Can Abilify (Aripiprazole) Cause Erectile Dysfunction?
Aripiprazole is actually associated with improvement rather than causation of erectile dysfunction, and it is frequently used to reverse sexual dysfunction caused by other antipsychotics. 1, 2, 3
Understanding Aripiprazole's Unique Sexual Profile
Unlike most antipsychotics that cause erectile dysfunction through D2 receptor blockade and resulting hyperprolactinemia, aripiprazole has partial dopamine agonist properties at D2 and D3 receptors that make it fundamentally different 4, 5. This mechanism explains why it typically does not cause sexual dysfunction and may actually reverse it 4, 3.
FDA-Labeled Sexual Side Effects
The official FDA labeling for aripiprazole lists erectile dysfunction as a rare adverse event (occurring in less than 1% of patients), not a common or frequent side effect 1. This contrasts sharply with other antipsychotics where sexual dysfunction is common 6.
Clinical Evidence for Sexual Function Improvement
Switching or Add-On Strategy
When patients develop erectile dysfunction on other antipsychotics:
- Switching to aripiprazole significantly reduces erectile difficulties by week 12 (p=0.04) and maintains improvement through week 26 3
- Adding aripiprazole to existing antipsychotic regimens reverses sexual dysfunction without compromising therapeutic efficacy 4, 2
- Prolactin levels decrease significantly (p=0.003), accompanied by improved libido (p=0.028) and erectile function 3
Specific Outcomes in Males
- Erectile dysfunction scores on validated questionnaires (NSFQ, ASEX) significantly decrease after aripiprazole initiation 2, 7
- Ejaculatory difficulties also improve significantly (p=0.017) 3
- Benefits appear as early as 8 weeks and continue improving through 24 weeks 2
Important Caveat: Paradoxical Hypersexuality Risk
While aripiprazole improves erectile dysfunction, it carries a rare but serious risk of compulsive sexual behaviors and hypersexuality due to its dopamine agonist properties in mesolimbic pathways 5. This occurs more frequently in young males with previous risk behaviors 5. Patients should be counseled about this potential side effect.
Comparison to Other Medications
Antipsychotics That DO Cause ED
The 2025 European Association of Urology guidelines specifically list antipsychotics as a drug-induced cause of erectile dysfunction 6. This refers primarily to typical antipsychotics and other atypical agents that block D2 receptors and elevate prolactin 6.
Antidepressants vs. Aripiprazole
SSRIs cause decreased libido, orgasmic dysfunction, and erectile problems 8. In contrast, aripiprazole's dopamine partial agonism provides a protective effect against sexual dysfunction 4.
Clinical Recommendation Algorithm
If a patient on aripiprazole reports erectile dysfunction:
First, evaluate other causes listed in EAU guidelines: diabetes, hypertension, metabolic syndrome, cardiovascular disease, other medications (antihypertensives, antidepressants), or psychogenic factors 6
Check if patient is taking concomitant medications that cause ED, particularly SSRIs, beta-blockers, or thiazide diuretics 6, 8
Assess baseline sexual function before aripiprazole was started—the ED may be pre-existing from the underlying psychiatric condition or previous antipsychotic treatment 2, 3
Consider that aripiprazole is unlikely the culprit given its mechanism and clinical evidence showing improvement rather than causation of ED 1, 4, 2, 3, 7
Treat the actual underlying cause identified in steps 1-3, using PDE5 inhibitors if appropriate and not contraindicated 6