Allopurinol is a widely prescribed medication for gout management in the UK, working by reducing uric acid production to prevent painful joint inflammation. Many men taking allopurinol wonder whether it might affect sexual function. This article examines the evidence linking allopurinol to erectile dysfunction, explores alternative gout treatments, and provides guidance on managing both conditions effectively. Understanding the relationship between gout medications and sexual health helps patients make informed decisions and seek appropriate support when needed.

What Is Allopurinol and How Does It Work?

Allopurinol is a xanthine oxidase inhibitor widely prescribed in the UK for the long-term management of gout and conditions associated with elevated uric acid levels (hyperuricaemia). It works by blocking the enzyme xanthine oxidase, which is responsible for converting purines into uric acid. By reducing uric acid production, allopurinol helps prevent the formation of urate crystals in joints and soft tissues, thereby reducing the frequency and severity of gout attacks.

The medication is typically initiated at a low dose (commonly 100 mg daily) and gradually titrated upwards based on serum uric acid levels. NICE guidance recommends a target uric acid level below 360 micromol/L for most patients, with a lower target of 300 micromol/L considered for those with tophaceous or severe gout. Doses may need adjustment in renal impairment, though allopurinol can still be used effectively with appropriate monitoring.

When starting allopurinol, prophylactic treatment with low-dose colchicine or an NSAID is usually recommended for the first 3-6 months to prevent gout flares that can occur as urate crystals dissolve.

Regarding erectile dysfunction (ED), there is no established clinical evidence linking allopurinol directly to sexual dysfunction. ED is not listed among the common or well-recognised adverse effects in UK prescribing information, though very rare individual case reports exist. No causal relationship between allopurinol and ED has been demonstrated in clinical trials or post-marketing surveillance.

It is important to recognise that gout itself, along with its associated comorbidities—such as cardiovascular disease, hypertension, diabetes, and obesity—are independent risk factors for erectile dysfunction. Therefore, any sexual health concerns in men taking allopurinol are more likely attributable to underlying health conditions rather than the medication itself.

Important safety note: If you develop a skin rash while taking allopurinol, stop the medication immediately and seek urgent medical advice, as this could be a sign of a serious hypersensitivity reaction. Also, allopurinol interacts significantly with azathioprine and mercaptopurine, requiring specialist supervision and dose reduction if these medications must be used together.

Other Medications for Gout and Sexual Function

When allopurinol is not suitable or tolerated, several alternative urate-lowering therapies are available in the UK. Febuxostat is another xanthine oxidase inhibitor that may be considered, but only if allopurinol is contraindicated or not tolerated. Like allopurinol, febuxostat has no documented association with erectile dysfunction in clinical literature. However, febuxostat carries cardiovascular safety concerns, and the MHRA advises caution in patients with pre-existing cardiovascular disease. Your doctor should discuss these risks with you before prescribing febuxostat.

Uricosuric agents work by increasing renal excretion of uric acid. In the UK, probenecid is occasionally used (though not licensed for gout), while benzbromarone is available on a named-patient basis and requires liver function monitoring. These medications are generally reserved for patients who cannot take xanthine oxidase inhibitors. There is no evidence linking uricosuric drugs to sexual dysfunction. They require adequate renal function, good hydration, and should be avoided in patients with a history of uric acid stones.

For acute gout flares, non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids are commonly used. Whilst these medications do not directly cause erectile dysfunction, some NSAIDs may contribute to cardiovascular risk factors that could theoretically affect sexual function, though this association is not well-established. Colchicine, at therapeutic doses, has no recognised impact on erectile function.

Diuretics, often prescribed for hypertension in gout patients, are known to be associated with erectile dysfunction. Thiazide diuretics in particular have been linked to ED in some studies. If you are taking multiple medications for gout-related comorbidities, it is worth discussing with your GP whether any of these—rather than allopurinol—might be contributing to sexual health concerns.

Importantly, like allopurinol, febuxostat also interacts with azathioprine and mercaptopurine. These combinations should be avoided or managed under specialist supervision with significant dose reductions.

When to Speak to Your GP About Erectile Dysfunction

Erectile dysfunction is a common condition affecting men of all ages, though prevalence increases with age and the presence of chronic health conditions. It is defined as the persistent inability (typically for at least 3 months) to achieve or maintain an erection sufficient for satisfactory sexual activity. Whilst ED can be distressing, it is important to remember that effective treatments are available, and discussing the issue with your GP is an essential first step.

You should contact your GP if you experience persistent erectile difficulties, particularly if:

• The problem has developed recently or worsened over time

• You have cardiovascular risk factors (hypertension, diabetes, high cholesterol, smoking)

• You are taking multiple medications and suspect one may be contributing

• You experience other symptoms such as reduced libido, fatigue, or mood changes

• The issue is affecting your quality of life, relationships, or mental wellbeing

Erectile dysfunction can be an early warning sign of cardiovascular disease, as the blood vessels supplying the penis are smaller than coronary arteries and may show signs of atherosclerosis earlier. Your GP will take a thorough medical and medication history, assess cardiovascular risk factors, and may arrange blood tests including fasting glucose or HbA1c, lipid profile, morning testosterone (with repeat if low), and thyroid function tests.

Your GP may refer you to a specialist if you have not responded to initial treatments, if there are signs of an underlying endocrine disorder, if you have penile abnormalities such as Peyronie's disease, or if you have significant cardiovascular risk requiring further assessment.

Do not stop taking allopurinol without medical advice if you suspect it is causing ED. Abruptly discontinuing urate-lowering therapy can trigger acute gout flares and allow uric acid levels to rise, potentially causing joint damage over time. Instead, discuss your concerns openly with your GP, who can review all your medications, assess other potential causes, and ensure your gout remains well-controlled whilst addressing sexual health concerns.

Managing Gout Treatment and Sexual Health

Optimising both gout management and sexual health requires a holistic approach that addresses lifestyle factors, comorbidities, and medication management. Since gout commonly coexists with conditions that independently increase ED risk—such as obesity, metabolic syndrome, hypertension, and diabetes—improving overall health can benefit both conditions simultaneously.

Lifestyle modifications play a crucial role:

• Weight management: Losing excess weight improves uric acid levels and cardiovascular health, both of which positively impact erectile function

• Dietary changes: Reducing purine-rich foods (red meat, seafood, alcohol—particularly beer) helps control gout, whilst a heart-healthy diet supports vascular health

• Regular exercise: Physical activity improves cardiovascular fitness, aids weight loss, and has been shown to improve erectile function

• Smoking cessation: Smoking is a significant risk factor for both cardiovascular disease and ED

• Alcohol moderation: Excessive alcohol intake worsens gout and can contribute to erectile difficulties

If erectile dysfunction persists despite lifestyle measures, your GP may consider phosphodiesterase-5 (PDE5) inhibitors such as sildenafil, tadalafil, or vardenafil. These medications are effective for most men and can be safely used alongside allopurinol, as there are no known drug interactions between PDE5 inhibitors and urate-lowering therapies. However, PDE5 inhibitors are contraindicated in men taking nitrates for angina or nicorandil, and should never be used with riociguat. Caution is also needed when using PDE5 inhibitors with alpha-blockers (used for prostate conditions or hypertension) due to the risk of blood pressure drops; dose separation and starting with the lowest PDE5 dose is recommended.

For men requiring multiple medications, a structured medication review is valuable. Your GP or pharmacist can assess whether any drugs in your regimen—such as beta-blockers, thiazide diuretics, or antidepressants—might be contributing to ED and whether alternatives are available. In some cases, switching to medications like losartan (which has mild uricosuric effects) may benefit both urate levels and sexual function when clinically appropriate.

The goal is to maintain effective gout control with allopurinol (or an alternative urate-lowering therapy) whilst optimising treatment for other conditions and addressing sexual health concerns. Open communication with healthcare professionals ensures that both gout and erectile function are managed effectively, supporting overall quality of life and long-term health outcomes.

If you experience any suspected side effects from your medications, you can report them through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or via the Yellow Card app).

Frequently Asked Questions