Sex Rx: Thiazide diuretics and your sex life

by Karen Schroeder, MS, RD

Medications:

  • Thiazide diuretics

What they are most often prescribed for:

  • Hypertension

How they work:

Thiazide diuretics, often referred to as water pills, help to lower blood pressure by decreasing the amount of fluid in your body. These drugs work by increasing the amount of salt and water you excrete in your urine.

Possible sexual side effects:

  • Erection impairment in men
  • Loss of lubrication in women
  • Difficulty reaching orgasm
  • Decreased sexual desire

How they cause sexual problems:

Diuretics, like other anti-hypertensive medicines, work by reducing the force of blood flow. In addition to lowering blood pressure, this action may also decrease blood flow to sexual organs, which may hinder sexual arousal.

Treatment options:

  • If you are experiencing any sexual side effects while taking a diuretic, talk to your physician about the following treatment options. Never change your dose, try a new drug or supplement, or stop taking your medication without consulting with your doctor.

Wait it out

  • As you adjust to your new medication, the sexual side affects may go away. However, if they persist, be sure to talk to your doctor.

Decrease the dosage

  • Sometimes tinkering with the dosage of a medication can provide some relief from unpleasant side effects.

Switch medications

  • There are many different thiazide diuretics available, and some are more likely to cause sexual side effects than others. Also, if you are unable to tolerate the effects of diuretics, ask your doctor about other types of medications that can lower high blood pressure, such as beta blockers, calcium channel blockers, ACE inhibitors, and angiotensin blockers.However, some of these medications, most notably beta blockers, are also associated with sexual dysfunction.

These diuretics are most likely to cause sexual dysfunction:

  • Bendroflumethiazide (Naturetin)
  • Chlorothiazide (Diuril)
  • Chlorthalidone (Hygroton)
  • Furosemide (Lasix)
  • Hydrochlorothiazide (Hydro Diuril)
  • Spironolactone (Aldactone)

These diuretics are least likely to cause sexual dysfunction:

  • Benzthiazide (Exna)
  • Bumetanide (Bumex)
  • Cyclothiazide (Anhydron)
  • Hydroflumethiazide (Diucardin, Saluron)
  • Indapamide (Lozol)
  • Methyclothiazide (Enduron)
  • Metolazone (Diulo, Zaroxolyn)
  • Polythiazide (Renese)
  • Quinethazone (Hydromox)
  • Torsemide (Demadex)
  • Trichlormethiazide (Metahydrin, Naqua)

Treat the dysfunction

  • Commonly known as a treatment for male impotence, sildenafil (Viagra) may also help women with sexual dysfunction, though it is not yet approved for use by women. However, the expense of this drug may prohibit many patients from using it.

Take a drug holiday

  • This involves, for example, taking your usual Thursday morning dose and then nothing again until noon on Sunday. Always discuss this option with your physician before trying it, as it may not be appropriate for all people.

Consider herbal supplements

  • The efficacy of herbal supplements to treat the sexual side effects of diuretics is not clear. There have not been many well-designed clinical trials, only case reports, some of which have shown positive effects and others that have shown no effects. Herbal products are not strictly regulated, as drugs are, and they may adversely interact with medications. Two herbs commonly used to resolve the sexual dysfunction associated with some medications are:

Yohimbine

  • Several reports have claimed that yohimbine (made from the bark of the yohimbe tree) can help resolve erectile dysfunction. The suggested dose is one tablet (5.4 grams) three times per day. If there is a response, it will be seen within four weeks. For those who do have success with yohimbine, the dosage may be adjusted to provide 1-2 tablets one hour before sexual activity is desired.
  • It is essential that your doctor know if you are taking yohimbine, because in some cases, it can cause an increase in blood pressure. You should not take yohimbine if you have liver or kidney disease. Other side effects that have been reported include: headaches, dizziness, insomnia, tremor, increased heart rate, nausea and anxiety.

Ginkgo Biloba

  • - This herb affects the circulatory system and improves blood flow, and has been reported to improve sexual dysfunction. Though gingko is considered safe, there are no convincing studies that support its use for this purpose.