Gabapentin-Induced Erectile Dysfunction: An Overview

Erectile dysfunction is a condition impacting sexual performance. It affects up to 30 million men¹ in the United States alone. 

There are numerous factors influencing erectile dysfunction, including commonly prescribed medications.

Gabapentin² is a medicine prescribed to manage and prevent seizures and relieve pain. Unfortunately, it is linked to the potential development of erectile dysfunction. 

If you have been prescribed gabapentin and are concerned, it is important that you know how this may affect your sexual performance. It’s also useful to find out what is available to you to manage and maintain your sex life.

What is gabapentin?

Gabapentin was developed as an anticonvulsive medication. It also currently has FDA approval for the treatment of postherpetic neuralgia — nerve and skin pain that is a common symptom of shingles, seizures, and moderate to severe restless leg syndrome.

Gabapentin also has a large variety of off-label uses, such as fibromyalgia, irritable bowel syndrome (IBS), depression and anxiety, alcohol withdrawal, post-traumatic stress disorder (PTSD), headaches, and others.

Gabapentin works by acting upon neurotransmitters in the brain. Neurotransmitters are chemicals that allow communication between nerve cells.

Although gabapentin is structurally related to GABA, it does not bind to GABA receptors nor influence the degradation or uptake of GABA. Gabapentin seems to exert its effects through gabapentin binding sites that ultimately work on voltage-gated calcium channels possessing the alpha 2 delta 1 subunit, modulating the release of excitatory neurotransmitters.

Gabapentin is available as a capsule, tablet, and oral solution. It is offered under the brand names Gabarone, Neurontin, Gralise, and Fanatrex.

What is ED?

Erectile dysfunction (ED) is the inability to get or maintain an erection that is hard enough for satisfactory sexual intercourse. 

The condition includes any change to the erectile response. It can vary in severity, from difficulty maintaining an erection for long enough to the complete inability to produce an erection, regardless of any stimulation.

There are multiple causes of ED, which can affect men of all ages and backgrounds. However, the likelihood of developing ED increases with age, with 30% of men between 40 and 79³ years of age experiencing some form of erectile dysfunction. 

The inability to have an erection occasionally should not be a cause for concern. However, if it becomes an ongoing issue, it can increase stress and affect your self-confidence. Erectile dysfunction can also point toward underlying health conditions.

Medical conditions, certain behaviors, and lifestyle choices can increase your chances of developing ED. Some common risk factors for ED are:

• Health conditions such as heart disease, clogged arteries (atherosclerosis), chronic kidney disease, and high blood pressure (hypertension)

• Psychological and emotional issues, such as depression, stress, and sexual performance anxiety

• Physical injuries that restrict blood flow and cause nerve damage, especially in and around the penis

• Engaging in the use of alcohol, cigarettes, and illicit substances

• Diets are low in whole grains, foods, legumes, fruits, and vegetables and high in red meat, high-fat dairy products, and sugar

• Low levels of physical activity

Can gabapentin cause ED?

If you have begun to experience erectile dysfunction after taking gabapentin, you are not alone. ED caused by gabapentin is a potential side effect. 

Additionally, research shows several medications used for treating epilepsy can cause sexual dysfunction in both men and women.

For example, studies⁴ have shown that gabapentin-induced ED can occur in some individuals who take only 300 milligrams of gabapentin per day. Unlike previous case reports suggesting a total daily dose requirement of 900mg before possible sexual dysfunction. 

You may also experience other sexual dysfunction, including loss of libido (sex drive), ejaculatory dysfunction, and the inability to orgasm (anorgasmia), especially in females. 

Can gabapentin cause permanent ED?

Although many people experience sexual dysfunction when using gabapentin, these side effects are not normally permanent. They are reversed when the medication stops. 

One study⁵ summarized 14 cases of orgasmic dysfunction in both men and women. Their doses varied from 900mg/day to 3600mg/day. 

For the men in this study, orgasmic dysfunction was typically accompanied by erectile dysfunction. After a few days of stopping the medication, the sexual function returned to normal.

When to see a doctor

If you begin to experience sexual dysfunction after starting treatment and are concerned, please talk to your healthcare provider. 

There are no bad reasons to see your doctor. If you are failing to achieve an erection, then it’s worth mentioning this to your doctor just in case it is caused by another underlying condition, such as dysfunction of the blood vessels. 

Multiple options are available to treat gabapentin-induced erectile dysfunction, including switching to an alternative medication, lowering your dosage, or using a medication to treat erectile dysfunction.

It is important that you do not simply adjust or stop the dosage of gabapentin. Consult your healthcare provider before beginning any attempts to treat ED.

Alternative anti-seizure medications

If approved by your healthcare provider, you may be able to switch from gabapentin to another anti-seizure medication.

There are a variety of antiepileptic drugs. Not all of these drugs cause ED. Research⁶ shows that medications such as lamotrigine, levetiracetam, and oxcarbazepine have the ability to improve sexual function.  

Erectile dysfunction medication

If you choose to remain on gabapentin, you may be able to take an erectile dysfunction medication. 

These medications referred to as PDE5 inhibitors,⁷ allow an erection to last longer. This is done by slowing the enzyme PDE5 from breaking down chemicals responsible for erection, which allows the corpus cavernosum in your penis to stay engorged for longer. 

These medications will not work in the absence of sexual stimulation when the recommended dose has been taken.

These medications include sildenafil (the generic name for Viagra), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra). They are available in tablet form.

There are currently no negative interactions known between gabapentin and PDE5 inhibitors. 

It is essential that you consult your healthcare provider before beginning any of these medications, as there can be side effects.

The lowdown

There is a researched link between sexual dysfunction and some antiepileptic medications, including gabapentin. Sexual dysfunction can appear as erectile dysfunction in some men.

It can also cause other sexual performance issues, such as changes in libido (sex drive) and difficulty achieving orgasm.

If you have noticed ED after beginning gabapentin, it is important to talk to your healthcare provider. You may be able to improve your sexual function by switching medication, adjusting your dosage, or beginning to take a PDE5 inhibitor, which can improve erections.