Q: I am 44 years old and am an old patient of essential hypertension. I am taking Losacar 50 & Amtas-AT one tablet twice a day and with this my BP remains 130/90. But I am suffering from impotency. Please advise how can I restore it.

A:High blood pressure itself causes male erectile dysfunction (impotence). Many drugs that are given to treat high blood pressure also can lead to impotence. For example Amtas-AT is a combination product that contains amlodipine 5mg and atenolol 50mg. Both these agents are known to cause impotence. A similar combination is also sold under the trade name of Amlodac AT by the same company that markets Losacar. Losacar contains a medicine called losartan potassium. It is not known to cause impotence. Please note the following points: 1. You have not mentioned the names of any drugs that were given to control your blood pressure in the past, particularly if enalapril (Brand name: BQL) was tried. It is one of the very few anti-hypertensives that does not cause impotence. If it was not tried, your doctor may wish to review the case and put you on this drug (normal average dose is 10mg twice or thrice daily in case like yours). 2. It is also not clear as to why three drugs (losartan, amlodipine, atenolol) are being administered to you. Have lesser number of drugs in their maximum recommended doses been tried and failed? Normally at your age, one would expect non-pharmacological measures (exercise, low-salt diet) coupled with one, at the most two drugs to be adequate. The more drugs one takes, the more side effects are caused. Besides in future you may need even more drugs. 3. Before a second or third drug is added, one should invariably give the maximum recommended dose of the initial drug. For example the maximum doses of the three drugs you are consuming are as follows: losartan: 100mg once daily; amlodipine - 10mg daily and atenolol - 100mg daily. The maximum dose of enalapril is 40mg daily. 4. If at all more drugs are needed, good clinical practice demands that all drugs be given separately in carefully individually-titrated doses. 5. The information provided by you does not address the above issues. Hence I am unable to give you a definitive advice. 6. For symptomatic relief of erectile dysfunction, your doctor may wish to prescribe sildenafil (Brand name: Penegra 50 or 100mg).