Cholesterol-lowering drugs and erectile dysfunction

Clinical bottom line

Both fibrates and statins appear to be associated with erectile dysfunction, though very infrequently. Switching drugs may be beneficial if it occurs.

Reference

K Rizvi et al. Do lipid-lowering drugs cause erectile dysfunction? A systematic review. Family Practice 2002 19: 95-98.

Review

The review process involved searching eight electronic databases for any reports linking erectile dysfunction or impotence in men with the use of cholesterol lowering drugs. National regulatory adverse drug reaction registers were also examined.

Results

Case reports linked both fibrates and statins with erectile dysfunction in a small number of men.
Review articles linked fibrates with erectile dysfunction.
Data from randomised clinical trials showed no difference between simvastatin and placebo in the 4S study (37/1814 on simvastatin, 28 of 1803 on placebo), but erectile dysfunction was not reported in other randomised trials.
One case-control study looked at the prevalence of erectile dysfunction in 339 patients attending a lipid clinic with matched controls. Both fibrates and statins were independent predictors of erectile dysfunction with odds ratios of about 1.5 [1].
Regulatory agencies in Australia and the UK had yellow card reports of erectile dysfunction in men on lipid lowering drugs, both fibrates and statins. In a small number of men, withdrawal of the lipid-lowering drug and rechallenge resulted in recurrent symptoms, though usually not a blind rechallenge.

Comment

This is an interesting paper because it attempts to systematically review adverse events, a subject too often ignored. It identified a number of cases, but in total these were small compared to the very widespread prescribing of lipid lowering drugs, especially statins. It is made more complicated by the average age of men reporting erectile dysfunction, mainly in their 50s when erectile dysfunction may occur anyway, and because many men using statins may be on therapy for other conditions.

One useful observation was that drug switching resolved the problem in a number of cases.

Reference:

E Bruckert et al. Men treated with hyoplipidaemic drugs complain more frequently of erectile dysfunction. J Clin Pharm Ther 1996 21: 89-94.