Can Metoprolol Cause Erectile Dysfunction?

Heart medications like metoprolol can often cause difficulties when it comes to achieving and maintaining an erection.

What does this mean for users, though? Metoprolol treatment is intended to bring life-threatening heart conditions under control and cannot be interrupted. However, a healthy sex life is also important.

In this article, we’ll get into the physiology behind metoprolol-induced erectile dysfunction and discuss some of the possible solutions.

Metoprolol & Erectile Dysfunction

Beta blockers like metoprolol, as well as other cardiovascular medications, are safe and effective but can indeed cause ED. In the case of metoprolol, this effect comes as a result of lowered blood pressure.

Several studies have confirmed this unfortunate adverse effect stemming from metoprolol use. For instance, one study found that men with high blood pressure who started metoprolol treatment had lower average scores on an erectile function survey than men who utilized alternate medication [1].

However, other studies suggest there is also a psychological component when it comes to ED and metoprolol.

One particular study took 114 men and divided them into three groups [2]:

  1. One group who was treated with metoprolol and was informed about its potential to cause ED.
  2. One group who was only partially informed (they knew they were being treated with metoprolol but not about its links to ED).
  3. A third and final group received no information at all about the medication they were given.

After two months of treatment, the results were quite interesting. In the first group, 32% of the men reported experiencing ED, while less than 13% did so in the second group and only 8% in the third group.

And there’s more. The men who reported ED were treated with either tadalafil (the active ingredient in the ED medication Cialis) or a non-therapeutic placebo. Both treatment options were almost equally effective.

These results suggest the psychological component is a major factor in determining whether a patient experiences ED or not.

Researchers call this the “Hawthorne Effect” — knowledge about a certain condition or medication can affect both the patient’s and the doctor’s expectations, which can lead to both positive and negative results during treatment.

How to Treat Metoprolol-Induced Erectile Dysfunction?

As a metoprolol user, don’t panic if you find your ability to achieve erections is impaired by your treatment. There are plenty of ways to help treat erectile dysfunction.

1. Allow Your Body to Adjust

It is quite common for prescription medications to produce more side effects at the start of treatment, usually in the first couple of weeks. If you just started taking metoprolol and experience erectile dysfunction, wait until the third or fourth week before you start to worry. In many cases, the ED symptoms will go away on their own.

2. Consider Other Factors That Contribute to ED

Some of the most common health issues men face, like obesity and high blood pressure, are significantly linked to ED [3]. And if you’re on metoprolol treatment, chances are your doctor is already concerned about improving your overall health, such as your BMI and blood pressure.

Research shows diet and exercise are the best natural ways to treat ED — and improve your health [4].

Regular exercise can improve blood flow and make it easier to achieve and maintain erections. However, certain heart conditions may place limits on what exercise can safely be performed. Make sure to consult your doctor for knowledge on how to exercise without risk.

Another relatively easy fix is to stop smoking and drinking [5]. Smoking, for example, is known to cause harm to blood vessels and can make it more difficult for blood flow to enter the penis, while the depressant effects of alcohol can also cause performance issues. Cutting back on these habits can meaningfully improve your ED symptoms.

3. Other Pharma Options

ED may also be treated through the use of prescription medication, usually in the form of some type of PDE-5 inhibitor like Viagra or Cialis. These medications improve blood flow to the penis and help patients achieve erections that allow for satisfactory sex.

However, these medications are prescription-only, so you’ll need to talk to a licensed physician. This doctor will need to make sure the use of a PDE-5 inhibitor does not interfere with your metoprolol treatment.

Luckily — with the exception of sildenafil, which can significantly add to the blood pressure-lowering effect of metoprolol — these two drug types are generally safe for concomitant use.

4. Therapy

In some cases, the incidence of ED owes more to psychological factors than to physiological ones. For this reason, therapy — with or without your partner — could provide the mental tools needed to overcome whatever is keeping you from achieving an erection.

5. Surgical & Non-Surgical Treatments

Your doctor can prescribe a vacuum device for ED, which simply pulls and holds blood in the penis, allowing an erection.

Surgical options are available for extreme cases of ED when other treatments fail. These include malleable and inflatable implants or artery reconstruction.

What is Metoprolol (Lopressor)?

Sold under the brand name Lopressor, among others, metoprolol is a prescription medication belonging to a class known as “beta blockers.”. These medications are primarily used to manage abnormal heart rhythms and to protect users from a second heart attack after a first has occurred.

Metoprolol is specifically indicated by the FDA for the treatment of:

  • Hypertension: Metoprolol tablets are indicated for the treatment of hypertension and can be used alone or in combination with other antihypertensive agents.
  • Angina Pectoris: Metoprolol is indicated in the long-term treatment of angina pectoris, a type of chest pain caused by a poor supply of oxygen-rich blood to the heart.
  • Myocardial Infarction: Lopressor ampuls and tablets are indicated in the treatment of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality. Treatment with intravenous Lopressor can be initiated as soon as the patient’s clinical condition allows. Alternatively, treatment can begin within 3 to 10 days of the acute event.

What Does Metoprolol Do?

Metoprolol works by latching onto beta-1 receptors found in heart cells. It causes them to relax and slows down cardiovascular activity, thus reducing blood pressure and improving blood flow. Metoprolol causes the heart to beat slower.

In essence, metoprolol produces two types of effects:

  • Chronotropic: Alters heartbeat
  • Inotropic: It’s a negative inotropic agent and weakens the force of contractions

Metoprolol treatment is mostly preventative and meant to avoid cardiovascular issues. Apart from its FDA-approved indications, metoprolol is also used off-label as a treatment for supraventricular tachycardia and thyroid storm [6].

How Does Metoprolol Work?

Metoprolol is a β1-selective adrenoceptor antagonist that lacks intrinsic sympathomimetic (stimulant) activity [7].

As a receptor antagonist, metoprolol blocks or dampens a biological response by binding to and blocking a receptor rather than activating it like an agonist. Specifically, metoprolol blocks the receptor sites for epinephrine (adrenaline) and norepinephrine (noradrenaline) on adrenergic beta receptors.

Studies show that metoprolol has a preferential effect on beta-adrenoreceptors, which are chiefly located in the cardiac muscle. This effect is not absolute, however. At higher doses, metoprolol also inhibits receptors located in the bronchial and vascular musculature.

Epinephrine and norepinephrine receptors have a stimulant effect on the heart, causing it to work harder and faster. Metoprolol dampens this response and “slows down” the cardiovascular system.

Final Thoughts: Metoprolol & Erectile Dysfunction

There is no doubt that one of the side effects of metoprolol is ED, but psychological factors can also play a meaningful role. If ED does manifest at the beginning of treatment, we suggest waiting a few weeks before going to pharmacological options.

Improve your health through diet and exercise, as well as cutting back on harmful habits, can also greatly help ED. Based on the need for metoprolol, these changes are probably something you should do anyway. If ED persists, see a doctor to explore the possibility of other treatments.

References Used

  1. Brixius, K., Middeke, M., Lichtenthal, A., Jahn, E., & Schwinger, R. H. (2007). N itric o xide, e rectile d ysfunction and beta-blocker treatment: benefit of nebivolol versus metoprolol in hypertensive men. Clinical and Experimental pharmacology and physiology, 34(4), 327-331.
  2. Cocco, G. (2009). Erectile dysfunction after therapy with metoprolol: the Hawthorne effect. Cardiology, 112(3), 174-177.
  3. Rew, K. T., & Heidelbaugh, J. J. (2016). Erectile dysfunction. American family physician, 94(10), 820-827.
  4. McMahon, C. G. (2019). Current diagnosis and management of erectile dysfunction. Medical Journal of Australia, 210(10), 469-476.
  5. Ostfeld, R. J., Allen, K. E., Aspry, K., Brandt, E. J., Spitz, A., Liberman, J., … & Freeman, A. M. (2021). Vasculogenic erectile dysfunction: The impact of diet and lifestyle. The American Journal of Medicine, 134(3), 310-316.
  6. Morris, J., & Dunham, A. (2018). Metoprolol.
  7. Benfield, P., Clissold, S. P., & Brogden, R. N. (1986). Metoprolol. Drugs, 31(5), 376-429.






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