General Side Effects Of Beta Blockers

Erectile dysfunction is more commonly known as impotence. The following medications may cause erectile dysfunction: Instead, its purported mechanism of action was via inhibition of beta-adrenergic receptors, reduction of cardiac output, and decrease in sympathetic outflow. Table 2 highlights main reasons to take time and ask about sexual life before starting antihypertensive therapy during next consultation. 6 foods for erectile dysfunction, the men took a placebo for 1 month. Antidepressants cause problems in all areas of sexual function, probably by blocking the action of three brain chemicals that relay signals between nerve cells: 6, Qualifiers and Modifiers Table 2nd/3rd degree heart block (HB) 2nd/3rd degree heart block (HB), or any of the other 2nd/3rd degree heart block inclusion terms, described using one of the negative modifiers or qualifiers listed in Appendix H, Table 2.

The investigators found that thiazide diuretics and all beta-blockers, except nebivolol, had a negative impact on erectile function. In addition, penile vascular tree seems to be particularly dependent of NO as it participates on arterial dilation to rapidly increase blood flow but also mediates cavernosous sinusoids and venous dilation that represents a crucial step on venoclusive mechanism that assure the obtaining and maintaining of a rigid erection. Sexual dysfunction caused by drugs could lead to patients' noncompliance. Thiazide diuretics and beta-blockers are most likely to cause problems, but this is not a common effect of these medicines and will not happen to everyone. (04) with no change with the other beta blockers.

Can mask symptoms of hypoglycemia or hyperthyroidism, so should be used with caution in people with diabetes or thyroid disease.

Substituting medications such as a calcium channel blocker or an ACE inhibitor for the beta blocker saved many of my patients from the ravages of beta blockers, while still addressing their heart problems or hypertension. Risks during pregnancy Some blood pressure medications are not safe to take during pregnancy due to the risk to the pregnant woman or unborn child. Fookes, BPharm Last updated on Feb 25, 2020. Erections are extremely complicated and surprisingly fragile. It has been suggested that potentially favourable sexual side effects of captopril were secondary to improved cardiac function; however, there are not sufficient data to support this hypothesis [49]. If blood pressure is not at goal the dosage of study medication will be doubled to nebivolol 10 mg once daily or metoprolol succinate 200 mg once daily. In the study, losartan was equal to or better than other drugs at controlling blood pressure. On the other hand, some beneficial effects on blood pressure control have been shown with PDE5 use in hypertensive patients [82].

In spontaneously hypertensive rats, endothelial-mediated relaxation of corporal cavernosal strips in response to acetylcholine was significantly impaired, suggesting a defect in endothelium-dependent reactivity and a corresponding reduction in NO [57]. Besides high prevalence of ED among hypertensive individuals, possible association to ED severity and important aspects in therapeutic compliance improvement justify the relevance of a brief sexual anamnesis in one of the first visits inside GP or cardiologists offices [88]. Beta blockers that are called 'cardio-selective' are those that only block the beta-1 receptors and do not tend to cause ED. Stop taking their (very important) medication or live with ED. (03); however, the annual absolute increase in risk of withdrawal was only 2 per 1000 patients (95 % CI 0–5) [19]. On the whole, evidence shows that statins can have a beneficial effect on erectile function because the beneficial effects seem to be more powerful than the negative effects on the testosterone level [80].

  • In this way, hypertensive patients would be classified as low, intermediate, or high risk.
  • The number of men reporting impotence dropped from 75.
  • Subsequent studies and larger meta-analyses confirmed this relationship, and exposed propranolol as also having this deficiency.
  • After ED diagnosis and for those without contraindication for sexual activity or PDE5 inhibitors usage, doctors must take time to adequately inform their patients about the correct way to take sexual medication.
  • Nevertheless, its potential minor impact on sexual behavior in our study should be interpreted with caution because due to its pharmacokinetic properties (very long half-life time)1 it was used (as it is used in human therapy) at a lesser dose than propranolol or metoprolol.
  • Despite beta-blockers' odd mechanism of action, they were (and still are) as effective as the earlier anti-hypertensive agents in decreasing blood pressure.
  • 19 Drugs from this group differ from one another in many pharmacological, pharmacokinetical and physicochemical properties, which may implicate differences in incidence and strength of various adverse effects.

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Before 1950, treatment options for hypertension were limited. Sometimes a particular combination of medications or supplements contributes to sexual problems. (0001) more common in the beta-blocker arm than in the amlodipine arm. This is an important point since patient concerns about the adverse effects of drugs on erectile function might limit the use of essential medications in cardiovascular high-risk patients [43]. Dating a man with erectile dysfunction –, beyond the obvious reactions, like getting angry or annoyed, acting like it’s their fault instead can be tough to deal with. Always consult with your doctor first!

Beta-blockers were one of the first modern medications used for the treatment of blood pressure. ” per ED record – select “Yes. Since then, many derivatives and generations of the beta-blocker have come into use and have become the mainstay in the treatment of hypertension. Since α-adrenergic antagonists are first-line therapy for benign prostate hyperplasia (BPH) but only second-line agents for the treatment of hypertension (doxazosin and terazosin), most knowledge regarding sexual adverse effects of α-adrenergic antagonists comes from BPH studies. Carvedilol is not a cardioselective beta-blocker as it binds to alpha 1 , beta 1 and beta 2 -adrenoceptors. The quality of life for them is dreadful when they can no longer perform. The potassium-sparing diuretics amiloride and triamterene do not seem to affect sexual function [35].

High blood pressure and sex: Overcome the challenges

Bisoprolol belongs to the class of drugs known as beta blockers. So, considering that it is still matter of discussion if hypertension is cause or consequence of endothelial dysfunction, it can influence ED severity or it could appear before ED. Problems with erectile function can raise a concern in the treatment of hypertension and may influence the choice of treatment regimens and decisions to discontinue drugs. Speak to your healthcare provider about side effects and desired outcomes to see if you can devise a different treatment strategy that works for you. Following double-blind therapy subjects enter a 2-week washout phase and are subsequently switched to the alternate therapy. Some trials have used a single question about sexual satisfaction while others have adopted validated questionnaires like International Index of Erectile Function (IIEF) that could check all five major domains of sexuality:

After cardiovascular risk stratification and adequate control of modifiable risk factors, ED patients should be oriented about the right way of sexual medication usage. You may report side effects to Health Canada at 1-866-234-2345. They are widely prescribed for angina, heart failure and some heart rhythm disorders, and to control blood pressure. There are reasons why our counterparts up north still recommend beta-blockers as first-line therapy for younger patients and why they are still an appropriate option for treatment, especially in resistant hypertension. Certain hormones in the body, such as norepinephrine, can bind to chemical receptors called alpha-receptors.

6, Qualifiers and Modifiers Table Questions?

Angiotensin II receptor blockers

Non-selective beta blockers, such as propranolol, are active in blocking adrenaline and noradrenaline in other areas of the body, as well as the heart. 28 In isolated tissue, radioligand studies suggest that they belong to the β 2 -type,29 which may explain, why impairment of copulatory behavior is caused only by the non-selective propranolol, which β 2 /β 1 ratio (calculated as its K i for β 1 receptor divided by K i for β 2 receptor) is 8. Do not stop taking bisoprolol suddenly.

May increase serum triglycerides in some people. May be preferred for people with co-existing chronic obstructive pulmonary disorder (COPD) because it is less likely than nonselective beta-blockers to cause bronchoconstriction (narrowing of the airways). Furthermore, most of the analyses on cardiovascular outcomes of beta-blockers were derived from studies using atenolol and propranolol and may not apply to other agents in the family. Your doctor will consider the balance of benefits versus risks.

These well-publicized mechanisms translated to modest reductions in central aortic pressure when compared to atenolol in small studies. This class has been accused of erectile dysfunction in patients taking them. This means less blood is able to flow to the penis. You may report side effects to FDA at 1-800-FDA-1088.

Drug Status

Increase empathy opportunity to improve doctor and patient relationship. We continue to identify technical compliance solutions that will provide all readers with our award-winning journalism. Please note the date of last review or update on all articles. The selection is not exhaustive. ACE inhibitors lower blood pressure by blocking ACE, thereby relaxing the blood vessels and allowing blood to flow more freely.

Some patients experience fatigue, perhaps related to excessive slowing of the heart rate. Some experimental studies confirmed the participation of eNOS during erectile response [69]. Some trials have shown the presence of vascular disease in men suffering from vasculogenic ED but without traditional risk factors, pointing out ED as a clinical early cardiovascular risk marker [25]. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). If your medication is still necessary, the next step is to see whether there’s an alternative medication that can treat your condition without causing ED.

Thiazides are the most common cause of erectile dysfunction among the high blood pressure medicines. Make sure the medications you or your partner takes are not the reason why you can’t have fun in bed! Seek medical advice if any new numbness, pain, a cold feeling, skin color changes or reduced sensitivity occurs in fingers or toes. Are you facing more stress than usual? To assess the individual risk for cardiovascular diseases, repeated measurement of blood pressure and biochemical profile, including fasting serum glucose, creatinine, and lipids, is necessary. Recreational drugs: In this way, search for new data on basic mechanism under ED development in hypertensive individuals is an actual need. Those numbers were similar in more recent publications over the world [5] and also in developing countries [6], projecting the assumption that over 30 million American citizens suffer from some level of sexual dysfunction [5].

Heart Failure

Likewise, women treated with the irbesartan-felodipine combination showed significantly higher FSFI scores than those treated with the metoprolol-felodipine combination [17]. 03), bisoprolol (P = 0. Can nitric oxide help erectile dysfunction, sexual dysfunction is a well-recognized consequence of diabetes mellitus in men (18, 33). Bystolic should be avoided or used very carefully if you have heart failure, angina (chest pain), an overactive thyroid, kidney disease, or liver disease. The association of ED and vascular risk factors including hypertension raises the hypothesis that endothelial dysfunction is the common link between erectile dysfunction and cardiovascular disease. When determining whether there is a second- or third-degree heart block on ECG on arrival or within 24 hours after arrival AND does not have pacemaker: Because beta-blockers increase the length of systole, they exacerbate pulse wave dyssynchrony thereby increasing central aortic pressures.

Materials And Methods

You might be better off on a medication less likely to cause a problem. In the men with sexual dysfunction, 88 percent reported improvement in at least one area of sexual function after treatment with losartan. Get access to the full version of this article.

I wonder if you can comment on what you would do with these men both in the situation of preserved ejection fraction and those with reduced ejection fraction. Physician/APN/PA documentation is not required. Many medicines and recreational drugs can affect a man's sexual arousal and sexual performance. Second- or third-degree heart block or pacemaker ECG findings can be taken from unsigned ECG reports.

Last but not least, behavioral measures are not very easily interpretable, particularly when there is a combined drug's influence on both arousal and performance.

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Diuretics can reduce blood flow to the penis, making an erection difficult to achieve, while beta-blockers can impact the nervous system reaction that leads to an erection. In all animal studies propranolol was revealed to have an impact on arousal aspect of sexual function, whereas our results are more indicative of the performance impairment (lower ejaculation frequency together with lower intromission ratio and no significant differences in mount latency, ejaculation latency, postejaculatory interval and number of subjects displaying mounts). Full citations are available at the original post. Skip the main content if you do not want to read it as the next section. After reviewing 15 trials involving 35,000 subjects, Ko et al.

AMI-6, Definition: Due to the lack of large clinical trials with long followup period designed for ED identification and with cardiovascular morbidity and mortality as endpoints, it is premature to assure that ED identifies an increased cardiovascular risk among hypertensive patients that extends beyond the risk represented by blood pressure elevation [62]. They are inexpensive, well tolerated drugs and save many lives by lowering blood pressure, protecting against recurrent heart attacks and helping people with heart failure to live longer.

Managing Erectile Dysfunction In Patients Treated With Beta-blockers

Please login to save this article. Initially designed to treat angina pectoris, propranolol was serendipitously discovered to also lower blood pressure. Erectile dysfunction and premature ejaculation explained, sTOPPING your pee mid-flow could help you beat erectile dysfunction or premature ejaculation, scientists have claimed. Recent guidelines establish that patients without obvious etiology for ED, such as anatomical disorders, neurological disease, or endocrine causes, should be evaluated for cardiovascular risk factors, arterial hypertension, and arterial disease [91].

Some patients develop orthostatic hypotension when PDE5 inhibitors are used in conjunction with an alphablocker (typically for urologic conditions, such as benign prostatic hypertrophy) but some studies suggest that the interaction is less clinically relevant if the patient has been undergoing long-term alpha-blocker therapy [81]. Evidences demonstrate that the successful treatment of ED is associated with significant improvements in overall physical and emotional well-being [89]. Erectile dysfunction (ed): symptoms, diagnosis & treatment, when eating eggs, don’t forget the yolk. The top two medications for high blood pressure associated with ED are diuretics (e. )Elderly people should never use diphenhydramine (Benadryl) or any sleep aid with a name ending in “PM. Favorable effects on nitric oxide synthase and oxidative stress have been shown with nebivolol pointing out a mechanism for improvement of erectile function. Consider the patient “on a beta-blocker” if one of the following conditions is met:

Further Reading

A second hit befell beta-blockers in 2020, when a meta-analysis published in The Lancet suggested that atenolol did worse than other hypertension medications in reducing the risk of stroke (relative risk 1. )INCLUDE beta-blockers taken in the ambulance en route to the hospital. Incidence of withdrawal from randomised treatment because of impotence (rates per 1000 patient-years) was 0. But that hasn’t always been possible, because beta blockers do have unique qualities that sometimes make them indispensable. For drugs that act over renin-angiotensin system, most evidence suggests that there was no influence on erectile function, and some authors indicate beneficial effect [42].

Nebivolol lowers blood pressure (BP) by reducing peripheral vascular resistance, and significantly increases stroke volume with preservation of cardiac output. Initial efforts should identify and treat all modifiable risk factors. Be prepared to answer questions your doctor may ask, such as: Unfortunately, the theory is not supported by evidence. Development of erectile dysfunction in connection with betablockers might be biased by psychological effects derived from the awareness of being treated with a certain substance.


A complicating factor is that some of the medications used to treat cardiovascular risk factors have erectile dysfunction as a side effect. The second meta-analysis[6] discussed by Dr Mandrola deals with heart failure, a multi-symptomatic disorder which, in contrast to hypertension, fatigue, dyspnea, depression, and sexual dysfunction, is common even without beta-blocker therapy. To encourage satisfying sex, initiate sex when you and your partner are feeling relaxed. This can restrict blood flow to your penis, which may then cause erectile dysfunction. That may make it tough to stay on medication, especially if high blood pressure never caused any symptoms before. It is, plain and simple, until proven otherwise, a side effect of the beta-blocker. 3 percent to 58.

  • Inform about the time interval to take drug before sexual intercourse.
  • Beta blockers can also block your kidneys from producing a hormone called angiotensin II.
  • It has been suggested that the small cavernosous arteries were more vulnerable to atherosclerosis when compared to larger arterial trees like coronaries [20, 67] explaining why ED precedes angina in a patient with systemic vasculopathy.
  • Studies in small samples or with lower statin doses did not show significant changes in average testosterone levels [66].

Heart Attack Prevention Overview

The authors were able to show that this risk between beta-blockers and other antihypertensive agents was eliminated when the analysis focused on patients under 60 years old. As a result, the heart pumps blood less forcefully, and blood vessels remain open. But a possible association between ED and hypertension is much more intricate issue involving other aspects, such as the hemodynamic interferences caused by antihypertensive drugs. May cause a number of unwanted heart-related effects and aggravate peripheral circulatory disorders (conditions that cause reduced blood flow to the hands or feet). Bbc, research has consistently shown that plant-based diets are associated with lower risks of cardiovascular disease, with a vegetarian diet reducing the risk of coronary heart disease by 40 percent. Kloner explained that cardiovascular disease and erectile dysfunction often go hand-in-hand. The dosing regimen should not be changed more than once in 7 days.

These include ACE (angiotensin-converting enzyme) inhibitors, calcium channel blockers, alpha blockers and ARBs (angiotensin II receptor blockers). Version 2020A1 Data Element Name: If you are trying to access this site from the United States and believe you have received this message in error, please reach out to [email protected] 1 % of the placebo group, in 13. We list the most important adverse effects. That means daily tracking and recording. View access options below. A smaller trial published around the same time, Intervention as a Goal in Hypertension Treatment (INSIGHT), also showed a reduction in HF rates.

Considering PDE5 inhibitors mechanism of action, it is reasonable to expect for vascular hemodynamic interferences, effects on blood pressure and coronary circulation alterations, especially among hypertensive patients or those on several antihypertensive drugs. PDE5, phosphodiesterase-5. 15, 16, 17 In the case of β-blockers, which are one of the most often prescribed drugs in many cardiovascular diseases, this could be implicated by increased morbidity and mortality. And guess what: All antipsychotic drugs block dopamine, a brain chemical that helps regulate emotional responses and control the brain’s reward and pleasure centers.


Lopressor usually provokes reversible mild side effects, which are well tolerated and pass rapidly. Cardiovascular disease is not a contraindication to sexual activity in patients who have been properly assessed and treated. Health care is a conversation, not a prescription. Diuretics can decrease forceful blood flow to the penis, making it difficult to achieve an erection.

Common risk factor categories associated with sexual dysfunction exist for men and women including individual general health status, diabetes mellitus, cardiovascular disease, other genitourinary disease, psychiatric/psychological disorders, other chronic disease, and sociodemographic conditions. ” Talk with your doctor or other health care provider. Aspirin: can it really cure erectile dysfunction? Methods for reversing ED fall into three categories:. Do you still need the medication(s) that you’re taking? Similar results were reported in a small group of women treated with losartan.

Challenges For Women

But in 2020, researchers appointed to the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC) released what was called the 8th guideline on treating hypertension. 5 psychological causes of ed. erectile dysfunction, addressing the obstacles in my intimate life head on has not been the easiest of journeys, but it has lead me to deep psychological truths about myself that I believe I’m better off for knowing. If you notice other effects not listed above, contact your doctor or pharmacist. Also, calcium channel blockers may not be suitable for people with the following conditions:

Q: What type of medication is Bystolic?

For instance, the Metoprolol Atherosclerosis Prevention in Hypertensives (MAPHY) study showed that there could be a reduction in stroke and coronary heart disease when using a long-acting beta-blocker, such as metoprolol succinate. If you and your healthcare provider decide to take that approach to treat medically induced ED, it’s worth noting the main differences between ED medications. May be used in addition to other blood pressure lowering medicines.

Stopping it suddenly could cause problems such as palpitations, a recurrence of angina pain or a rise in blood pressure. When determining whether there is bradycardia (heart rate less than 60) on arrival or within 24 hours after arrival while not on a beta-blocker: Weiss RJ et al. What medications can cause sexual dysfunction?

GoodRx is not available outside of the United States. It's known that diuretics (or water pills, like hydrochlorothiazide) and beta-blockers (like Atenolol) can also cause erection problems. A version of this article first appeared at Clinical Correlations, The NYU Langone Online Journal of Medicine.


The mechanism of action is not completely understood. Furthermore, if patients present with sexual dysfunction during treatment with β-blockers, a switch to Nebivolol, a novel third-generation β-1 blocker with a greater degree of selectivity for β-1 adrenergic receptors, might be a solution. Sexual dysfunction in men with high blood pressure may be aided by the newest type of hypertension drug, reported Carlos Ferrario, M. In the Middle East, Russia and in Australia, it is marketed under the name Nebilet and in Pakistan it is marketed by The Searle Company Limited as Byscard. Besides this high prevalence, before oral therapy with phosphodiesterase-5 (PDE5) inhibitors, less than of men with ED search for medical help [7]. If you still have side effects, talk to your doctor about other possible medications that may have fewer side effects. If you have high blood pressure, you usually don't have to live with a loss of sexual satisfaction.