Can losartan (angiotensin II receptor antagonist) cause sexual dysfunction?

Losartan and Sexual Dysfunction

Losartan is less likely to cause sexual dysfunction compared to other antihypertensive medications and may actually improve sexual function in some patients. 1

Antihypertensive Medications and Sexual Dysfunction

Risk Hierarchy of Antihypertensives for Sexual Dysfunction

Antihypertensive medications have varying effects on sexual function, with the following hierarchy from highest to lowest risk 1:

1. Thiazide diuretics
2. Beta-blockers (especially non-selective ones)
3. Centrally acting alpha-agonists
4. ACE inhibitors and ARBs (lowest risk)
5. Calcium channel blockers (lowest risk)

Evidence for Losartan and Sexual Function

Losartan, as an angiotensin II receptor blocker (ARB), has been associated with:

• Preservation or improvement of sexual function in hypertensive patients 2
• Improved sexual satisfaction from 7.3% to 58.5% in hypertensive men with sexual dysfunction after 12 weeks of treatment 3
• Increased frequency of sexual activity in previously affected patients 3
• No significant negative effects on sexual function in animal studies, unlike beta-blockers which showed decreased libido and erectile function 4

Clinical Implications

When to Consider Losartan for Hypertensive Patients with Sexual Concerns

• For patients experiencing sexual dysfunction with other antihypertensive medications, particularly thiazide diuretics or beta-blockers 1
• For patients at high risk of developing sexual dysfunction who require antihypertensive therapy 5
• For women with hypertension, as ARBs including losartan have been associated with higher odds of sexual activity compared to other antihypertensive classes 6

Mechanism of Benefit

The favorable effects of losartan on sexual function may be related to:

• Blocking angiotensin II, which has been recognized as a mediator of detumescence and possibly erectile dysfunction 2
• Improved vascular function and endothelial health 1
• Lack of negative effects on sympathetic nervous system function compared to beta-blockers 4

Important Considerations

• Sexual dysfunction in hypertensive patients may be multifactorial, with hypertension itself being a risk factor independent of medication 1
• Erectile dysfunction may be an early marker of vascular disease rather than solely a medication side effect 1
• The steroidal mineralocorticoid receptor antagonist spironolactone has been specifically associated with sexual dysfunction, unlike losartan 7
• If sexual dysfunction occurs with losartan, consider:
  • Evaluating for other causes (diabetes, obesity, smoking)
  • Phosphodiesterase-5 inhibitors, which can be safely co-administered with losartan 1

Conclusion

When treating hypertension in patients concerned about sexual function, losartan represents a favorable option with potential benefits for sexual function compared to other antihypertensive classes, particularly thiazide diuretics and beta-blockers.