ADHD medication sexual side effects: what FDA labels and studies say

Sexual side effects are among the hardest things to bring up with a prescriber, and they may be underreported as a result. This page sets out what FDA labels (checked on DailyMed on November 4, 2026) and studies say about each medication type, how strong that evidence is, and how to raise the topic. It gives no doses. It is not a reason to stop a medication on your own.

Urgent: priapism

Priapism is an erection that lasts too long, whether or not it hurts. Go to an emergency room or call 911 for an erection that will not go away. Do not wait for it to pass.

• Methylphenidate. The Concerta label warns that prolonged and painful erections, sometimes requiring surgery, have been reported in adult and pediatric males using methylphenidate. It says priapism was not reported when starting the drug. It occurred after some time on it, often after a dose increase, and also during withdrawal, such as drug holidays or stopping. Patients with abnormally sustained or frequent and painful erections should seek immediate medical attention.
• Atomoxetine. The Strattera label says prompt medical attention is required. It describes rare postmarketing cases in children and adults and defines priapism as a painful or nonpainful erection lasting more than 4 hours. Its Medication Guide says the problem can cause lasting damage to the penis and may require surgery.
• Amphetamines. The Adderall XR and Vyvanse labels list frequent or prolonged erections among reactions reported after approval. Such reports cannot show how often this happens or establish that the drug caused it. Treat a prolonged erection on any medication as urgent.

The Concerta passage on withdrawal is one more reason not to manage this on your own by stopping or skipping doses.

What labels report, medication by medication

Figures come from each label's own trials and cannot be directly compared across drugs. Male-only figures are noted as such.

Atomoxetine: the most direct evidence

Strattera stands out because the label gives adult figures and addresses the issue head-on. It says the drug "impaired sexual function in some patients", and that estimates are likely to underestimate true rates because patients and clinicians may be reluctant to discuss them. It also says there are no adequate, well-controlled studies examining sexual dysfunction with the drug, and that health care providers should routinely ask about it. Patients are told to contact their provider if it occurs. Erectile dysfunction led 0.4% of adults in the trials to stop treatment.

Metabolism may matter. Among adults who are CYP2D6 poor metabolizers, the label reports erectile dysfunction in 21% against 9% in other metabolizer types, and ejaculation disorder in 6% against 2%. NICE guidance specifically advises monitoring young people and adults for erectile and ejaculatory dysfunction as potential adverse effects of atomoxetine. A 2019 network meta-analysis of 10 adult trials also found a difference in decreased libido between atomoxetine and placebo. More is on the Strattera page.

Stimulants: listed, but less well measured

Sexual effects appear in stimulant labels mostly as short lines, and trials were not designed to measure them. Long-term data are sparse. In a Swedish study following adults about six years after evaluation, 17% of those still taking methylphenidate reported decreased sexual desire. That study was not placebo-controlled, so the figure does not show how much was due to the drug. A 2025 narrative review concluded that stimulants and nonstimulants have shown both beneficial and adverse effects on sexual function, and that data are limited.

Viloxazine and bupropion

The Qelbree label's adult table contains no sexual side effect, and the label has no priapism warning. Its adult safety data come from one 6-week trial, so it could miss less common or slower effects. "Not listed" should not be read as "does not happen."

Bupropion is approved for depression and seasonal depression, and it is off-label for ADHD. See bupropion for ADHD. In two 8-week trials in adults with major depression, orgasm dysfunction at week 8 was reported by 15% on bupropion XL, 30% on escitalopram and 9% on placebo. Bupropion was not statistically different from placebo on sexual measures, but it also did not separate from placebo on the main depression rating scale in those trials. These results come from depression, not ADHD, and they do not show that switching will solve a sexual side effect from an ADHD medication.

It may not be the medication

Three other explanations are worth considering.

• ADHD itself. A 2020 systematic review found people with ADHD report more sexual desire, less satisfaction and more sexual dysfunction than the general population, while noting few studies, small samples and possible bias. In a Dutch outpatient clinic, 39% of men and 43% of women with ADHD had symptoms of a sexual dysfunction. A 2026 systematic review of 13 observational studies called the link between ADHD and sexual dysfunction probably bidirectional, while noting that measures varied too much to pool and that several studies found no difference. These studies do not establish cause. See ADHD and relationships.
• Depression. A 2012 meta-analysis of prospective studies found depression raised the risk of sexual dysfunction, and sexual dysfunction raised the odds of depression. The authors said patients reporting sexual dysfunction should be routinely screened for depression. See ADHD or depression.
• Other medications. In the trials above, escitalopram had higher rates of sexual side effects than placebo. A full list of what you take helps your prescriber. See drug interactions.

How to raise it with a prescriber

You do not need to have the right words. The Strattera label asks clinicians to raise the topic, so the question is an expected one. Any of these can open the conversation:

• "Since starting this medication, I have noticed a change in my sex life. Is it okay to talk about that?"
• "Is this a known side effect of what I take?"
• "I am having trouble getting or keeping an erection," or "orgasm is harder to reach," or "I have lost interest."

Before the visit, write down:

1. What changed, and when compared with starting or changing a medication.
2. How things were before treatment. ADHD, low mood or a relationship issue may already have been part of it.
3. Everything else you take, including antidepressants, blood pressure medicines, alcohol and supplements.
4. Your mood and sleep lately.
5. How much this bothers you, and how it weighs against the benefit from the medication.

Then ask: Could this be the medication, ADHD, mood or something else? Should I see my primary care doctor or a urologist or gynecologist for other causes? Is there a change you would consider, and what are the trade-offs? Options depend on your medication and history, and evidence on what relieves these side effects in ADHD treatment is limited. Do not stop on your own: stimulant labels describe withdrawal after abrupt stopping, and the risks differ by drug. See stopping ADHD medication. A broader overview is in side effects in adults.

If this is weighing on your mood, tell someone. For thoughts of suicide, call or text 988. Call 911 for emergencies.

Dr. Shershow evaluates and treats adults with ADHD located in New York or New Jersey, including medication management when medication is appropriate. See adult ADHD treatment.