Is Wellbutrin (bupropion) effective for treating erectile dysfunction?

Wellbutrin (Bupropion) for Erectile Dysfunction Treatment

Wellbutrin (bupropion) is not recommended as a first-line treatment for erectile dysfunction; phosphodiesterase type 5 inhibitors (PDE5i) are the strongly recommended first-line agents for treating erectile dysfunction. 1

Evidence-Based Treatment Algorithm for Erectile Dysfunction

First-Line Treatment

• PDE5 inhibitors (sildenafil, vardenafil, tadalafil) are the recommended first-line pharmacologic treatment for erectile dysfunction with strong evidence supporting their efficacy 1
• PDE5 inhibitors have demonstrated statistically significant and clinically relevant improvements in sexual intercourse and erectile function in patients with ED, with success rates of 69% compared to 35% with placebo 1
• Treatment should begin with conservative dosing of PDE5 inhibitors and titrated to maximum dose if needed 1

Contraindications to PDE5 Inhibitors

• PDE5 inhibitors are contraindicated in patients taking nitrates due to risk of dangerous hypotension 1
• Cardiovascular risk assessment is essential before prescribing PDE5 inhibitors 1
• Patients unable to walk 1 mile in 20 minutes or climb 2 flights of stairs in 20 seconds without symptoms should be referred to a cardiologist before treatment 1

Role of Bupropion in Sexual Dysfunction

While not first-line for erectile dysfunction specifically:

• Bupropion may be beneficial for antidepressant-induced sexual dysfunction in both men and women 2
• Limited evidence suggests bupropion at higher doses (150mg twice daily) may improve some aspects of sexual function, though results are inconsistent 2
• In diabetic men with erectile dysfunction, bupropion showed a trend toward improved sexual functioning without worsening erectile function 3
• Bupropion does not appear to negatively affect sexual function or nocturnal erections in healthy men 4
• For primary lifelong delayed ejaculation, bupropion showed limited benefit with some improvement in intercourse satisfaction and orgasmic domains 5

Practical Considerations

Treatment Selection Factors

• Choice of specific PDE5 inhibitor should be based on individual patient preferences, ease of use, cost, and adverse effects profile 1
• An adequate trial of PDE5i is defined as at least 5 separate occasions at the maximum dose before considering it ineffective 1
• If one PDE5i fails, a different PDE5i should be tried before moving to second-line therapies 1

Lifestyle Modifications

• All patients with erectile dysfunction should be advised on risk factor modification including smoking cessation, weight loss, increasing physical activity, and avoiding excess alcohol consumption 1
• Treatment of psychosocial problems and referral to sex and couples therapy when appropriate can help alleviate symptoms of ED 1

Second and Third-Line Options

• If PDE5 inhibitors fail, second-line interventions include intraurethral alprostadil suppositories, intracavernous vasoactive drug injection therapy, and vacuum constriction devices 1
• Penile prosthesis implantation is considered a third-line, definitive intervention 1

Common Pitfalls and Caveats

• Hormonal testing is not routinely recommended for all patients with erectile dysfunction; decisions to measure hormone levels should be individualized based on clinical presentation 1
• Testosterone therapy is not indicated for erectile dysfunction in patients with normal serum testosterone levels 1
• Other treatments such as trazodone and yohimbine are not recommended for erectile dysfunction based on insufficient evidence 1
• Bupropion should not be considered a primary treatment for erectile dysfunction but may be considered when erectile dysfunction is associated with antidepressant use or when other options have failed 2, 6