Which Beta-Blockers Cause Erectile Dysfunction?

Beta-blockers, commonly prescribed for high blood pressure, can effectively lower blood pressure and heart rate. But can they also kill erections?

It’s possible.

If you’re prescribed a beta-blocker, you may notice changes in your ability to get an erection, as well as other aspects of your sexual function. But not all beta-blockers are created equal.

Below, we’ve discussed what beta-blockers are, why they’re prescribed, and which ones may contribute to erectile issues. 

We’ve also explained your options if you’re prescribed a beta-blocker and think that it may have a negative impact on sexual performance.

Beta-adrenergic receptor antagonists, or beta-blockers, are medications that reduce the effects of certain chemicals, such as epinephrine and norepinephrine, on receptors found throughout your body.

More specifically, beta-blockers prevent these substances from attaching to beta receptors — a class of receptors found in your heart and other organs.

Epinephrine and norepinephrine are adrenal hormones and neurotransmitters, or chemicals, used within the nervous system to send messages. Norepinephrine, for example, stimulates heart rate and increases blood pressure.

Your body needs these chemicals to properly respond to stressful or dangerous situations. They’re part of your “fight-or-flight” response to dealing with danger when it occurs.

Norepinephrine also breaks down fat, regulates your sleep-wake cycle, allows you to focus on specific tasks, and regulates your emotions.

Although epinephrine and norepinephrine are critical for your health, having high levels of these hormones could cause your heart to work harder than it should. This can contribute to elevated blood pressure, panic attacks, and hyperactivity.

What Do Beta-Blockers Do?

Beta-blockers can slow heart rate, reduce high blood pressure, and relieve some physical symptoms of anxiety by blocking the effects of epinephrine and norepinephrine on the heart.

Your healthcare provider may suggest taking a beta-blocker if you have:

• An overly fast heart rate (tachycardia)

• High blood pressure (hypertension)

• Had a previous heart attack (myocardial infarction)

• High thyroid hormone levels (hyperthyroidism)

• Coronary artery disease (CAD)

• Congestive heart failure

• Aortic dissection (AD)

• Heart disease

• Essential tremor

• Glaucoma

• Chest pain (angina)

Beta-blockers are also occasionally used to treat and prevent migraines, which are moderate and severe headaches that occur frequently and cause discomfort.

Common beta-blocker medications include:

• Atenolol

• Bisoprolol

• Carvedilol

• Labetalol

• Metoprolol

• Propranolol

• Sotalol

Our guide to beta-blockers discusses these medications in more detail, including how they work, popular uses, potential drug side effects, interactions, and more.

Like all medications, beta-blockers can cause side effects, including sexual performance issues such as erectile dysfunction (ED).

If you’re prescribed a beta-blocker as a blood pressure medication, you may notice that it’s more difficult for you to get an erection that’s firm enough for sexual intercourse than before you started using the medication.

Experts can’t confirm why or how some beta-blockers can cause erectile dysfunction, but research suggests it’s likely related to the effects of these medications on blood flow to the smooth muscle tissue inside the penis.

Erections depend on healthy, consistent blood flow. When you experience sexual desire, blood flows to the erectile tissue inside your penis, resulting in a penile erection.

This blood flow to your penis is what gets you hard and helps you stay that way during sex. A range of medical conditions and medications that reduce blood flow can make getting an erection harder and contribute to ED.

We’ve discussed how erections work, as well as how important blood flow is for healthy sexual function, in our guide to what erections are and how they work. 

Because there are several different kinds of beta-blockers, and ED can vary significantly in severity, there’s no surefire analysis about beta-blocker therapy and difficulties related to erections and sexual performance.

Several beta-blockers commonly prescribed as antihypertensive drugs have led to an increased risk of ED in hypertensive men. But most of the problematic drugs are first- and second-generation drugs, which are older beta-blockers like propranolol and metoprolol. Newer beta-blockers do not seem to carry the same risk.

For example, research shows that hypertensive patients who use the beta-blocker metoprolol (a second-generation drug) to treat high blood pressure have higher rates of ED than men who use other treatments.

Meanwhile, other scientific research, including one 2017 study published in the journal Annals of Thoracic and Cardiovascular Surgery, has found that third-generation beta-blockers like nebivolol have a lower risk ratio for ED than metoprolol in men with ischemic cardiac disease. This is due to nebivolol’s vasodilation effects (blood vessel widening) and its ability to increase nitric oxide production.

Another study on nebivolol found that the drug also had a lower risk ratio for ED when compared to another third-generation beta-blocker, carvedilol, and older drugs, bisoprolol, atenolol, and metoprolol. However, though carvedilol's side effects include erectile dysfunction, it still carries a lower risk as a third-generation drug.

If you’re prescribed a beta-blocker or other blood pressure drug and think that it’s more difficult for you to get and stay hard during sexual activity, it’s important to keep in mind that your medication may not be the only factor involved in your symptoms.

Beta-blockers are commonly prescribed to treat high blood pressure and heart health problems, including after cardiovascular events such as a heart attack.

Because blood flow is essential for healthy erections, many conditions that affect your heart can also cause or contribute to erectile dysfunction. These include atherosclerosis (clogged arteries), heart disease, elevated blood pressure, type 2 diabetes, and chronic kidney disease. 

In addition to cardiovascular health issues, a range of other risk factors can affect your ability to get and maintain an erection sufficient for sex. These include:

• Injuries to your penis, spinal cord, bladder, prostate and/or pelvis

• Complications from prostate surgery, bladder surgery, or radiation therapy

• Mental health issues, such as depression, stress, or sexual performance anxiety

• Feelings of guilt or worry about having sex

• Smoking, drinking alcohol, or using illicit drugs

• Being overweight and/or physically inactive

Other medications, including antidepressants, antiandrogens, alpha-blockers, diuretics, sleeping pills, ulcer medications, and appetite suppressants, may also cause or contribute to drug-related erectile dysfunction.

Whether it develops as a side effect of therapy with beta-blockers, as the result of performance anxiety, or due to a physical health issue, erectile dysfunction is almost always treatable.

If you take a beta-blocker and feel like you’re less able to get and/or maintain an erection than before starting treatment, it’s important to let your healthcare provider know.

They may adjust the dosage of your beta-blocker medication or switch you to a different type of cardiovascular medication, such as a calcium channel blocker, angiotensin-converting enzyme (ACE) inhibitor, or angiotensin receptor blocker. They may also suggest other changes that you can make to reduce the risk of ED and other unwanted, negative effects. 

It’s important not to abruptly stop taking your beta-blocker without talking with your healthcare provider first. Stopping treatment suddenly can reverse the beneficial effects of treatment with beta-blockers and may cause your blood pressure, heart health, or anxiety to worsen. 

Is It Safe to Take Viagra With Beta-Blockers?

In some cases, your healthcare provider may recommend taking erectile dysfunction medication to increase blood flow to your penis and improve your erections.

Popular medications for treating ED include sildenafil (the active ingredient in Viagra®), tadalafil (Cialis®), vardenafil (Levitra®), and avanafil (Stendra®), which are part of a class of drugs called PDE5 inhibitors. 

ED medications are safe and effective for most men, even those taking beta-blockers. However, you should talk to your provider about any potential side effects that may occur and whether this drug combination is right for you.

Some beta-blockers may also interfere with the effectiveness of your ED medication. For instance, when it comes to propranolol and Viagra, one animal study found that the beta-blocker may “mask” or diminish the PDE5 inhibitor’s impact on erectile function. This could be due to propranolol’s effects on blood flow, which might counteract Viagra’s intended effects. However, more human research is needed to confirm these findings.

You also shouldn’t mix PDE5 inhibitors like Viagra with nitrates and other types of medication for heart disease and high blood pressure. 

Lifestyle Changes to Treat ED

Beyond taking medication, making changes to your habits and quality of life can often improve your ability to get an erection.

Because erections are all about healthy blood flow, many habits that are good for your erections can also benefit your heart health and blood pressure.

Good habits for treating erectile dysfunction include limiting your alcohol consumption, giving up smoking, avoiding illicit drugs, keeping yourself physically active, and maintaining a healthy body weight.

When ED is caused by a psychological issue, such as stress or anxiety, participating in therapy is also often helpful.

Our full guide to maintaining an erection naturally covers more about how you can change your habits for better blood flow, erections, and sexual function. 

Beta-blockers are common medications that are usually prescribed to treat high blood pressure, heart disease, and certain physical symptoms of anxiety.

Although beta-blockers offer plenty of benefits as cardiovascular medications, the effects of beta-blockers may also increase your risk of erectile dysfunction. Remember:

• Some beta-blockers carry a higher risk of ED than others. Generally, first- and second-generation beta-blockers have a higher risk of ED than third-generation drugs.

• Many medical conditions for which beta blockers are prescribed are also linked to ED. For example, high blood pressure is a leading risk factor for the development of ED, along with anxiety. Therefore, when a patient taking a beta blocker reports erectile dysfunction, it can be hard to figure out the exact cause.

• If your sexual performance has suffered since you started taking a beta-blocker, be sure to let your healthcare provider know. They may suggest adjusting your dosage, switching to a different beta-blocker, or taking a second medication to treat ED. 

With the right treatment approach, many men who are prescribed beta-blockers can experience a significant improvement in erectile function.

Interested in getting started? Schedule an erectile dysfunction consultation to discuss your treatment options with a licensed healthcare provider.