Metoprolol and Erectile Dysfunction: What's the Connection?

Published: 2021-07-13

Updated: 2024-05-15

4 mins

When it comes to erectile dysfunction, ideal treatment can depend on what's catalyzing your issue in the first place: underlying medical conditions, medication interactions, declining libido, or mental health issues?

A variety of common prescription medications can lead to erectile dysfunction as a side effect, and one medication that has a potential link is the blood pressure pill metoprolol. 

What Is Metoprolol?

Metoprolol is a prescription medication commonly used to effectively manage high blood pressure (hypertension), either alone or in combination with other medications to enhance treatment efficacy. It is often prescribed to prevent various cardiovascular issues such as angina (chest pain), kidney complications, migraines, heart attacks, and strokes, all of which can arise due to elevated blood pressure. In some cases, it is postulated that a doctor might prescribe it following a heart attack to promote survival, alleviate heart failure, and even assist in regulating an irregular heartbeat in patients.

It’s crucial to understand that while metoprolol may help manage these symptoms, it is not a curative treatment for the underlying conditions that lead to them.

The most recognized branded variations of metoprolol include Lopressor®, Toprol®, and Toprol XL®, and it can also be found in formulations that combine it with other active ingredients, such as Dutoprol®, Lopressor HCT®, and Lopressidone®.  

How Does Metoprolol Work? 

Metoprolol is typically prescribed in tablet form or as an extended-release capsule that is meant to be taken orally; however, healthcare professionals can also administer it via injection when necessary. Generally, the tablet version is taken once or twice daily either with food or immediately after a meal, while the extended-release capsule is specifically designed for once-daily dosing, often recommended to be taken during breakfast after awakening. 

This medication falls under the category of drugs known as beta blockers, which are widely utilized to address a variety of blood flow-related issues. These medications function by blocking the effects of norepinephrine (commonly known as adrenaline) on receptors located in the blood vessels and heart. 

When muscle receptors encounter norepinephrine, they typically constrict, which reduces the volume of blood able to circulate through them. This constriction leads to undue strain on the heart, an elevation in blood pressure, and an increased oxygen demand throughout the body. 

By mitigating these effects, metoprolol can help enhance blood flow and lower blood pressure, enabling the heart to pump blood more efficiently while alleviating feelings of chest pain.

What Are the Side Effects of Metoprolol?

As with any prescription medication, it is essential to be aware that metoprolol can be associated with several side effects. Most of these issues tend to be transient, but should they persist or worsen, it is imperative to seek medical attention promptly. 

The most frequently reported side effects associated with metoprolol include: 

• Abdominal pain

• Bloating

• Cold hands and feet

• Constipation

• Coughing or wheezing

• Depression

• Diarrhea

• Dizziness

• Dry mouth

• Fatigue

• Gas

• Heartburn

• Lightheadedness

• Nausea

• Rash or itching

• Reduced interest in sex

• Runny nose

• Shortness of breath

• Slow heartbeat

• Vomiting

Owing to its effect on blood pressure, one potential side effect of metoprolol is erectile dysfunction (ED).

What Is the Connection Between Metoprolol and Erectile Dysfunction?

Numerous studies have been conducted to determine the causative factors of erectile dysfunction among men. Findings indicate that one significant contributor to ED is the side effect of various medications.

In fact, it has been reported that one in four instances of erectile dysfunction is attributed to medication use, making it the predominant contributing factor.

Common medications that have shown a correlation with erectile dysfunction include antidepressants, diuretics, and antihypertensive agents. While beta blockers are routinely prescribed to manage high blood pressure, research indicates that the incidence of erectile dysfunction associated with these medications is significantly lower than that related to other antihypertensive drugs.

Despite metoprolol and beta blockers generally being associated with a decreased likelihood of erectile dysfunction, it is important to note that it can still occur. 

According to one particular study, men treated with metoprolol for high blood pressure exhibited lower overall erectile function compared to those receiving other types of antihypertensives after an eight-week period.

Furthermore, an additional investigation into the links between metoprolol and erectile dysfunction suggested that the causation may not be solely physical; psychological factors might contribute significantly as well.

This study monitored 114 men who had recently been diagnosed with high blood pressure but were not previously experiencing erectile dysfunction. These men were randomly divided into three distinct groups: group A was informed they were taking metoprolol and that it is associated with erectile dysfunction; group B was told they were on metoprolol but were not made aware of its possible link to ED; and group C was not informed about what medication they received nor were they made aware of any potential for ED as a side effect.

After a treatment duration of 60 days, it was found that 32% of the men in group A reported experiencing erectile dysfunction, while only 13% in group B and a mere 8% in group C faced similar issues.

These findings indicate that awareness of the possibility of experiencing erectile dysfunction while on metoprolol significantly heightened the likelihood of it manifesting.

How To Treat Erectile Dysfunction

If you find yourself struggling with erectile dysfunction and suspect that metoprolol may be the underlying cause, it is advisable to consult with your prescribing physician regarding the possibility of switching to an alternative medication. In scenarios where this may not be feasible, there are other treatment options available to help manage and alleviate the symptoms of erectile dysfunction.

Oral Medications 

The first line of treatment that typically comes to mind for most men is also the most well-known – and frequently the most effective: prescription ED medications. Whether it’s Viagra®, Cialis®, or another option, these medications generally operate using a similar mechanism and come in the form of small tablets for easy ingestion.

These oral medications function in a manner that is somewhat analogous to metoprolol and other beta blockers in that they influence blood flow within the body, specifically directing it towards the penis. This connection helps to clarify why hypertension medications can sometimes lead to erectile dysfunction as well.

Unlike metoprolol, which obstructs norepinephrine’s actions, these prescription ED medications inhibit the phosphodiesterase type 5 enzyme, which prevents blood vessels from constricting. By halting this enzyme's action, blood vessels can remain dilated, ensuring improved and sustained blood flow to the penis, ultimately facilitating an erection. 

After ingestion, most of these medications typically take around 30 minutes to an hour to take effect. After this waiting period, individuals should be able to achieve an erection for several hours (in the case of Viagra), provided adequate stimulation is present. In contrast, Cialis has a prolonged duration of action, lasting up to 36 hours.

Although these medications are generally safe for the majority of patients, they might not be suitable for those who are concomitantly taking antihypertensive medications. Their interaction can produce adverse effects, particularly when combined with nitrates. If you are unable to transition from metoprolol to another medication, it is wise to have a dialogue with your healthcare provider regarding the safety of these ED medications in your treatment plan as well.

Penile Injections 

Should your healthcare provider advise against the use of oral medications, various alternatives are available.

Penile injections rank just behind oral medications in terms of effectiveness, yet they do not carry the same risk of side effects and drug interactions. However, many patients find them daunting since they necessitate injecting the medication directly into the penis.

These self-administered injections can induce an erection within approximately 20 minutes and are anticipated to last around an hour. Due to the nature of the injections, erections can often occur spontaneously, necessitating no additional stimulation. 

Although mastering the injection technique may require a bit of practice to minimize discomfort, healthcare providers can guide patients on the proper administration methods. It's not uncommon for the erection to persist even beyond ejaculation, but it typically dissipates within an hour or two.

Vacuum Pump 

For men who find the idea of injecting their penis challenging, vacuum pumps serve as a popular mechanical alternative.

These devices are cylindrical in shape and can either be battery-operated or manually powered. To utilize a vacuum pump, the penis is placed within the cylinder, creating a seal around the base. As air is expelled from the cylinder, a vacuum is formed, which draws blood into the penis. After a few moments, sufficient blood flow is generated to produce an erection.

Most vacuum pump systems come with a constriction device – typically a rubber band – that is placed at the base of the penis to sustain blood retention. 

Vacuum pumps are user-friendly and quick to set up, receiving favorable feedback from many men who give them a try.

The Takeaway: While metoprolol can cause erectile dysfunction, the risk is fairly low compared to other hypertension medications. There may also be a psychological effect.

One of the principal causes of erectile dysfunction is the adverse reaction to other prescription medications. It’s advisable to converse with your healthcare provider about the potential for medication adjustments, or whether alternative treatments may be suitable for your situation.

If switching medications isn't feasible, there are options available, including prescription ED medications or vacuum pumps, both of which offer compelling and straightforward solutions for many men. 

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