Amlodipine (sometimes known by the brand name Norvasc) is one of the most commonly prescribed blood pressure medications in the UK. Whilst generally well-tolerated, some men wonder whether amlodipine might contribute to erectile dysfunction. Understanding the relationship between blood pressure treatment and sexual health is important, as both untreated hypertension and certain medications can affect erectile function. This article examines the evidence on amlodipine and erectile dysfunction, explains why blood pressure drugs may influence sexual health, and outlines practical steps if you experience difficulties whilst taking this medication.

What Is Amlodipine and How Does It Work?

Amlodipine is a widely prescribed calcium channel blocker used primarily to treat hypertension (high blood pressure) and certain types of angina (chest pain). In the UK, amlodipine is available both as a branded product (such as Istin) and in generic formulations, and it remains one of the most commonly dispensed antihypertensive medications through the NHS. The brand name Norvasc is used in some countries but is less common in UK practice.

Amlodipine works by blocking calcium channels in the smooth muscle cells of blood vessel walls. Calcium is essential for muscle contraction, so by preventing calcium from entering these cells, amlodipine causes the blood vessels to relax and widen (vasodilation). This reduces peripheral vascular resistance, which in turn lowers blood pressure and decreases the workload on the heart. The medication has a long half-life, allowing for once-daily dosing, which improves patient adherence to treatment.

According to NICE guideline NG136 on hypertension in adults, calcium channel blockers like amlodipine are recommended as first-line treatment for hypertension in patients aged 55 years or older, or in black African or African-Caribbean patients of any age. They are also used in combination therapy when blood pressure is not adequately controlled with a single agent. The MHRA/EMC Summary of Product Characteristics (SmPC) for amlodipine states that the typical starting dose is 5 mg once daily, which may be increased to 10 mg depending on response. In some adults, a lower starting dose of 2.5 mg may be considered.

Common side effects of amlodipine include ankle swelling (peripheral oedema), flushing, headache, and dizziness. These effects are generally related to its vasodilatory action. While amlodipine is generally well-tolerated, patients may experience various adverse effects that can impact quality of life, including concerns about sexual function. Further information is available on the NHS Medicines: Amlodipine page.

Why Blood Pressure Medications May Affect Sexual Function

The relationship between antihypertensive medications and sexual function is complex and multifactorial. Erectile dysfunction (ED) can occur as a consequence of both the underlying cardiovascular disease itself and as a potential side effect of blood pressure treatments. Understanding this distinction is crucial for both patients and healthcare professionals.

Untreated hypertension is itself a significant risk factor for erectile dysfunction. High blood pressure damages the endothelium (inner lining) of blood vessels, impairing their ability to dilate properly. Since achieving and maintaining an erection requires adequate blood flow to the penile tissues, vascular damage from chronic hypertension can directly contribute to ED. Additionally, hypertension often coexists with other cardiovascular risk factors such as diabetes, obesity, and high cholesterol, all of which independently increase ED risk.

Regarding amlodipine specifically, the MHRA/EMC SmPC lists impotence as an uncommon adverse reaction (affecting between 1 in 100 and 1 in 1,000 people). However, establishing a direct causal link is difficult because erectile dysfunction is common in men with cardiovascular disease regardless of treatment. Unlike some older antihypertensive drugs (particularly certain beta-blockers and thiazide diuretics), calcium channel blockers are generally considered to have a relatively neutral effect on sexual function according to systematic reviews.

Individual responses vary considerably. Some patients may report sexual difficulties after starting amlodipine, which could be due to:

• Psychological factors: Anxiety about taking medication or concerns about side effects

• Timing coincidence: ED developing due to progression of underlying vascular disease

• Indirect effects: Fatigue or dizziness from blood pressure reduction affecting sexual activity

• Polypharmacy: Interactions with other medications the patient is taking

According to NICE Clinical Knowledge Summary (CKS) on Erectile Dysfunction, healthcare professionals should consider ED as a potential marker of cardiovascular disease and assess cardiovascular risk in men presenting with this symptom.

What to Do If You Experience Erectile Dysfunction on Amlodipine

If you develop erectile dysfunction after starting amlodipine, it is essential to discuss this with your GP or healthcare provider rather than stopping the medication abruptly. Discontinuing antihypertensive treatment without medical supervision can lead to dangerous blood pressure elevations and increased cardiovascular risk.

Initial assessment by your doctor should include:

• Comprehensive medication review: Identifying all current medications, as other drugs (antidepressants, antihistamines, or other blood pressure tablets) may contribute to ED

• Cardiovascular risk evaluation: Assessing whether ED might indicate worsening vascular disease requiring additional investigation, including QRISK assessment where appropriate

• Lifestyle factors: Discussing alcohol consumption, smoking, exercise levels, and psychological stressors

• Blood tests: Checking for diabetes, cholesterol levels, thyroid function, and morning total testosterone (with repeat confirmation if initially low; prolactin if clinically indicated)

According to NICE CKS on Erectile Dysfunction, healthcare professionals should consider the condition as a potential marker of cardiovascular disease. Men presenting with ED should undergo cardiovascular risk assessment, as erectile dysfunction often precedes coronary events by several years due to the smaller diameter of penile arteries compared to coronary vessels. In men with unstable cardiovascular disease, sexual activity may need to be deferred pending specialist cardiology review.

Management options your doctor might consider include:

• Lifestyle modifications: Weight loss, increased physical activity, smoking cessation, and reducing alcohol intake can significantly improve both blood pressure control and erectile function

• Medication adjustment: Your doctor may consider switching to an alternative antihypertensive with a different mechanism of action, though this should be done cautiously with appropriate monitoring

• Treatment for ED: Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil can be prescribed if appropriate. Important safety information from the BNF: PDE5 inhibitors are absolutely contraindicated with nitrates (e.g., GTN spray, isosorbide mononitrate) or nicorandil due to risk of severe hypotension. They can cause additive blood pressure lowering with amlodipine, so your doctor may consider a lower starting dose and counsel you about symptoms of hypotension (dizziness, fainting). Caution is also needed if you take alpha-blockers (e.g., doxazosin, tamsulosin)

• Specialist referral: In complex cases, referral to a cardiologist or urologist may be warranted

Patient safety advice: Contact your GP promptly if you experience ED alongside chest pain, severe breathlessness, or other concerning cardiovascular symptoms, as these may indicate inadequate disease control requiring urgent review.

Reporting side effects: If you suspect amlodipine or any other medicine is causing side effects, you can report this 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.

Alternative Blood Pressure Treatments and Sexual Health

For patients concerned about sexual function, several alternative antihypertensive options exist, though the choice must be individualised based on clinical factors, comorbidities, and evidence-based guidelines. NICE guideline NG136 on hypertension management provides a stepped approach that allows for flexibility in drug selection.

ACE inhibitors and angiotensin receptor blockers (ARBs) are generally considered to have minimal negative impact on sexual function. Medications such as ramipril, lisinopril (ACE inhibitors), or losartan and candesartan (ARBs) work by blocking the renin-angiotensin-aldosterone system, reducing blood pressure without the mechanisms that might impair erectile function. These medications are typically first-line choices for patients under 55 years of age or those with diabetes, according to NICE NG136.

Calcium channel blockers as a class (including amlodipine) are generally regarded as having a relatively neutral effect on sexual function. If a patient experiences problems with amlodipine specifically, switching to an alternative calcium channel blocker such as felodipine or lercanidipine might be considered, though there is limited evidence to suggest significant differences between agents in this class regarding sexual side effects.

Beta-blockers have historically been associated with erectile dysfunction, particularly older non-selective agents like propranolol. However, newer, more selective beta-blockers such as nebivolol have demonstrated better tolerability profiles. Nebivolol has additional vasodilatory properties through nitric oxide release. Nevertheless, beta-blockers are not typically first-line for uncomplicated hypertension unless there are specific indications such as heart failure or post-myocardial infarction.

Thiazide-like diuretics such as indapamide or chlortalidone are preferred by NICE NG136 when initiating diuretic therapy for hypertension. Older thiazide diuretics like bendroflumethiazide may be continued in patients already taking them with good effect and tolerability. Some studies have associated diuretics with erectile dysfunction, though the evidence is inconsistent. The BNF provides detailed information on antihypertensive drug classes and their effects.

Important considerations when changing antihypertensive therapy:

• Blood pressure control must remain the primary objective, as uncontrolled hypertension poses serious health risks

• Medication changes should be implemented gradually with appropriate monitoring

• Combination therapy may be necessary to achieve target blood pressure

• The NICE NG136 target for most adults is clinic blood pressure below 140/90 mmHg (or 135/85 mmHg for home monitoring). For people aged 80 years and over, the clinic target is below 150/90 mmHg

Holistic approach: Optimal management combines appropriate medication selection with lifestyle interventions. Regular physical activity, maintaining a healthy weight, reducing salt intake, and moderating alcohol consumption all contribute to better blood pressure control and improved sexual health. Patients should be encouraged to view their treatment as a comprehensive cardiovascular risk reduction strategy rather than focusing solely on individual medication effects. Further patient information is available on NHS: High blood pressure (hypertension) and NHS: Erectile dysfunction pages.

Frequently Asked Questions