If you've noticed any changes to your erections since starting a beta blocker, you may be wondering whether your medication is to blame. Beta blockers and erectile dysfunction (ED) have a complex relationship. Some men experience sexual side effects, but research findings are mixed, and ED is not inevitable for everyone taking these medicines.
Your overall health, other medications, mental health, and response to treatment can all play a part, and knowing these potential causes can help you when discussing ED with your GP.
Do not stop taking your medication unless it's been advised by a medical professional, as doing so suddenly can pose health risks and isn't always advised depending on what medication you're taking.
What Does Research Say About Beta Blockers and Erectile Dysfunction?
Research indicates that the use of beta blockers may play a role in sexual side effects in some patients. However, there is uncertainty around the impact that they have on a person’s erectile function.
A 2002 meta-analysis published in JAMA by Ko et al. looked at 15 randomised controlled trials and more than 35,000 patients. They found approximately five extra cases of reported sexual dysfunction per 1,000 patients taking beta blockers for one year, which equals one extra report of sexual dysfunction for every 199 patients treated per year.
This figure only refers to all sexual dysfunction and not specifically to erectile dysfunction (ED). Sexual dysfunction is a general term that covers several issues, and using this number to calculate the likelihood of developing ED would be misleading.
A 2021 network meta-analysis, which included 25 studies involving 7,784 patients, found no statistically significant differences in erectile function between the main types of antihypertensive drugs. Nebivolol appeared to perform better than non-vasodilating beta blockers, but this difference was not significant when comparing it to a placebo.
Research, therefore, does not support a simple link between beta blockers and ED. The impact of these medications on sexual function may vary in different individuals, and other factors can also contribute to ED, including the underlying cardiovascular disease, other medications, and patient-specific factors. Patients concerned about sexual side effects should talk to their GP about their symptoms and treatment options rather than adjusting their medication without specialist advice.
Can High Blood Pressure Cause Erectile Dysfunction?
High blood pressure can affect blood vessels that supply blood to the penis, causing reduced blood flow, which can lead to impotence. This is because, for an erection to occur, blood has to flow into the penis, and high blood pressure can reduce this blood supply. Heart disease, diabetes, high cholesterol, and smoking are also associated with Erectile Dysfunction. Several risk factors can contribute to erection problems at the same time.
If you started having problems with erections after starting beta blockers, this may be a possible cause; however, it only suggests that it could be a possible cause, not that it is definitely the reason. You should talk to your GP about your concerns; they can review your symptoms, medical history, and medications to find the possible cause and which treatment option can be suitable for you.
Can Expectations About Side Effects Affect Erections?
Psychological factors can influence sexual function, including how a person experiences and reports side effects of medication. This is sometimes known as a nocebo effect.
A small study from 2003 by Silvestri et al. of 96 men newly diagnosed with cardiovascular disease who were placed on atenolol treatment provides some insight into the issue. During the course of treatment, erectile dysfunction was noted by around 3% of men who were unaware of the drug's name, 15.6% of men who knew the name of the drug but were not warned about this particular side effect, and 31.2% of men who were made aware of this specific side effect. These results suggest that a person's expectations and anxieties around the medication may play a role in their experience of erectile dysfunction. However, it should be noted that the study was small and cannot establish beyond doubt that psychological factors are the sole cause of ED in all men who take a beta-blocker.
If you are concerned that your medication is affecting your sex life, communicate with your GP openly instead of assuming that the problem is either purely psychologically caused or definitively due to the medicine.
Which Beta Blockers Are More Likely to Affect Erections?
Beta blockers can differ in their properties and effects on the cardiovascular system. According to the research, the sexual side effects can vary between medicines, but the evidence is not strong enough to predict an individual’s response with certainty.
- Nebivolol: This beta blocker promotes blood vessel dilation through nitric oxide-related mechanisms. Some studies suggest that it may have a more favourable effect on erectile function than certain other beta blockers. The evidence for the effects is limited, and improvement is not guaranteed.
- Atenolol – This drug has been studied in relation to beta blockers, patient expectations and erectile dysfunction (ED). However, individual study results should not be extrapolated to the general population.
- Metoprolol and bisoprolol – Sexual side effects have been reported for these drugs in some men. However, cardiovascular disease, concomitant drug use and other individual factors should also be taken into account when addressing erectile dysfunction.
- Propranolol – There are conflicting reports on sexual side effects in men who take propranolol. However, this is not indicative of definitive causality for every individual who takes this medication.
- Carvedilol – The evidence base for this drug’s effects on male sexual function is limited. As with any medication, it must be considered in the context of an individual’s cardiovascular condition, treatment requirements and overall health status.
Do not stop taking a beta blocker or alter your dose without consulting a physician. Your GP can review your cardiovascular history, reason for your treatment, your current symptoms, then weigh up the potential benefits and harms of other medications in your particular circumstance.
Why Might Beta Blockers Affect Erections?
The reasons why some beta blockers may contribute to erectile dysfunction are complex and cannot be fully understood. Multiple factors play a role and their effect can vary individually.
- Vascular effects: An erection involves good blood flow to the penis and the relaxation of smooth muscles in the erectile tissues. The impact of beta blockers on the cardiovascular system varies depending on the drug. For instance, nebivolol has been studied in relation to its effect on nitric oxide signalling and blood vessel dilation.
- Fatigue: The fatigue side effect of beta blockers may have an impact on sex drive and function. Fatigue is a common side effect of several illnesses as well as other medications.
- Psychological factors: Stress, fears regarding the side effects of the drugs and performance anxiety can also contribute to erectile dysfunction.
- Underlying health conditions: Illnesses like high blood pressure, cardiovascular diseases, and diabetes can affect the erection mechanism by weakening the blood vessels and/or the nerves.
These factors can occur together. Consulting your GP can help you assess the likely contributors instead of jumping to the conclusion that the medication is the cause just because it started soon after it was taken.
Treatment Options if You Think a Beta Blocker Is Affecting You
1. Don't stop your medication, and don't stay silent
Beta blockers are prescribed for several cardiovascular conditions, including certain heart rhythm problems, angina, and heart failure, depending on the medicine. They are indicated in the treatment of a number of diseases that affect the heart and blood vessels, but they are prescribed by a doctor. Stopping the beta blockers without a doctor’s approval can aggravate the existing disease. If you have erectile dysfunction, speak to your GP or cardiologist instead of stopping the drug.
When describing the situation to the doctor, be sure to mention when exactly the symptoms began, whether you changed the dose or the drug itself, and whether you have any other side effects.
2. Ask for a Medication Review
Your GP or cardiologist can review the drugs you are taking and see if they are causing you any problems.
Depending on the situation, the doctor may recommend changing the dose or prescribe other medications instead. In some cases, nebivolol or another blocker drug may be recommended, but this is a decision that only the doctor can make, based on your personal health situation.
Your review may also include tests of blood pressure, blood sugar, cholesterol levels, and other drugs as well as an assessment of your lifestyle, and hormone tests if there is a suspicion of a hormonal disorder.
Do not make these changes without the guidance of a clinician, particularly if you have a history of heart disease or heart failure.
3. Ask whether ED treatment is appropriate
It can sometimes be possible to treat ED even when a person takes a medicine for blood pressure, but treatment should only be considered after a review of cardiovascular health and possible medicine interactions.
Medicines in the phosphodiesterase type 5 (PDE5) inhibitor class are often used to treat ED, but are not suitable for everyone. Key safety considerations include:
- Nitrates: PDE5 inhibitors should not be taken in combination with nitrate medicines such as glyceryl trinitrate used for angina, as this can cause a dangerous drop in blood pressure.
- Alpha blockers: These are used to treat high blood pressure or benign prostatic hyperplasia, but can increase the risk of hypotension when combined with ED medicines. A clinician may need to adjust treatment or give specific advice.
- Riociguat: This medicine is used for certain forms of pulmonary hypertension, but must not be used in combination with PDE5 inhibitors.
- Cardiovascular fitness: Men with unstable or high-risk cardiovascular conditions need to be assessed before engaging in sexual activity or receiving ED treatment.
Chest pain after taking an ED medicine: If you have chest pain after taking an ED medicine, call 000 straight away. Do not take glyceryl trinitrate (GTN) or any other nitrate yourself, as nitrates combined with PDE5 inhibitors can cause a dangerous drop in blood pressure. Tell the ambulance and emergency staff which ED medicine you took.
4. Address anxiety and lifestyle issues
Psychological factors sometimes play a role in ED, with or without an underlying medical cause. Anxiety about sex or about having sexual intercourse can contribute to ED, especially when combined with stress about medication side effects. This can create a cycle that makes ED seem more severe.
Depending on the cause of your ED and your personal circumstances, some approaches that may help include:
- Talking to your partner and healthcare professional about your feelings and concerns
- Seeking psychological counselling or psychotherapy if anxiety or other psychological factors contribute to your ED
- Getting regular exercise as tolerated, based on your healthcare professional's advice, particularly if you have heart conditions
- Stopping smoking and limiting alcohol consumption
- Eating a healthy diet and maintaining a healthy body weight, if appropriate
If you become dizzy, faint, or feel as if you are about to faint after taking a medicine for ED, seek immediate medical attention. If you are experiencing chest pain or severe dizziness, call (000) for an ambulance.
Why Erectile Dysfunction Matters Beyond Sexual Health
Erectile dysfunction can affect confidence, relationships, and even quality of life. It can also be associated with cardiovascular risk factors because healthy erections depend on adequate blood flow.
Persistent ED does not automatically mean that one has heart disease. If you have high blood pressure, diabetes, abnormal cholesterol levels, or a history of smoking, then you can discuss your cardiovascular health with a GP.
Frequently Asked Questions
How common is erectile dysfunction with beta blockers?
The evidence is mixed. One large meta-analysis concluded that there was approximately 1 additional case of sexual dysfunction overall for every 199 patients who took beta blockers for a year. This figure does not consider ED specifically, and high blood pressure itself can contribute to erection problems.
Which beta blocker is least likely to cause erectile dysfunction?
Nebivolol may have a more favourable effect on erectile function than some non-vasodilating beta blockers. However, the evidence is limited, and it is not necessarily appropriate for everyone – speak to your GP before considering a change to your medication.
Can I take Viagra or Cialis with beta blockers?
Some men taking beta blockers may be eligible for ED treatment, but a clinician will need to assess their medical history, cardiovascular health and other medicines first. PDE5 inhibitors must not be taken with nitrates or riociguat, and caution is needed when combining them with alpha blockers. If you have chest pain after taking an ED medicine, call 000, do not take GTN or other nitrates yourself, and tell emergency staff which ED medicine you took and when.
Can I stop my beta blocker if I think that it is causing ED?
No, you shouldn't just stop taking your beta blocker without telling your doctor. Tell them about your concerns, and they will be able to look into it and find out what might be the cause.
Is it the beta blocker or my high blood pressure that is causing the ED?
It can be either your medication, your high blood pressure, or something else. Symptoms of ED that start when you start a new drug or when you increase the dose of an existing one can suggest that the medication might be the cause, but this isn't always the case.
Will my ED get better if I change to nebivolol?
Possibly. Some studies suggest that erectile function can be improved after switching to nebivolol, but the evidence for these effects is limited, and improvement is not guaranteed. Whether nebivolol is suitable depends on your medical history and why you need a beta blocker. Discuss any medication changes with your doctor.
