Does Aricept cause erectile dysfunction? This is a question some patients and carers ask when noticing changes in sexual function during dementia treatment. Aricept (donepezil) is a cholinesterase inhibitor widely prescribed in the UK for Alzheimer's disease, helping to improve memory and cognitive symptoms. Whilst erectile dysfunction is not listed as a common side effect in UK prescribing information or major clinical trials, sexual health concerns can arise from multiple factors—including age, comorbid conditions, other medications, and dementia itself. Understanding the full clinical picture is essential for addressing these concerns appropriately and maintaining quality of life.

What Is Aricept and How Does It Work?

Aricept (donepezil hydrochloride) is a prescription medication used to treat symptoms of Alzheimer's disease. It belongs to a class of drugs called cholinesterase inhibitors, which work by increasing levels of acetylcholine in the brain—a neurotransmitter essential for memory, learning, and cognitive function. By preventing the breakdown of acetylcholine, Aricept helps improve communication between nerve cells. It can help with symptoms and may delay worsening in some people, but it does not alter the underlying progression of Alzheimer's disease.

In the UK, donepezil is licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) for mild to moderately severe Alzheimer's disease. NICE (National Institute for Health and Care Excellence) recommends it as an option for managing this condition (NICE TA217). Donepezil is sometimes used off-label in other dementias, such as Lewy body dementia or Parkinson's disease dementia, but this is usually initiated by a specialist in line with NICE guidance (NICE NG97).

Aricept is typically prescribed as a once-daily tablet, available in 5 mg and 10 mg strengths. Treatment usually begins with 5 mg once daily; after at least one month, the dose may be increased to 10 mg once daily if tolerated and clinically appropriate (MHRA Summary of Product Characteristics).

Common side effects of Aricept include nausea, diarrhoea, muscle cramps, fatigue, and insomnia. Important cautions include risks of bradycardia (slow heart rate), syncope (fainting), gastrointestinal bleeding, and seizures. These effects are generally mild and often diminish as the body adjusts to the medication. However, some patients and carers have raised concerns about whether Aricept might contribute to sexual dysfunction, including erectile difficulties.

There is no well-established link between Aricept and erectile dysfunction in the UK Summary of Product Characteristics or major clinical trials. Sexual side effects are not listed among the common adverse reactions. Nevertheless, individual experiences can vary, and understanding the broader context of sexual health in dementia is essential for patients and their families.

If you suspect a side effect from any medicine, you can report it via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or by searching for 'Yellow Card' in the Google Play or Apple App Store.

Other Factors That May Affect Sexual Function in Dementia

Sexual dysfunction, including erectile difficulties, is relatively common in older adults and can be influenced by numerous factors unrelated to Aricept. Age-related physiological changes naturally affect sexual function, with reduced testosterone levels, decreased blood flow, and changes in nerve sensitivity all contributing to erectile dysfunction (ED) in men over 60.

Dementia itself can have a significant impact on sexual health. Cognitive decline may alter libido, reduce interest in intimacy, or affect the ability to initiate or respond to sexual cues. Emotional changes such as depression, anxiety, and apathy—frequently seen in dementia—can further diminish sexual desire and performance. Additionally, the psychological burden of a dementia diagnosis often affects both patients and their partners, leading to relationship strain and reduced intimacy.

Comorbid medical conditions are highly prevalent in people with dementia and are major contributors to erectile dysfunction. These include:

• Cardiovascular disease (hypertension, atherosclerosis)

• Diabetes (causing nerve and vascular damage)

• Chronic kidney disease

• Neurological disorders (Parkinson's disease, stroke)

Polypharmacy is another critical consideration. Many individuals with dementia take multiple medications, some of which are known to cause or worsen erectile dysfunction. Common culprits include:

• Antihypertensives (beta-blockers, thiazide diuretics)

• Antidepressants (SSRIs, tricyclics)

• Antipsychotics (sometimes used for behavioural symptoms in dementia)

• 5-alpha reductase inhibitors (finasteride, dutasteride)

• Opioids and benzodiazepines

It is therefore essential to consider the full clinical picture rather than attributing sexual difficulties solely to Aricept. A comprehensive medication review and assessment of underlying health conditions can help identify the true cause of erectile dysfunction (NICE Clinical Knowledge Summaries: Erectile dysfunction; NHS: Erectile dysfunction).

Managing Sexual Side Effects While Taking Aricept

If you or a loved one experiences erectile dysfunction or other sexual difficulties while taking Aricept, there are several practical steps to consider. Do not stop taking Aricept without medical advice, as stopping may lead to worsening of symptoms in some people.

Medication review is a sensible first step. Ask your GP or pharmacist to review all current medications to identify any that might contribute to sexual dysfunction. In some cases, adjusting the dose or switching to an alternative drug (for conditions other than dementia) may improve symptoms without compromising overall treatment.

Lifestyle modifications can also support sexual health. These include:

• Regular physical activity to improve cardiovascular fitness and blood flow

• Healthy diet rich in fruits, vegetables, whole grains, and lean proteins

• Smoking cessation and moderating alcohol intake

• Weight management to reduce the risk of diabetes and heart disease

Psychological support should not be overlooked. Counselling or sex therapy, either individually or as a couple, can help address emotional and relational aspects of sexual dysfunction. Many NHS trusts offer access to psychosexual therapy services, and charities such as Relate provide specialist support.

For men with persistent erectile dysfunction, medical treatments may be appropriate. Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil are commonly prescribed and can be effective. However, these medications require careful consideration in older adults. PDE5 inhibitors are contraindicated in men taking nitrates (e.g., GTN spray, isosorbide mononitrate) or riociguat, as the combination can cause dangerous drops in blood pressure. Caution is also needed with alpha-blockers and in men with significant cardiovascular disease. Your GP will assess your cardiovascular fitness, suitability, and potential interactions with other medications before prescribing (BNF; NICE CKS: Erectile dysfunction).

Open communication with healthcare professionals and partners is vital. Sexual health is an important aspect of quality of life, and concerns should be addressed with sensitivity and without embarrassment.

When to Speak to Your GP About Aricept Side Effects

It is important to maintain regular contact with your GP or memory clinic while taking Aricept, particularly if you experience new or worsening symptoms. You should contact your GP if:

• Erectile dysfunction or other sexual difficulties develop suddenly after starting Aricept

• Sexual side effects are causing significant distress or affecting your relationship

• You experience other troublesome side effects such as persistent nausea, dizziness, or fainting

• You notice a decline in cognitive function or behavioural changes

Urgent medical attention is required if you experience:

• Severe chest pain or palpitations

• Very slow or irregular heartbeat

• Fainting or near-syncope

• Difficulty breathing or swallowing

• Seizures or loss of consciousness

• Signs of gastrointestinal bleeding (black stools, vomiting blood)

Your GP can conduct a thorough assessment to determine whether sexual dysfunction is related to Aricept, another medication, an underlying health condition, or a combination of factors. This may involve:

• Reviewing your full medication list

• Checking blood pressure, fasting glucose or HbA1c, and lipid levels

• Assessing cardiovascular and neurological health

• Considering morning total testosterone levels (if features of hypogonadism or persistent ED)

• Thyroid function tests where clinically indicated

• Discussing psychological and relationship factors

In some cases, referral to a specialist may be appropriate—such as a urologist for persistent erectile dysfunction or a psychiatrist for mood-related concerns. NICE guidance emphasises the importance of holistic, person-centred care in dementia, which includes addressing quality-of-life issues such as sexual health (NICE NG97; NICE CKS: Erectile dysfunction).

Remember, sexual health is a legitimate medical concern, and healthcare professionals are trained to discuss these matters professionally and confidentially. Do not hesitate to raise your concerns—early intervention can often lead to effective solutions that improve both physical and emotional wellbeing.

Frequently Asked Questions