Medications That Can Cause ED: Metoprolol, Finasteride, HCTZ, SSRIs

The NIDDK says it plainly: "Do not stop taking any medicines on your own. Talk with your health care professional first." (NIDDK: ED treatment, read 14 November 2026). A prescriber may change the dose, switch you to a related drug, or add an ED pill. Stopping a heart or blood pressure drug suddenly can be dangerous.

Drugs most likely to cause ED

No official list ranks drugs by how often they cause ED. Labels only report what was seen in each drug's own trials and later reports, so the numbers cannot be lined up against each other. What the NIDDK gives is a list of drug groups that can cause it (NIDDK: ED causes):

• antidepressants
• appetite suppressants, "or medicines that make you less hungry"
• antihistamines, "or medicines for allergies or heartburn"
• "blood pressure medicines and diuretics, or water pills"
• "chemotherapy and hormone medicines"
• some pain relievers, including anti-inflammatory drugs, codeine and oxycodone
• sedatives, "or medicines that make you calm or sleepy"
• ulcer medicines

The table below sums up what each label says for the drugs people ask about most. All labels were read on DailyMed on 14 November 2026.

Placebo means a dummy pill. A drug's rate only means something next to its placebo rate.

Can metoprolol cause ED?

Yes, it can. MedlinePlus says "Metoprolol is in a class of medications called beta blockers" (MedlinePlus: metoprolol, read 14 November 2026). A beta blocker slows the heart and lowers blood pressure. The Toprol-XL label says: "Based on the published literature, beta-blockers (including metoprolol) may cause erectile dysfunction and inhibit sperm motility." (DailyMed: Toprol-XL label). Its list of side effects also includes "decreased libido, male impotence". Libido means sex drive. Sperm motility means how well sperm swim.

The Lopressor label, which is metoprolol tartrate, carries the same line (DailyMed: Lopressor label). Many men on metoprolol also take an ED pill. The Cialis label tested tadalafil with metoprolol and found only small extra drops in blood pressure. Our ED and blood pressure guide covers the combination.

Can hydrochlorothiazide cause ED?

Yes, per its label. Hydrochlorothiazide, often shortened to HCTZ, is a water pill: it makes you pee out extra salt and fluid to lower blood pressure. Its label lists "Urogenital Impotence" among the side effects (DailyMed: hydrochlorothiazide label). Urogenital means the urinary and sex organs.

The label does not give a rate. Combination tablets, such as losartan with hydrochlorothiazide, contain the same drug.

Does metformin cause ED?

Not on its label. The metformin label we read lists common side effects such as "diarrhea, nausea/vomiting, flatulence, asthenia, indigestion, abdominal discomfort, and headache", and no erection problem (DailyMed: metformin label). Asthenia means weakness.

The link people notice is usually the diabetes itself. The NIDDK names diabetes first among "the most common diseases and conditions that can lead to ED" (NIDDK: ED causes). High blood sugar over years can damage the nerves and blood vessels an erection needs. So a man starting metformin may notice ED, but the label does not point to the drug.

Does finasteride cause ED?

It can, in a small share of men. Finasteride blocks DHT, the hormone behind male pattern hair loss and prostate growth. In the hair loss trials, the Propecia label reports "Erectile Dysfunction 1.3" percent on the drug against 0.7 on placebo in year 1 (DailyMed: Propecia label).

The prostate tablet, Proscar, is a higher strength. Its four-year trial showed impotence in 8.1% of men against 3.7% on placebo in year 1. The label adds: "In years 2-4 of the study, there was no significant difference between treatment groups in the incidences of impotence, decreased libido and ejaculation disorder." (DailyMed: Proscar label).

The Propecia label also lists reports, after the drug went on sale, of "sexual dysfunction that continued after discontinuation of treatment, including erectile dysfunction". Our finasteride side effects guide and post-finasteride syndrome guide go through what is known.

Antidepressants: sertraline and other SSRIs

SSRIs are the most common group of antidepressants. The Zoloft (sertraline) label has a warning section on sexual problems. It says: "In male patients, SSRI use may result in ejaculatory delay or failure, decreased libido, and erectile dysfunction." (DailyMed: Zoloft label). Ejaculatory delay means taking longer to finish.

That delay is why some clinicians prescribe sertraline for premature ejaculation, a use it is not approved for. Our PE pills cost guide covers it. Depression itself can also cause ED, so the drug and the condition are hard to separate.

What a prescriber can do

The NIDDK says your health care professional "may review any medicines you are taking to see if a medicine you need for another health condition is causing ED. They may suggest taking a different dose of medicine or switching to another medicine." (NIDDK: ED treatment).

Options a prescriber may weigh:

• A different strength of the same drug.
• A related drug in another class.
• Adding an ED pill, if your heart and other medicines allow it. Nitrates, the chest-pain drugs, rule ED pills out completely.

Our erectile dysfunction causes guide covers the other causes, such as heart disease, diabetes and stress.

If you add an ED pill

Online ED programs check your other medicines at the visit. Generic sildenafil starts at $1.60 a dose at Strut Health, and generic tadalafil at $1.80 a dose at Rex MD, visit included, as checked November 14, 2026. Every program is ranked on Best online ED programs.