6 Meds That Can Mess With Your Sex Life

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Antihypertensives
... spironolactone or any thiazide are notorious for negatively affecting the ability to achieve an erection. To make the problem worse, during sexual stimulation, a person's heart rate increases; thus, beta-blockers such as metoprolol, which are designed to limit increases in heart rate, are some of the worst offenders in this category.

Alpha-Blockers
... terazosin and prazosin are also antihypertensive medications and thus have the same problem as all antihypertensives: they decrease blood flow to the penis and therefore worsen erectile dysfunction. The second side effect, common even in the later generations of alpha-blockers (like tamsulosin or silodosin), is retrograde ejaculation. Let's be blunt: For some men, sex without ejaculation isn't worth having. Alpha-blockers relax muscles in the bladder neck, allowing the ejaculate to go into the bladder instead of out of the penis. This side effect is very patient- and drug-specific, so changing the alpha-blocker will not always solve the problem.

SSRIs
SSRIs like fluoxetine, paroxetine, sertraline, citalopram, and escitalopram all have a sexual side effect that can be very bothersome to both men and women: delayed ejaculation or delayed orgasm. This side effect is so common that low-dose paroxetine is my preferred treatment for men who come to my clinic with premature ejaculation.

Other Antidepressants
Almost all antidepressants — whether tricyclic antidepressants (amitriptyline, doxepin, imipramine, and nortriptyline), monoamine oxidase inhibitors (phenelzine and tranylcypromine), or antipsychotic medications (thioridazine, thiothixene, and haloperidol) — can negatively affect libido. Some of these medications, such as citalopram, may dramatically lower sperm count or even cause azoospermia.

Advanced Prostate Cancer Drugs
...first-generation hormone therapy (leuprolide) or one of the later-generation drugs (darolutamide, enzalutamide, apalutamide, or abiraterone); all of these dramatically reduce libido by decreasing the level of testosterone. Because the underlying cancer is hormone sensitive, there is no good way to increase serum testosterone levels without potentially worsening the patient's cancer.

PDE5 Inhibitors
Yes, I realize that the PDE5 inhibitors (sildenafil, tadalafil, vardenafil, and avanafil) are used to help men achieve erections, so it may seem odd to include these agents in a discussion of meds that can mess with a patient's sex life. But these drugs, like all drugs, have side effects. Headaches, nasal congestion, facial flushing, and heartburn can happen while taking these drugs and can ruin the mood. Advise your patients to avoid food before taking these medications, avoid alcohol, stay hydrated, and use over-the-counter drugs such as acetaminophen or ibuprofen to help counter any of these other side effects and keep the moment going.

https://www.medscape.com/viewarticle/943985