Can Losartan Cause Erectile Dysfunction or Reduced Sex Drive?

Losartan (an angiotensin II receptor blocker, or ARB) is generally considered neutral or sometimes even beneficial regarding sexual function compared with older blood pressure medicines like thiazide diuretics and many beta‑blockers. However, erectile dysfunction (ED), reduced libido, and impotence have been reported as possible side effects in drug labeling and consumer‑facing references, so they can occur in some individuals. ^{[1] [2]} ED and loss of sexual desire are listed among adverse effects with “incidence not known” in a widely used clinical reference, indicating they are uncommon and not well quantified. ^[3]

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Quick Summary

• Possible but uncommon: Losartan’s official labeling includes reports of impotence and decreased libido. ^{[1] [2]}
• Compared to other BP drugs: ARBs like losartan tend to be neutral or favorable for erectile function versus diuretics and many beta‑blockers. ^[4]
• Real‑world reports exist: Spontaneous pharmacovigilance reports do include ED with ARBs, but causation is not certain and further study is suggested. ^[5]
• Potential benefit in specific groups: Small clinical data suggest losartan may improve ED in men with diabetes, and laboratory studies show ARB activity may support nitric‑oxide‑mediated penile relaxation. ^{[6] [7]}

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What Official Sources Say

• The consumer and professional labels for losartan (Cozaar) list “impotence” and “decreased libido” among adverse reactions, acknowledging sexual side effects can occur. ^{[1] [2]}
• Comprehensive consumer drug information also includes “loss in sexual ability, desire, drive, or performance” and difficulty having or keeping an erection, with frequency not well established. ^[3]

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Evidence From Clinical Research

Comparative Effects Across Blood Pressure Medications

• Systematic analyses indicate thiazide diuretics and most beta‑blockers (except nebivolol) can worsen erectile function, while ACE inhibitors, ARBs, and calcium‑channel blockers are typically neutral or sometimes positive for sexual function. ^[4]
• Reviews of antihypertensive therapy and sexual dysfunction consistently place ARBs among the more favorable options for patients concerned about ED. ^[8]

Pharmacovigilance Signals

• A review of spontaneous adverse event reports found ED reported with all major antihypertensive classes, including ARBs, and noted that the relatively high reporting for ARBs contrasted with prior clinical trial impressions; the authors suggested more research to clarify this potential risk. ^[5]

Potential Benefits in Diabetes and Mechanistic Insights

• In a clinical study of men with diabetes and ED, losartan improved erectile function scores, and combination therapy with tadalafil was more effective than either alone. ^[6]
• Laboratory work in human corpus cavernosum shows losartan can inhibit angiotensin‑II–mediated contraction and enhance nitric‑oxide–mediated relaxation, supporting a mechanistic rationale for neutral or beneficial effects on erection. ^[7]

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Why Sexual Symptoms Can Happen With Blood Pressure Treatment

• Underlying hypertension itself is strongly linked with ED due to vascular changes and endothelial dysfunction. Treating BP can unmask or change sexual symptoms over time. ^[4]
• Medication class differences: Older agents (thiazides, many beta‑blockers) are more likely to impair erection; ARBs typically are not, but individual responses vary and sexual side effects are still possible. ^[4]
• Comorbidities and lifestyle: Diabetes, smoking, obesity, low testosterone, stress, depression, and sleep issues can all contribute to decreased libido and ED independent of the medication. ^[4]

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Practical Guidance If You Notice Sexual Side Effects

• Do not stop losartan abruptly. Maintaining blood pressure control is crucial for heart, brain, and kidney health. Discuss symptoms with your clinician so you can adjust safely.
• Review other medications: If you take diuretics (like hydrochlorothiazide), beta‑blockers, SSRIs, or finasteride, these may play a larger role than losartan in sexual symptoms; sometimes switching agents within BP therapy can help. ^[4]
• Screen for contributing factors: Diabetes control, lipid profile, testosterone, depression/anxiety, sleep quality (including sleep apnea), and lifestyle habits often need attention. ^[4]
• Evidence‑based treatments: If ED persists, PDE‑5 inhibitors (e.g., sildenafil, tadalafil) are effective and generally safe alongside ARBs; avoid nitrates due to interactions. ^[8]
• Combination approach: For men with diabetes, combining losartan with tadalafil showed greater improvement than either alone in a small study; your clinician can tailor this to your situation. ^[6]

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Bottom Line

• Losartan can occasionally be associated with erectile dysfunction or reduced sex drive, as reflected in official product information, but these effects appear uncommon and not well quantified. ^{[1] [2] [3]}
• Compared to several older blood pressure drugs, ARBs like losartan are generally neutral or sometimes favorable for sexual function, and some data suggest potential benefits in specific groups such as men with diabetes. ^{[4] [6] [7]}
• If you experience changes in sexual function while on losartan, talk with your clinician; there are practical steps and effective treatments that can help without sacrificing blood pressure control. ^[8]