pressure drop comes with lower peripheral arterial resistance and little change in heart rate or cardiac output.

The link between hypertension and erectile dysfunction

Erectile dysfunction is more common in men with essential hypertension than in men with normal blood pressure (Doumas 2006). The AUA guideline also treats ED as a risk marker for underlying cardiovascular disease that may need evaluation (AUA 2018). Blood-pressure treatment is for that cardiovascular risk. Other medicines can affect erections as well (Adderall and erectile dysfunction).

Lisinopril and erectile dysfunction: what the evidence says

The label lists impotence in 1% of men on lisinopril (1,349 men in hypertension trials) versus 0% on placebo (207 men), and decreased libido in 0.4% versus 0% (lisinopril label).

In Fogari's crossover trial, 3% of men on lisinopril reported sexual-dysfunction symptoms versus 17% on atenolol. Intercourse frequency recovered on lisinopril (7.7 episodes per month, not different from the placebo run-in) and stayed down on atenolol (4.2) (Fogari 1998).

An 18-year ALLHAT-Medicare follow-up of 7,444 men found no statistically significant difference in erectile-dysfunction claims among chlorthalidone, amlodipine, and lisinopril (ALLHAT-Medicare 2023).

A 2006 review concluded that ACE inhibitors appear to have a neutral effect on erectile function in men with hypertension, while older drugs (some beta blockers and diuretics) are more often implicated. The same review said the ACE-inhibitor studies are limited in size and quality, and some men still report symptoms (Doumas 2006).

Addressing erectile dysfunction

If you have ED while taking lisinopril, talk with the clinician who manages your blood pressure. They can look at other causes, including the hypertension itself, other drugs, and cardiovascular disease, and decide whether a dose change or a different antihypertensive is warranted. Do not stop lisinopril on your own.

For men with ED and other conditions that hurt erectile function, the AUA recommends counseling on lifestyle changes, including diet and more physical activity, which improve overall health and may improve erections (AUA 2018).

FDA-approved oral phosphodiesterase type 5 (PDE5) inhibitors are a first-line option unless they are contraindicated (Strong Recommendation, Evidence Level Grade B) (AUA 2018). Sildenafil (Viagra) and tadalafil (Cialis) are two of those drugs. They are contraindicated with nitrates and with guanylate cyclase stimulators such as riociguat (VIAGRA label). Alpha blockers need extra caution because of added blood-pressure lowering. A 2006 review found PDE5 inhibitors can be used in men on antihypertensive therapy, with that same alpha-blocker caution (Doumas 2006).

Bottom line

Lisinopril is not a common cause of lasting ED. The best lisinopril-specific trial showed a temporary dip that recovered, and long-term ALLHAT follow-up did not find a higher ED rate than with chlorthalidone or amlodipine. ED is more common in men with hypertension. If erections change after you start lisinopril, tell the clinician who prescribed it rather than stopping the drug on your own.