Can Strattera and Abilify Cause Increased Spontaneous Erections?
No, neither Strattera (atomoxetine) nor Abilify (aripiprazole) typically cause increased spontaneous erections; in fact, atomoxetine is associated with priapism (prolonged erections) as a rare adverse effect, while both medications are more commonly linked to erectile dysfunction rather than increased spontaneous erections.
Atomoxetine (Strattera) and Erectile Effects
Priapism Risk
- Rare postmarketing cases of priapism have been reported with atomoxetine, defined as painful and nonpainful penile erections lasting more than 4 hours in both pediatric and adult patients 1
- This represents a medical emergency requiring prompt attention, not a therapeutic increase in normal spontaneous erections 1
- The erections resolved following discontinuation of atomoxetine in cases where follow-up information was available 1
More Common Sexual Side Effects
- Atomoxetine is more commonly associated with urinary hesitation (5.6%) and urinary retention (1.7%) in adult ADHD trials, suggesting effects on autonomic function that would not favor increased erections 1
- The medication affects norepinephrine reuptake, which could theoretically impact erectile function through sympathetic nervous system modulation 2
Aripiprazole (Abilify) and Sexual Function
While the provided evidence does not contain specific FDA labeling for aripiprazole, the available guideline evidence addresses sexual dysfunction patterns:
General Antipsychotic Effects
- Antipsychotic agents are listed among medications that can cause pharmacokinetic interactions and are associated with sexual dysfunction 3
- The 2025 European Association of Urology guidelines note that decreased spontaneous/morning erections are a specific symptom of hypogonadism and sexual dysfunction, not an increase 3
Clinical Context: Decreased vs. Increased Erections
Normal Pattern of Sexual Dysfunction
- Decreased spontaneous erections are recognized as a specific symptom of sexual dysfunction and late-onset hypogonadism 3
- Medications affecting sexual function typically cause reduced libido, erectile dysfunction, and decreased spontaneous/morning erections rather than increases 3
- A comprehensive FDA pharmacovigilance database analysis found that neuropsychiatric medications accounted for 40% of erectile dysfunction reports, with these medications causing dysfunction rather than enhancement 4
Mechanism Considerations
- Drugs that cause erectile dysfunction typically work by diverting blood flow from the penis, affecting spinal reflexes, or blocking dopamine/testosterone 5
- Neither atomoxetine's norepinephrine reuptake inhibition nor aripiprazole's dopamine partial agonism would be expected to increase spontaneous erections 2
Important Clinical Caveat
If a patient reports increased spontaneous erections on these medications, consider:
- Priapism (medical emergency) if erections are prolonged >4 hours 1
- Baseline sexual dysfunction that is improving due to treatment of underlying ADHD or psychiatric condition
- Concurrent medications or medical conditions affecting sexual function
- The possibility that this represents a paradoxical or idiosyncratic reaction requiring medication adjustment