Department of Research & Evaluation News

PASADENA, Calif. – The use of multiple medications is associated with increased severity of erectile dysfunction, according to a Kaiser Permanente study published online in the British Journal of Urology International.

This study found that men taking various medications are likely to have more severe ED. The study was conducted as part of the California Men’s Health Study, a multiethnic cohort of men ages 46 to 69 who are members of Kaiser Permanente in California. This study surveyed 37,712 ethnically diverse men from Southern California.

Information about medication use between 2002 and 2003 was obtained from pharmacy records. This study looked at men who were taking more than three medications. Survey responses about ED were used to quantify its presence and severity. Of the men included in this study, 29 percent reported moderate or severe ED. In addition to the number of medications, ED was associated with older age, higher body mass index, diabetes, high cholesterol, hypertension, depression, and being a current or past smoker. After taking these conditions into account, the relationship between multiple medications and ED persisted.

Clinically, the findings from this study suggest that a crucial step in the evaluation of ED would be to review the current medications the patient is taking and their potential side effects. When appropriate, decreases or changes in the amount of or type of medication should be considered, said study lead author Diana C. Londoño, MD, from the urology department at Kaiser Permanente Los Angeles Medical Center.

Across all age groups, ED was more prevalent as the number of medications increased.

The most common medications associated with ED include antihypertensives (beta blockers, thiazides, and clonidine) and psychogenic medications such as selective serotonin reuptake inhibitors, tricyclic antidepressants, lithium, monoamine oxidase inhibitors, and any medication which can interfere with testosterone pathways.

Researchers found that 57 percent of men in the study took more than three medications. Use of multiple medications was the greatest among older age groups, with 53 percent of men ages 50 to 59 years taking at least three medications and 66 percent men ages 60 to 70 taking at least three medications. Seventy-three percent of the men who used more than three medications had a BMI greater than 35 kg/m2 (obese). Twenty-five percent of the men used at least 10 medications.

ED is a problem that affects a significant number of men in the United States and around the world. Previous studies have shown that 35 percent of men over the age of 60 suffer from ED, a condition with multiple causes including thyroid diseases, depression, stress, medication side effects, atherosclerosis, coronary artery disease, alcoholism, smoking, trauma and surgery. Most of these conditions decrease nitric oxide, the main neurotransmitter that initiates and maintains an erection.

This study highlights that while physicians still need to treat patients with medications when indicated, they should be aware that erectile dysfunction may occur, said Michael Kanter, medical director of Quality & Clinical Analysis for Kaiser Permanente Southern California.

Study authors included: Diana C. Londoño, MD, from Kaiser Permanente Los Angeles Medical Center; Steven J. Jacobsen, MD, PhD, Jeff M. Slezak, MS, and Virginia P. Quinn, PhD, from the Kaiser Permanente Southern California Department of Research & Evaluation; Ronald K. Loo, MD, from the department of urology, Kaiser Permanente Downey Medical Center; and Stephen K. Van Den Eeden, PhD, from the Kaiser Permanente Division of Research in Oakland, Calif.

About the Kaiser Permanente Department of Research & Evaluation
The Department of Research & Evaluation (R & E) conducts high quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiology, health sciences, and behavioral research as well as clinical trials. Areas of interest include diabetes and obesity, cancer, HIV/AIDS, cardiovascular disease, aging and cognition, pregnancy outcomes, women’s and children’s health, quality and safety, and pharmacoepidemiology. Located in Pasadena, Calif., the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general population. Visit www.kp.org/research.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We serve approximately 8.9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.