Based on NIH | Can Losartan cause erectile dysfunction, and how common is this side effect?

Losartan and Erectile Dysfunction: What We Know

Losartan (an angiotensin II receptor blocker, ARB) can be associated with erectile dysfunction (ED), but this appears to be uncommon and, in many studies, ARBs are considered neutral or even potentially beneficial for sexual function compared with several older blood pressure drugs. Official product information lists “impotence/erectile dysfunction” as a possible adverse effect, yet large reviews suggest ARBs overall tend to have little to no negative impact on erections compared with diuretics and many beta‑blockers. ^{[1] [2] [3] [4]}

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What official labeling says

• The FDA‑approved labeling for brand losartan (Cozaar) includes “impotence” in the urogenital adverse reactions section. This means ED has been reported in people taking losartan, though the frequency is not specified. ^[1]
• Consumer-facing labeling for losartan similarly lists “impotence” as a reported adverse event. Again, the label does not quantify how often it occurs, indicating that it is not a clearly frequent event in trials. ^[2]
• Combination products that include losartan with hydrochlorothiazide (HCTZ) also list erectile dysfunction/impotence among post‑marketing adverse reactions. This is important because HCTZ (a thiazide diuretic) is independently linked to ED, which can confound attribution when used together. ^[5]

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How common is ED with losartan?

• Product labels mention ED but do not provide a specific incidence, suggesting it was not common enough to be quantified in controlled trials. In many labels, ED is listed without a frequency (“incidence not known”), which typically implies rare or infrequent reporting. ^{[1] [2]}
• Broad reviews of antihypertensive drugs indicate that thiazide diuretics and many beta blockers are the most likely to worsen erectile function. By contrast, ARBs, including losartan, generally show neutral or sometimes favorable effects on sexual function compared with these older classes. ^{[3] [4]}
• Observational pharmacovigilance has captured ED reports with virtually all antihypertensive classes, including ARBs. However, spontaneous reports cannot determine true rates and are influenced by reporting bias; controlled data still suggest ARBs are among the more “sexual‑function friendly” options. ^[6]

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Why ED can still occur

• ED has many contributors: vascular disease, diabetes, high blood pressure itself, stress/anxiety, depression, sleep problems, alcohol, smoking, and other medications. Even with drugs that are typically neutral, individual reactions vary, and some people may notice ED temporally related to starting or changing therapy. ^{[3] [4]}
• When losartan is combined with a diuretic like hydrochlorothiazide, the diuretic component may be the main driver of ED risk rather than losartan itself. ^{[5] [3]}

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Practical guidance if you notice ED after starting losartan

• Do not stop your blood pressure medicine abruptly. Poorly controlled blood pressure can itself worsen erectile function and overall cardiovascular risk. ^[3]
• Discuss timing and dose changes with your clinician. Sometimes adjusting the regimen, switching away from a diuretic component, or considering another ARB or ACE inhibitor can help while keeping blood pressure controlled. ^{[3] [4]}
• If ED persists despite optimizing your antihypertensive plan, medications for ED such as PDE‑5 inhibitors (e.g., sildenafil) are usually effective and generally safe alongside ARBs; they should not be combined with nitrates. ^[4]

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Bottom line

• ED is listed in losartan’s official safety information, so it can occur. However, available evidence suggests ARBs like losartan are less likely to cause ED than diuretics and many beta blockers, and overall the risk appears low and not well‑quantified. ^{[1] [2] [3] [4]}
• If ED develops after starting losartan especially if you’re also on a diuretic talk with your clinician about alternative regimens and other treatments. Most people can maintain good blood pressure control and sexual function with a tailored plan. ^{[5] [4]}