SexRx: Cimetidine and your sex life

Type of Medication

Brand Names

What This Medication Is Most Often Prescribed For

• Peptic ulcer disease – An ulcer is a sore in the lining of the stomach (gastric ulcer) or more commonly the first part of the small intestine (duodenal ulcer)
• Gastrointestinal hypersecretory disorders - Conditions in which the stomach is stimulated to produce excessive amounts of acid, such as Zollinger-Ellison syndrome
• Heartburn, acid indigestion, or sour stomach
• Gastroesophageal reflux disease (GERD)
• Prevention of upper GI bleeding in critically ill patients

How This Medication Works

Possible Sexual Side Effects

Sexual side effects from cimetidine are extremely rare in people who take typical doses of this drug or other H2-antagonists. Such side effects are more likely to occur in people with Zollinger-Ellison syndrome who take high doses of cimetidine for a long period of time.

In men:

• Decreased sexual desire
• Impotence
• Excessive development of breast tissue, called gynecomastia
• Modest decrease in sperm count, but not enough to affect fertility

In women:

• Decreased sexual desire
• Pain and tenderness in the breasts

How This Medication Can Affect Sexual Function

Treatment Options

Since cimetidine is a relatively rare cause of sexual dysfunction, you and your doctor should carefully consider other factors. If you still feel cimetidine is contributing to your sexual dysfunction, consider taking the following steps.

Wait it out

As you adjust to your new medication, the sexual side effects may go away.

Decrease the dosage

This tactic will work occasionally, but carries the risk of a relapse of your symptoms. Never change your dosage without checking with your doctor first.

Switch medications

Depending on your condition, there may be other medications that can manage your medical symptoms without affecting sexual function. If switching is appropriate for you, your options include:

Another histamine-2 antagonist – Sexual side effects are also uncommon with the other drugs in this class. Ask your doctor about switching to one of these:

• Famotidine (Pepcid)
• Nizatidine (Axid)
• Ranitidine (Zantac)

Another type of treatment –

• Antibiotics – Many cases of stomach irritation and ulcer are actually caused by infection with the bacteria Helicobacter pylori. In these situations, antibiotics may treat the problem.
• Antacids (Di-Gel, Maalox, Tums, etc.) – to treat heartburn and GERD
• Sucralfate (Carafate) – to treat and prevent ulcers
• Omeprazole (Prilosec) – to treat and prevent ulcers

Try an antidote

Taking an antidote involves maintaining your current level of medication, while adding a second medication to offset the sexual side effects. This should rarely be necessary in the case of cimetidine, for which there are many alternatives. Keep in mind that these antidotes can also cause side effects. Cimetidine can adversely interact with certain drugs, so it is essential to discuss the other drugs you are taking with your doctor. Two drugs that have been used as antidotes are:

• Amantadine (Symmetrel) – Several case reports have shown amantadine to be an effective antidote for medication-related sexual dysfunction, however it has not yet been proven effective in a double-blind clinical study, which is the gold standard for drug efficacy.
• Sildenafil (Viagra) – Commonly known as a treatment for male impotence, sildenafil may also help women with sexual dysfunction. However, the expense of this drug may prohibit many patients from using it. Also, since cimetidine can interfere with the clearance of sildenafil from the body, care should be taken when combining the two drugs.

Consider herbal supplements

The efficacy of herbal supplements in treating sexual side effects of various medications is not clear. There have not been any double-blind clinical studies, only case reports, some of which have shown positive effects and others that have shown no effects. Care should also be taken with herbal products because they are not strictly regulated, as drugs are, and may interact negatively with certain medications. Ask your doctor about these two herbs commonly used to treat sexual dysfunction associated with medications:

• Yohimbine
• Ginkgo