Can losartan cause sexual side effects?

Losartan and Sexual Side Effects

Losartan is unlikely to cause sexual side effects and may actually improve sexual function in some hypertensive patients compared to other antihypertensive medications. 1

Evidence on Losartan and Sexual Function

• Unlike some antihypertensive medications such as thiazide diuretics at high doses and beta-blockers, angiotensin receptor blockers (ARBs) like losartan have not been observed to increase the incidence of erectile dysfunction 2
• In a prospective interventional study of hypertensive men with sexual dysfunction, a 12-week regimen of losartan therapy (50-100 mg/day) improved sexual satisfaction from 7.3% to 58.5%, and increased the frequency of sexual activity 1
• Losartan may have an advantage in preservation of sexual function compared to other antihypertensive medications like propranolol (a beta-blocker) 3

Comparison with Other Antihypertensive Classes

• The Treatment of Mild Hypertension Study (TOMHS) found that participants randomized to chlorthalidone (a thiazide diuretic) reported a significantly higher incidence of erection problems at 24 months compared to placebo, though this difference became non-significant by 48 months 2
• In the VA Cooperative trial, no significant difference in the incidence of sexual dysfunction was noted between calcium channel blockers (CCBs), ACE inhibitors, hydrochlorothiazide, or beta-blockers compared with placebo 2
• Centrally acting alpha-agonists have been associated with erectile dysfunction, while ACE inhibitors, ARBs, and CCBs have not been observed to increase its incidence 2
• In a double-blind, randomized study comparing nebivolol (a beta-blocker) and losartan, there was no difference in sexual function between the two treatments 4

Sex-Specific Considerations

• There are no definitive data on a relation between sexual dysfunction and hypertension in women 2
• Most studies on sexual side effects of antihypertensive medications have focused on men, with limited data available for women 2

Management Recommendations

• If erectile dysfunction appears after institution of antihypertensive drug therapy, the offending agent should be discontinued and treatment restarted with another agent, such as an ARB like losartan 2
• Lifestyle modifications (physical activity, weight management, smoking cessation) should be encouraged as they can reduce the risk of erectile dysfunction 2
• Losartan can be administered at doses of 50-100 mg/day, either as a once-daily dose or by splitting the same total daily dose into two doses 5

Clinical Pearls and Caveats

• Losartan is generally well tolerated with dizziness being reported as the only common drug-related adverse effect 6
• The overall rate of patient withdrawal from therapy due to adverse experiences with losartan is lower (2.3%) than that of placebo (3.7%) 6
• Losartan does not require dosage adjustment for mild hepatic impairment or various degrees of renal insufficiency 5
• Losartan should be avoided in pregnancy, especially in the second and third trimesters, as it is associated with serious fetal toxicity 5