Metoprolol and Erectile Dysfunction: What's the Connection?

July 13, 2021

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. 

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What Is Metoprolol?

Metoprolol is a prescription medication commonly used to treat high blood pressure (hypertension), either alone or as part of a combination of other medications. It's generally used to prevent angina (chest pain), kidney problems, migraines, heart attacks, and strokes from occurring due to high blood pressure. Sometimes its prescribed after a heart attack in order to increase survival, treat heart failure, and even help to improve an irregular heartbeat. 

It’s important to note that metoprolol only treats these symptoms and will not cure the condition that causes them.

The most popular branded forms of metoprolol are Lopressor®, Toprol® and Toprol XL®, and it may be found in combination with other active ingredients in Dutoprol®, Lopressor HCT®, and Lopressidone®.  

How Does Metoprolol Work? 

Metoprolol is most commonly prescribed as a tablet or extended release capsule to be taken orally, but it can be injected by a healthcare professional. In general, the tablet form will be taken once or twice daily either with a meal or immediately following one. The extended release capsule is only taken once per day and usually during breakfast after waking. 

Metoprolol belongs to a class of drugs called beta blockers, which are commonly used to treat issues with blood flow. These medications block the effect that norepinephrine (adrenaline) has on receptors in the blood vessels and heart. 

When muscle receptors encounter norepinephrine they naturally constrict, reducing the amount of blood that can flow through them. This leads to excess strain on the heart, an increase in blood pressure, and higher demand for oxygen throughout the body. 

By preventing these effects, metoprolol can increase the flow of blood and decrease blood pressure. The heart is also able to pump blood more efficiently and chest pain should be reduced. 

What Are the Side Effects of Metoprolol?

Just like any other medication, there are several side effects associated with metoprolol. Most of these issues are only temporary and should pass, but if they prolong or get worse, immediate medical attention may be required. 

The most common side effects 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

Due to its impact on blood pressure, another potential side effect of metoprolol is erectile dysfunction. 

What Is the Connection Between Metoprolol and Erectile Dysfunction?

A host of studies have been performed to identify what causes erectile dysfunction in men. As it turns out, one of the leading factors for ED is as the side effect of another medication.

In fact, as many as one in every four cases of erectile dysfunction is the result of medication, and it is the largest single contributing factor. 

Some of the most common medications that have a demonstrated connection to erectile dysfunction include antidepressants, diuretics, and high blood pressure medications. While beta blockers are used to treat high blood pressure, the rate of erectile dysfunction is much lower than most other hypertension medications. 

While metoprolol and beta blockers in general are associated with a much lower risk of erectile dysfunction, it does still happen. 

In one study, men that were given metoprolol to treat their high blood pressure had a lower average erectile function than men given other medications after eight weeks of treatment.

Another study into the connections between metoprolol and erectile dysfunction concluded that the cause might not be purely physical, but that psychological factors could play a role.

This study followed 114 men that were recently diagnosed with high blood pressure and not experiencing erectile dysfunction. The men were randomly split up into three groups: group A were informed that they were taking metoprolol and that it is known to cause erectile dysfunction; the men in group B were informed that they were taking metoprolol, but were not told that it has a connection to erectile dysfunction; and the men in group C were not informed of the medication they were given nor informed that they could experience erectile dysfunction due to the meds.

After 60 days of treatments, 32% of the men in group A reported they were experiencing erectile dysfunction, but only 13% in group B and 8% in group C. 

These findings suggest that knowing there is a possibility of erectile dysfunction with metoprolol dramatically increased the likelihood that it might occur. 

How To Treat Erectile Dysfunction

If you're experiencing erectile dysfunction and think that it may be the result of taking metoprolol, talk with your prescribing doctor about switching medications. In the event that this is not an option, there may be alternative treatment modalities that can help alleviate the symptoms of erectile dysfunction.

Oral Medications 

The first treatment for erectile dysfunction that comes to mind for most men is also the most popular – and the most effective: prescription ED medications. Whether it’s Viagra®, Cialis®, or another, they mostly work by the same mechanism and are taken easily as a small tablet.

These medications work in similar ways to metoprolol and other beta blockers in that they affect blood flow in the body, specifically to the penis. That's part of the reason hypertension medications can lead to erectile dysfunction, too.

Instead of blocking norepinephrine, these prescription ED medications block the phosphodiesterase type 5 enzyme from constricting blood vessels. By blocking this enzyme, blood vessels remain dilated and blood flow to the penis is improved and maintained, allowing for an erection. 

After swallowing the tablet, most of these medications take 30 minutes to an hour before the effects kick in. After that, you should be able to achieve an erection for the next few hours (in the case of Viagra), provided you're adequately stimulated. Cialis' effects can last up to 36 hours.

While these medications are generally safe for most people, they are not often well suited for use by people who are also taking high blood pressure medication. They have a particularly negative impact when combined nitrates. If you are unable to switch from metoprolol to an alternative medication, talk with your doctor to see if these medications could be safe to use as well.

Penile Injections 

In the event that your doctor does not advise using oral medications, other options are available.

Penile injections are only slightly behind oral medications in terms of effectiveness, but don’t come with the same potential side effects and negative drug interactions. They are, however, challenging for most patients given that they're injected directly into the penis,

These self-administered injections provide an erection within about 20 minutes and last for around an hour. Due to the nature of the injection, the erection will most likely happen spontaneously and require no stimulation. 

It may take some practice in order to perform the injection properly and with minimal pain, but your doctor can demonstrate proper use. It’s common for an erection to persist even after ejaculation, but it should go down within an hour or two.

Vacuum Pump 

For those that have a hard time fathoming injecting their penis with a needle, vacuum pumps are a popular mechanical alternative.

Vacuum pumps are cylindrical in shape and come with a battery or hand-powered pump. The penis is placed into the cylinder, where it creates a seal at the base of the penis. Air is pumped out of the cylinder creating a vacuum, which draws blood into the penis. After a few minutes, enough blood is pulled into the penis to create an erection.

Most devices then require a constriction device – like a large rubber band – at the base of the penis to help keep blood in the penis. 

Vacuum pumps are easy and fast to use, and are mostly well-liked by men who try them.

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 leading causes of erectile dysfunction is as an adverse effect to another prescription medication. Talk to your physician about switching medications, or whether you might have alternatives.

If a medication switch isn't an option, talk to a doctor about prescription ED medications or vacuum pumps, both compelling and easy-to-use options for most men. 

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