Does lorazepam cause erectile dysfunction? It is not listed as a side effect in the Australian Ativan leaflet, but benzodiazepines, the group of medicines lorazepam belongs to, have been linked with erection problems. The evidence for lorazepam itself is thin, and anxiety, the reason most people take it, can cause erection problems on its own. If you notice a change, talk to your doctor, and do not stop lorazepam suddenly.
Does the Ativan leaflet list erection problems?
No. Ativan is lorazepam, a benzodiazepine "thought to work by its action on brain chemicals"; it "is used to relieve anxiety" and also before surgery. Its common side effects are "drowsiness, dizziness, sleepiness, clumsiness or unsteadiness, weakness, loss of memory", and no sexual side effect appears anywhere in the leaflet, which adds: "Other side effects not listed above may occur in some people" (Ativan CMI, ARTG 10387). The Australian product information for doctors lists none either (Lorazepam Viatris PI). That differs from alprazolam (Xanax), another benzodiazepine, whose leaflet lists "changes in sex drive" (alprazolam CMI).
What do studies show about benzodiazepines and ED?
A link, but not proof that lorazepam is the cause. Australian Prescriber lists anxiolytics (anti-anxiety medicines) among the medicines that are risk factors for erectile dysfunction (Australian Prescriber, 2022). In a survey of 2,301 men aged 30 to 79 in Boston, those taking a benzodiazepine had more than twice the odds of ED (adjusted odds ratio 2.34) after allowing for age, other illnesses and lifestyle (Kupelian et al., 2013). A survey like this shows an association; it cannot show which came first.
For lorazepam itself there is very little. In the records of 100 veterans with post-traumatic stress disorder, 18 of 42 men given clonazepam complained of sexual problems, mainly erectile dysfunction, while none of the 8 given lorazepam did (Fossey and Hamner, 1994-95). One published case report describes "complete loss of libido with short-term use of lorazepam" (Khandelwal, 1988). Neither can say how often it happens.
Could it be the anxiety rather than the medicine?
It could be either, or both. Australian Prescriber's list of risk factors for ED includes psychological ones: stress, "situational anxiety", "generalised anxiety disorder" and depression. It adds that the response to ED tablets "can be affected by anxiety, alcohol, excessive expectations of how these drugs should work, and not waiting long enough for them to work". More on the anxiety side in can anxiety cause erectile dysfunction? and is erectile dysfunction physical or psychological?
What should you do if you have erection problems on lorazepam?
Tell your doctor, and keep taking it until you have. "Do not stop taking ATIVAN or lower the dose, without first checking with your doctor. Stopping this medicine suddenly may cause some unwanted withdrawal effects"; the doctor will "slowly reduce your dose" if it is to stop (Ativan CMI). The leaflet also says Ativan "is usually used for short periods only (for example 2-4 weeks)" and that "The use of benzodiazepines may lead to dependence on the medicine", so how long you have been on it is part of that conversation. healthdirect's advice on erections: "If the problems continue or you are worried, see your doctor" (healthdirect — ED medicines). Treatments that work on the anxiety itself are in treatment options for psychogenic ED.
Can you take Viagra or Cialis with lorazepam?
No interaction is listed. The Ativan leaflet's list of medicines that may interfere with it names sleeping tablets and sedatives, antidepressants, antihistamines, pain relievers, muscle relaxants and medicines for fits, not ED medicines (Ativan CMI), and lorazepam is not on the Viagra or Cialis leaflet's list (Viagra CMI; Cialis CMI). The shared risk is dizziness, and alcohol makes lorazepam's worse: "Combining ATIVAN and alcohol can make you more sleepy, dizzy, or lightheaded" (Ativan CMI). In an Italian clinic study of men with ED who were taking psychotropic medicines, those on benzodiazepines did better on ED tablets after three months than those on antidepressants (Mazzilli et al., 2018). Nitrates, the medicines for angina, are never taken with an ED medicine (healthdirect — ED medicines). The same question for alprazolam is answered in can Xanax and Cialis be taken together? and can Xanax and Viagra be taken together?; for antidepressants, in Viagra with antidepressants and anxiety medication.
The short answer
Erection problems are not on lorazepam's Australian leaflet, but benzodiazepines as a group are linked with ED, and so is anxiety. If it happens, see your doctor rather than stopping the tablets; a change of treatment, help with the anxiety, or an ED medicine are all options to discuss. The other psychological sides of ED are in our guide to psychological causes of erectile dysfunction.
