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Key takeaways
Lisinopril, an ACE inhibitor, is not likely to cause erectile dysfunction like other types of blood pressure drugs.
If a patient using lisinopril is experiencing ED, the culprit is usually an underlying condition such as high blood pressure, heart disease, or Type 2 diabetes, not the drug itself.
If you are taking lisinopril and experiencing ED, talk to your healthcare provider about other possible causes of sexual dysfunction.
Lisinopril is a high blood pressure medication prescribed on its own to treat hypertension in adults and children older than 6, and alongside other medications as a treatment for heart failure. It is also used after a heart attack to improve outcomes. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that is not known to cause erectile dysfunction (ED) and may, in fact, help improve erectile function in some people.
Can lisinopril cause erectile dysfunction?
In short, no, lisinopril (brand name Zestril) does not usually cause ED, a common men’s health issue. While other classes of antihypertensive therapy, such as beta blockers, may cause sexual performance problems, ACE inhibitors like lisinopril usually do not.
“Unlike older blood pressure medications (like certain beta blockers or thiazide diuretics), ACE inhibitors like lisinopril are generally considered neutral or even mildly beneficial for erectile function,” explains Justin Houman, MD, a board-certified urologist and fellowship-trained men’s sexual and reproductive health specialist. “That said, individual responses vary, and some patients report ED after starting it—but causation is not well established.” Sometimes two events occur together, but one does not cause the other.
Common side effects of lisinopril include a dry cough, dizziness, headache, and fatigue. “It is not a common cause of sexual dysfunction occurring in less than 1% of its users and is considered a better option for sexual health compared to other medications used for hypertension,” says George Ellis, MD, a urologic surgeon based in Orlando, Florida. In fact, “some patients may see improvement in overall vascular health, which can alleviate ED caused by high blood pressure,” adds Dr. Ellis.
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What the research says
A study published in The Journal of Clinical Hypertension found that lisinopril had no significant effect on sexual function in comparison to other ACE inhibitors. Another study in the same journal found that while some patients using lisinopril experienced an initial brief decline in sexual performance, they resumed their usual sexual activity while continuing treatment, while users of other blood pressure drugs, such as atenolol, did not. “Rarely, men may experience new ED, which often resolves within a month of starting treatment,” notes Dr. Ellis.
The ACE inhibitor effect
Dr. Houman explains that ACE inhibitors work by blocking the conversion of angiotensin I to angiotensin II, which is a vasoconstrictor. This leads to widening of the blood vessels (vasodilation) and reduced aldosterone levels, which translate into less sodium and less water retention. With lower blood pressure and reduced vascular resistance, ED should actually improve. “From a sexual health standpoint, improved vascular relaxation should theoretically support erections, not impair them,” Dr. Houman concludes.
Other ACE inhibitors include enalapril, benazepril, ramipril, and captopril.
Why correlation isn’t causation
“If a patient develops ED while on lisinopril, the medication is rarely the primary driver; it’s usually the underlying vascular disease,” Dr. Houman says.
It’s more likely that an underlying medical condition, such as uncontrolled hypertension, worsening heart disease, or Type 2 diabetes (commonly associated with high blood pressure), is causing ED.”All three conditions damage blood vessels (the endothelium) and impair blood flow, leading to erectile dysfunction,” Dr. Ellis says.
“Erections are fundamentally vascular events,” Dr. Houman says. “Anything that damages blood vessels negatively affects erections.” Hypertension damages the lining of major arteries, which reduces penile blood flow. Atherosclerosis (cardiovascular disease) causes plaque buildup, which also impairs inflow. Type 2 diabetes leads to microvascular damage and neuropathy, which causes impaired signaling and blood flow. The result is a reduced ability to achieve an erection. “ACE inhibitors do not significantly increase rates of ED. Compared to other antihypertensives, ACE inhibitors are among the least likely to impair sexual function.” In fact, they may help ED by improving the underlying condition causing it.
Other potential causes of ED in lisinopril users
People taking lisinopril may have other health conditions or lifestyle habits that could cause ED, such as:
- Underlying vascular disease (most common)
- Low testosterone
- Insulin resistance/metabolic syndrome
- Obesity
- Sedentary lifestyle
- Sleep apnea
- Psychological factors (stress, anxiety, performance pressure)
- Other medications (SSRIs, antidepressants, beta blockers, finasteride, etc.)
- Smoking or alcohol overuse
“So when a patient says ‘this started after lisinopril,’ I dig deeper, because that’s often when their cardiometabolic disease is progressing, not because of the drug,” Dr. Houman shares.
“ED is sometimes seen as an early warning sign of [hypertension, heart disease, and Type 2 diabetes], and it should prompt consideration of undiagnosed heart disease if physical examination and preliminary lab tests have not found evidence of diabetes or hypertension,” Dr. Ellis explains.
What to do if you are experiencing ED while on lisinopril
If you experience sexual issues after starting lisinopril, it’s important to keep taking the medication until you seek medical advice from your healthcare team. “It’s protecting your heart, kidneys, and long-term health,” Dr. Houman says. Your provider may run tests such as testosterone levels, HbA1c/fasting glucose, and a lipid panel to figure out why you are experiencing ED. A coronary calcium score may also be ordered. This is a test that shows the amount of atherosclerosis (or plaque) in the blood vessels feeding the heart muscle. If there is a lot of plaque around the heart, there is probably plaque affecting the blood vessels of the penis.
- Lifestyle changes can also help to improve sexual function, such as:
- Losing weight
- Incorporating resistance training and cardiovascular exercise into your fitness routine
- Getting enough quality sleep
- Reducing alcohol intake
After ruling out other causes, if ED persists, your healthcare provider might try switching you to another antihypertensive medication or adding an ED medication like Viagra (sildenafil) or Cialis (tadalafil) to your treatment plan.
The bottom line
Lisinopril is not known to cause erectile dysfunction and may, in fact, improve sexual performance for those taking the medication. If ED occurs, it is very rarely the result of lisinopril and is more likely to be caused by a medical condition, possibly even the condition lisinopril was prescribed to treat.
If you are taking lisinopril and experiencing sexual performance issues, speak with your healthcare provider before stopping lisinopril. They will be able to work with you to find the underlying cause of ED, which is not likely to be this particular medication.
“Lisinopril is not the villain in most cases,” concludes Dr. Houman.”If ED develops, think of it as a signal, not a side effect, pointing toward underlying vascular or metabolic dysfunction.”
- Lisinopril, MedlinePlus (2021)
- The effect of antihypertensive drugs on erectile function: A proposed management algorithm, The Journal of Clinical Hypertension (2007)
- Sexual function in hypertensive males treated with lisinopril or atenolol: A cross-over study, The Journal of Clinical Hypertension (1998)