Xarelto and erectile dysfunction

Xarelto and Erectile Dysfunction: Personal Story

I was prescribed Xarelto (rivaroxaban) for deep vein thrombosis (DVT) following a treatment with heparin injections.

A few weeks after switching to Xarelto I noticed loss of libido, severe erectile dysfunction, reduced genital sensation, no response to sexual stimuli, and sexual anhedonia (pleasureless orgasm) when an orgasm was achieved. It was like I had become completely asexual. Even nocturnal erections had become extremely sparse and feeble, which was another way for me to confirm that there was something wrong on a physical rather than psychological level. To be more precise, the problem was not simply erectile dysfunction, but a sexual dysfunction with multiple side effects.

The above dramatic changes took place in about 2 weeks after starting Xarelto (20 mg once per day), at a time when I was taking no other drug or supplement, and have persisted unchanged since discontinuing the drug (March 2017).

The host of sexuality-related side-effects I experienced can be aptly summed up in two words: chemical castration. Such was the extent and depth of change in such a short period of time. A severe “punishment” for an (intentionally?) misinformed medication user when in most countries even child molesters are exempt from such a “treatment“.

Surprisingly, such adverse effects were not listed on the a Xarelto patient information leaflet. But this should not come as much of a surprise, as it is alleged that Bayer Health Group and Johnson and Johnson (the pharmaceutical companies which developed the drug) were well aware of studies showing Xarelto had higher rates of serious side effects but failed to provide adequate warnings about the known side effects both to doctors and to patients [1]. And the side effects referred to here are the ones that quite often lead to death, i.e. internal bleeding. If they were reticent about such… lethal side effects, would they be eloquent about sexuality-related side effects? I very much doubt it… In fact, a Google search for Xarelto lawsuits gives plenty of results. Xarelto’s serious side effects have a long range, if one takes into account post-marketing reports: internal bleeding, wound infections, thrombocytopenia (platelet deficiency), hepatitisStevens-Johnson syndrome (severe skin reaction) [2]:

Summary of Xarelto Warning Label Updates
  • August 2013: Black-box warning added on the increased risk of spinal bleeds
  • January 2014: Warnings about the lack of an antidote and that the drug should not to be used by patients with prosthetic heart valves
  • March 2014: Additional information added for healthcare professionals on limiting spinal bleeds
  • December 2014: Addition of new adverse reactions, thrombocytopenia and hepatitis
  • May 2016: Warning of an increased bleeding risk with SSRI and SNRI antidepressants

The vascular specialists I asked had no clue about such an adverse effect. I thought that this reaction would probably resolve when I stop the drug. The medication was discontinued on March 2017 and the condition has not resolved at all (last update: 11 July 2018). In effect, it has remained exactly as it was when it first appeared.

Following visits to urologists/andrologists, I was asked to check hormone levels for testosterone, prolactin, estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex hormone-binding globulin (SHBG) and albumin.

There was nothing in the results that indicated why this problem had presented itself. In fact, my testosterone was 981 ng/dl, putting me at the top 2,5% of men.

The doctors said that the medical knowledge on these physiological mechanisms is limited; there are plenty of unknown chemical paths where this could go wrong. They don’t even know which are the chemical triggers of libido, apparently, this is not testosterone.

When I searched on EudraVigilance and FDA’s Adverse Event Reporting System (FAERS) I found that there was a number of Individual Case Safety Reports with same adverse reactions (one even included penile size reduced). I would encourage anyone to submit side effects directly or via one’s healthcare professional to these databases, as well as Rxisk.

Currently, I am at a loss as what I should do to resolve the situation, or as to how the drug affected my organism and whether this can be remedied.

Drugs with similar side-effects

Interestingly, there are other medications that recently proved to have similar effects, like finasteride, causing post-finasteride syndrome (more about it by the Post-Finasteride Syndrome Foundation) and isotretinoin (Accutane, an acne medicine), causing post-retinoid sexual dysfunction (PRSD). And there are some papers on Endocrine Journal and International Journal of Risk & Safety in Medicine making the connection: 

Dr David Healy who wrote the book Pharmageddon and created the Rxisk website makes a suggestion of nerve damage, and specifically of c-fibers in a presentation regarding sexual problems caused by post-SSRI sexual dysfunction. I was particularly touched by a comment to that video: 

…not only do they destroy ability to experience physical affection. They also stop ability to feel love, empathy, compassion, regret, human connection. They make you a shell of a human being. In fact they take away the essential essence of being human. Beyond unconscionable.

If one were to coin a term for this issue, since it is a kind of drug-induced erectile dysfunction or more aptly drug-induced sexual dysfunction, it would be rivoraxaban-induced sexual dysfunction / rivoraxaban-induced erectile dysfunction or post-rivoraxaban sexual dysfunction.

To put all this into context, such sexuality-related issues affect the individual on a scale that goes far beyond the sexual plane [4]:

Brain mechanisms involved in fundamental pleasures (food and sexual pleasures) overlap with those for higher-order pleasures (for example, monetary, artistic, musical, altruistic, and transcendent pleasures).

Which is hardly an original concept and has very aptly been described by Nietzsche, in the Twilight of the Idols (Raids of an Untimely Man, §8):

For there to be art, for there to be any aesthetic activity and observation, one psychological prerequisite is indispensable: intoxication. Intoxication must have already heightened the sensitivity of the whole machine: otherwise, no art will be forthcoming. All kinds of intoxication, as different as their causes may be, have this power: above all, the intoxication of sexual excitement, that oldest and most primordial form of intoxication.

To wrap it up, I wonder whether there is any way to find out what is the status of the other people who reported the same issue; so if you are facing a similar situation, kindly get in touch.

You can see screenshots of the Individual Case Safety Reports at the end of this post.

Xarelto and Erectile Dysfunction: FDA reports

Erectile dysfunction is found among people who take Xarelto, especially for people who are 60+ old , have been taking the drug for 1 – 6 months, also take medication Amlodipine, and have Stroke. This study is created by eHealthMe based on reports of 119,666 people who have side effects when taking Xarelto from FDA, and is updated regularly (from ehlealthme.com).

Possible treatments for Xarelto-induced erectile dysfunction

Since the issues that arise from the use of Xarelto are much more complex than erectile dysfunctionPDE5 inhibitors like sildenafil (Viagra), tadalafil (Cialis) and the like are not likely to give anything more than an artificial erection which would not improve the quality of sensation.

If we accept the conjecture that anhedonic symptoms are due to some sort of nerve damage (as posited by David Healy above regarding PSSD) then there is nothing available on the market. In a trial stem cells were used for erectile dysfunction which was the result of radical prostatectomy (interestingly, exclusion criteria for this study was treatment with anticoagulants and lack of sexual interest):

Drugs that may cause erectile dysfunction /sexual dysfunction

Here is a list of drugs [3] (which will be edited here by me to update with new data) that may cause impotence/erectile dysfunction/sexual dysfunction:

Antidepressants and other psychiatric medicines

Amitriptyline (Elavil)
Amoxapine (Asendin)
Buspirone (Buspar)
Chlordiazepoxide (Librium)
Chlorpromazine (Thorazine)
Clomipramine (Anafranil)
Clorazepate (Tranxene)
Desipramine (Norpramin)
Diazepam (Valium)
Doxepin (Sinequan)
Fluoxetine (Prozac)
Fluphenazine (Prolixin)
Imipramine (Tofranil)
Isocarboxazid (Marplan)
Lorazepam (Ativan)
Meprobamate (Equanil)
Mesoridazine (Serentil)
Nortriptyline (Pamelor)
Oxazepam (Serax)
Phenelzine (Nardil)
Phenytoin (Dilantin)
Sertraline (Zoloft)
Thioridazine (Mellaril)
Thiothixene (Navane)
Tranylcypromine (Parnate)
Trifluoperazine (Stelazine)

Antihistamine medicines

(certain classes of antihistamines are also used to treat heartburn)

Cimetidine (Tagamet)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Hydroxyzine (Vistaril)
Meclizine (Antivert)
Nizatidine (Axid)
Promethazine (Phenergan)
Ranitidine (Zantac)

High blood pressure medicines and diuretics (water pills)

Atenolol (Tenormin)
Bethanidine
Bumetanide (Bumex)
Captopril (Capoten)
Chlorothiazide (Diuril)
Chlorthalidone (Hygroton)
Clonidine (Catapres)
Enalapril (Vasotec)
Furosemide (Lasix)
Guanabenz (Wytensin)
Guanethidine (Ismelin)
Guanfacine (Tenex)
Haloperidol (Haldol)
Hydralazine (Apresoline)
Hydrochlorothiazide (Esidrix)
Labetalol (Normodyne)
Methyldopa (Aldomet)
Metoprolol (Lopressor)
Nifedipine (Adalat, Procardia)
Phenoxybenzamine (Dibenzyline)
Phentolamine (Regitine)
Prazosin (Minipress)
Propranolol (Inderal)
Reserpine (Serpasil)
Spironolactone (Aldactone)
Triamterene (Maxzide)
Verapamil (Calan)
Thiazides are the most common cause of impotence among the high blood pressure medicines. The next most common cause is beta blockers. Alpha blockers tend to be less likely to cause this problem.

Parkinson disease medicines

Benztropine (Cogentin)
Biperiden (Akineton)
Bromocriptine (Parlodel)
Levodopa (Sinemet)
Procyclidine (Kemadrin)
Trihexyphenidyl (Artane)

Chemotherapy and hormonal medicines

Antiandrogens (Casodex, Flutamide, Nilutamide)
Busulfan (Myleran)
Cyclophosphamide (Cytoxan)
Ketoconazole
LHRH agonists (Lupron, Zoladex)

Other medicines

Aminocaproic acid (Amicar)
Atropine
Clofibrate (Atromid-S)
Cyclobenzaprine (Flexeril)
Cyproterone
Digoxin (Lanoxin)
Disopyramide (Norpace)
Estrogen
Finasteride (Propecia, Proscar, Avodart)
Furazolidone (Furoxone)
H2 blockers (Tagamet, Zantac, Pepcid)
Indomethacin (Indocin)
Isotretinoin (Accutane, Roaccutane)
Lipid-lowering agents
Licorice
Metoclopramide (Reglan)
NSAIDs (ibuprofen, etc.)
Orphenadrine (Norflex)
Prochlorperazine (Compazine)
Pseudoephedrine (Sudafed)
Sumatriptan (Imitrex)

Opiate analgesics (painkillers)

Codeine
Fentanyl (Innovar)
Hydromorphone (Dilaudid)
Meperidine (Demerol)
Methadone
Morphine
Oxycodone (Oxycontin, Percodan)

Recreational drugs

Alcohol
Amphetamines
Barbiturates
Cocaine
Marijuana
Heroin
Nicotine

Alternative Names

Impotence caused by medications; drug-induced erectile dysfunction; drug-induced sexual dysfunction; prescription medicines and impotence; prescription medicines and sexual dysfunction

Screens from Pharmacovigilance databases

Xarelto and erectile dysfunction
FDA’s Adverse Event Reporting System (FAERS) reports for erectile dysfunction and Xarelto
Xarelto erectile dysfunction
EudraVigilance results for erectile dysfunction side effects following use of Xarelto
Xarelto libido side effect
FDA’s Adverse Event Reporting System (FAERS) reports for erectile dysfunction and Xarelto
FDA's Adverse Event Reporting System (FAERS) reports for erectile dysfunction and Xarelto
FDA’s Adverse Event Reporting System (FAERS) reports for erectile dysfunction and Xarelto
Xarelto's side effects
FDA’s Adverse Event Reporting System (FAERS) – Xarelto’s side effects
[1] WJB Associates – side effects of Xarelto

[2] Xarelto Serious Side Effects

[3] Drugs that may cause impotence

[4] Kringelbach ML. The hedonic brain: a functional neuroanatomy of human pleasure. In: Kringelbach ML, Berridge KC, editors. Pleasures of the Brain. Oxford, UK: Oxford University Press; 2010. See also: Neurobiology of sexual desire

Κάταγμα = ακινησία = θρόμβωση

Σπύρος ΔόικαςΣτον τίτλο περιγράφεται με τρεις λέξεις η ιστορία μου. Το αστείο της υπόθεσης είναι ότι πολύ εύκολα αυτή η δυσοίωνη εξίσωση θα μπορούσε να έχει βγάλει… άλλα αποτελέσματα αν έστω και ένας από τους ιατρούς ή/και λοιπούς λειτουργούς υγείας με είχε ενημερώσει για τους δυνητικούς κινδύνους («πρόληψη») ή είχε φροντίσει να αποκλείσει το τρίτο σκέλος («θρόμβωση») συνιστώντας θρομβοπροφυλακτική αγωγή ή και πολύ απλές και ανώδυνες εξετάσεις (υπερηχογράφημα τρίπλεξ) ή ακόμη απλούστερα το δεύτερο σκέλος της εξίσωσης («ακινησία»), συνιστώντας κάποιας μορφής κινητικότητα. Keep reading →