Felodipine is a calcium channel blocker commonly prescribed for high blood pressure, and many men wonder whether it might affect sexual function. Whilst erectile dysfunction can occur with some blood pressure medications, felodipine is generally considered to carry a lower risk compared to older drug classes such as beta-blockers or thiazide diuretics. Understanding the relationship between antihypertensive treatment and sexual health is important for informed decision-making. This article examines the evidence linking felodipine to erectile dysfunction, explores why blood pressure medications may affect sexual function, and outlines practical management options for men experiencing these concerns.

What Is Felodipine and How Does It Work?

Felodipine is a calcium channel blocker prescribed primarily for the management of hypertension (high blood pressure) and, in some cases, angina pectoris. It belongs to the dihydropyridine subclass of calcium antagonists and is available in modified-release formulations, typically taken once daily. In the UK, felodipine is licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) and prescribed according to NICE guidance (NG136) for hypertension management.

The mechanism of action involves selective inhibition of L-type calcium channels in vascular smooth muscle. By preventing calcium influx into arterial walls, felodipine causes vasodilation—particularly in peripheral arteries—which reduces systemic vascular resistance and lowers blood pressure. Unlike some other antihypertensives, felodipine has relatively little effect on cardiac contractility or conduction, making it suitable for certain patient groups as outlined in NICE guidance.

Common adverse effects include peripheral oedema (ankle swelling), flushing, headache, dizziness, palpitations and, less commonly, gingival hyperplasia (gum overgrowth). These side effects are related to its vasodilatory properties. Felodipine is metabolised primarily by the hepatic cytochrome P450 3A4 enzyme system, meaning interactions with certain foods (notably grapefruit juice) and medications (such as certain antibiotics and antifungals) must be considered. The usual starting dose is 5 mg once daily (2.5 mg in elderly patients or those with hepatic impairment), with a maximum dose of 10 mg daily, in line with the BNF recommendations.

Why Blood Pressure Medications May Affect Sexual Function

The relationship between antihypertensive medications and sexual function is complex and multifactorial. Erectile dysfunction (ED) can arise through several mechanisms related to blood pressure treatment, though the evidence varies considerably between drug classes. It is important to distinguish between medication-induced effects and ED caused by the underlying cardiovascular disease itself, as hypertension and atherosclerosis independently impair erectile function.

Calcium channel blockers, including felodipine, are generally considered to have a lower risk of causing erectile dysfunction compared to older antihypertensives such as thiazide diuretics and beta-blockers. ED is not commonly reported with calcium channel blockers, though the SmPC for felodipine does list sexual dysfunction as a possible adverse reaction at low frequency. Individual patient experiences vary, and causality can be difficult to establish definitively in clinical practice.

Several factors may contribute to sexual dysfunction in men taking antihypertensives:

• Haemodynamic effects: In theory, medications that lower blood pressure may reduce penile arterial perfusion, though calcium channel blockers' vasodilatory action might actually improve blood flow in some vascular beds.

• Psychological factors: Anxiety about medication side effects, or the diagnosis of hypertension itself, can contribute to performance anxiety and secondary ED.

• Underlying vascular disease: Hypertension, diabetes, and hyperlipidaemia—conditions often co-existing with cardiovascular disease—are independent risk factors for erectile dysfunction due to endothelial dysfunction and atherosclerosis.

Beta-blockers (though with variability within the class) and thiazide diuretics have historically been more strongly associated with ED, possibly through effects on sympathetic tone, hormonal changes, or reduced cardiac output. In contrast, ACE inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers generally appear more neutral regarding sexual function, though individual responses vary.

What to Do If You Experience Erectile Dysfunction on Felodipine

If you develop erectile dysfunction after starting felodipine, it is essential to discuss this openly with your GP or prescribing clinician. Sexual health concerns are common, legitimate medical issues that warrant professional assessment. Do not stop taking felodipine abruptly without medical advice, as uncontrolled hypertension poses significant cardiovascular risks including stroke and myocardial infarction.

Your healthcare provider will typically undertake a comprehensive assessment to identify potential causes:

• Medication review: Evaluating all current medications, as polypharmacy (especially with multiple antihypertensives) may contribute to ED. Your doctor may consider whether felodipine is the likely culprit or if other drugs are more probable contributors.

• Cardiovascular risk assessment: Checking blood pressure control, reviewing lipid profiles, assessing for diabetes (HbA1c), and evaluating overall cardiovascular health using tools such as QRISK3, in line with NICE guidance (NG136 and NG238).

• Lifestyle factors: Discussing smoking, alcohol consumption, physical activity, obesity, and psychological stressors—all modifiable risk factors for ED.

• Hormonal evaluation: In some cases, checking morning testosterone levels (9-11 am) may be appropriate, particularly if other symptoms of hypogonadism are present.

Management options may include:

• Watchful waiting: If ED is mild and recent, symptoms may improve as your body adjusts to the medication.

• Medication adjustment: Switching to an alternative antihypertensive class (such as an ACE inhibitor or ARB) if felodipine is suspected as the cause, whilst maintaining blood pressure control.

• Phosphodiesterase-5 (PDE5) inhibitors: Medications such as sildenafil, tadalafil, or vardenafil can be prescribed for ED. These are generally safe to use alongside calcium channel blockers, though blood pressure should be monitored. Important safety note: PDE5 inhibitors are contraindicated with nitrates or nicorandil and should be used with caution alongside alpha-blockers due to the risk of hypotension.

When to seek urgent advice: Contact your GP promptly if you experience chest pain, severe dizziness, or other concerning cardiovascular symptoms. Erectile dysfunction itself is not a medical emergency, but it may be an early marker of cardiovascular disease requiring further investigation.

If you suspect felodipine has caused erectile dysfunction, you can report this via the MHRA Yellow Card Scheme, which helps monitor medication safety.

Alternative Blood Pressure Treatments and Sexual Health

For men concerned about sexual function, several alternative antihypertensive classes may be considered, always balancing efficacy, safety, and individual patient factors. NICE guidance (NG136) provides a stepped approach to hypertension management, and medication choice should be individualised based on age, ethnicity, comorbidities, and tolerability.

ACE inhibitors and angiotensin receptor blockers (ARBs) are often considered favourable options for men with sexual health concerns. These medications work by blocking the renin-angiotensin-aldosterone system, reducing blood pressure through vasodilation and decreased fluid retention. Evidence suggests they have a neutral or potentially beneficial effect on erectile function, possibly by improving endothelial function and vascular health. Common examples include ramipril, lisinopril (ACE inhibitors), and losartan, candesartan (ARBs).

Alpha-blockers such as doxazosin may be appropriate in specific circumstances, particularly for men with both hypertension and lower urinary tract symptoms related to benign prostatic hyperplasia. These medications are not first-line for hypertension according to NICE guidance but may be considered when other agents are not tolerated. Note that alpha-blockers can cause postural hypotension and ejaculatory problems, and should be used with caution alongside PDE5 inhibitors due to the risk of blood pressure drops.

Lifestyle modifications remain foundational to blood pressure management and sexual health:

• Weight reduction: Obesity is strongly associated with both hypertension and ED; even modest weight loss can improve both conditions.

• Salt reduction: Limit salt intake to no more than 6g per day (about a teaspoonful).

• Mediterranean-style diet: Rich in fruits, vegetables, whole grains, fish, and olive oil, with limited red meat.

• Regular physical activity: Aim for at least 150 minutes of moderate-intensity exercise weekly.

• Smoking cessation: Smoking damages blood vessels and is a major risk factor for ED.

• Alcohol moderation: Limit alcohol to no more than 14 units per week, spread over several days.

Combination therapy may be necessary for optimal blood pressure control. Your clinician will aim to use the lowest effective doses of medications with the most favourable side-effect profiles. Regular monitoring, including home or ambulatory blood pressure measurements, and open communication about sexual health concerns enable personalised treatment adjustments. Remember that well-controlled blood pressure ultimately protects vascular health throughout the body, including the penile vasculature, potentially improving long-term sexual function even if short-term medication adjustments are needed.

Frequently Asked Questions