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David asked...

I have been taking methotrexate and hydroxychloroquine for rheumatoid arthritis. However, whilst the mind is willing I am unable to obtain an erection. Is there anything I can take to overcome this without affecting the above medication. Many thanks.

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The Answer

The loss of libido and or impotence is a common problem and well-recognised as a side effect of Methotrexate. Methotrexate is also an immunosuppressant which means that it supresses the immune system. There are medications available to help with this problem otherwise known as erectile dysfunction. Not everyone can have medications that help with erectile dysfunction on an NHS prescription. There are certain groups who can have them on an NHS prescription including those who take medicines that supress the immune system. For this reason we think your doctor should be able to prescribe medications such as Sildenafil (better known as Viagra), Avanafil, Tadalafil and Vardenafil.

To help you make your choice I have listed each of these medications below and how each is taken.

Avanafil

Use in adult men: The recommended dose is 100 mg (2x50mg tablet or 1x100mg tablet) taken as needed approximately 15 to 30 minutes before sexual activity. Based on individual efficacy and tolerability, the dose may be increased to a maximum dose of 200 mg or decreased to 50 mg. The maximum recommended dosing frequency is once per day. Sexual stimulation is required for a response to treatment.

Sildenafil

Use in adults: The recommended dose is 50 mg (1x50mg tablet) taken as needed approximately one hour before sexual activity. Based on efficacy and tolerability, the dose may be increased to 100 mg or decreased to 25 mg. The maximum recommended dose is 100 mg. The maximum recommended dosing frequency is once per day. If Sildenafil is taken with food, the onset of activity may be delayed compared to the fasted state.

Tadalafil

Erectile dysfunction in adult Men: In general, the recommended dose is 10 mg (4x2.5mg/2x5mg/1x10mg tablet) taken prior to anticipated sexual activity and with or without food. In those patients in whom Tadalafil 10 mg does not produce an adequate effect, 20 mg might be tried. It may be taken at least 30 minutes prior to sexual activity.

The maximum dose frequency is once per day.

Tadalafil 10 and 20 mg is intended for use prior to anticipated sexual activity and it is not recommended for continuous daily use.

Vardenafil

Use in adult men: The recommended dose is 10 mg (2x5mg/1x10mg tablet) taken as needed approximately 25 to 60 minutes before sexual activity. Based on efficacy and tolerability the dose may be increased to 20 mg or decreased to 5 mg. The maximum recommended dose is 20 mg. The maximum recommended dosing frequency is once per day. Levitra can be taken with or without food. The onset of activity may be delayed if taken with a high fat meal.

Vardenafil is available as Levitra 10 mg orodispersible tablets. These are taken as needed approximately 25 to 60 minutes before sexual activity.

We have checked and confirmed that all of the above medicines are compatible with Methotrexate and Hydroxychloroquine.

However, they are generally not be used in men for whom sexual activity is inadvisable such as patients with severe cardiovascular disorders such as unstable angina or severe cardiac failure. In addition certain other groups of people, because of their medical condition are unable to take these medications.

As with all medicines the medicines listed above all have side effects which may influence your choice. As you can see you and your doctor will need to consider all of the above factors before your doctor can prescribe any of these medicine to help you.

If the medications listed above are unsuitable then there are injections and devices that your doctor may be able to offer you.

We suggest to discuss this matter with your GP.

Answered by the Health at Hand nurses  

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