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Erectile dysfunction (ED) refers to the inability to get or keep an erection for sexual intercourse. It’s not a natural part of aging, though it is more common among older men. Still, it can affect men at any age.

ED is often the sign of a separate medical condition, such as diabetes or depression. While some drugs can effectively treat this condition, many drugs, including beta-blockers, can sometimes cause the problem.

Your doctor should look at the drugs you take to find possible causes of ED. Drugs for lowering blood pressure — like beta-blockers — are among the most common drug-related causes of ED.

Beta-adrenergic blocking agents (beta-blockers) are a common type of heart medication. They work by decreasing your heart rate and your heart’s contraction force, which decreases blood pressure. In other words, these medications reduce your heart’s workload.

Doctors commonly prescribe beta-blockers to treat the following heart-related conditions:

Sometimes, doctors may also prescribe beta-blockers to treat:

There are three types of beta receptors: B1, B2, and B3.

B1 receptors are primarily located in the heart area. B2 receptors are located in other organs and contribute to metabolic activity. B3 receptors help break down fat cells.

Overall, beta-blockers block certain nervous system receptors. These receptors are usually affected by chemicals, such as epinephrine (adrenaline).

Epinephrine constricts your blood vessels and causes blood to pump more forcefully. It’s thought that by blocking these receptors, beta-blockers may interfere with the part of your nervous system responsible for causing an erection.

The most common side effects associated with beta-blockers include:

ED and sexual dysfunction may also occur in some people who take beta-blockers. While the exact rate is unknown, a 2020 review suggests the rate of ED associated with beta-blocker usage may be more common than previously thought.

Another consideration is whether ED is present before the use of heart medications. Researchers in a 2017 study found that ED commonly occurs alongside high blood pressure. This suggests that people who take beta-blockers for high blood pressure may already be experiencing ED before starting their medication.

However, the same study also noted that one type of beta-blocker, nebivolol (Bystolic), was found to improve erectile function in study participants who had both ED and high blood pressure.

Other common blood pressure-lowering medications that can contribute to ED are diuretics.

Diuretics cause you to urinate more often. This leaves less fluid in your circulation, which leads to lower blood pressure.

Diuretics may also relax muscles in your circulatory system. This may decrease the blood flow to your penis necessary for an erection.

Learn more: Lifestyle and medical conditions that can cause ED »

Other blood pressure drugs may be less likely to cause ED.

Calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors may be as effective as beta-blockers at reducing high blood pressure.

However, there have been fewer reports of ED by men who have used these drugs.

If your doctor thinks that your ED may be related to your beta-blocker and you can’t take other blood pressure drugs, you may still have options.

In many cases, you can take drugs to treat ED. Your doctor must have a complete list of your current medications. This can help them know if the ED drugs could interact with drugs you already take.

Currently, there are six drugs on the market to treat ED:

  • Caverject
  • Edex
  • Viagra
  • Stendra
  • Cialis
  • Levitra

Of these, only Caverject and Edex are not oral pills. Instead, they’re injected into your penis.

None of these drugs are currently available as generic products. The side effects of these drugs are similar, and none of them interacts with beta-blockers.

Be sure to take your blood pressure drugs exactly as prescribed. This will help minimize side effects. If ED seems to be a side effect of your beta-blocker, talk with a doctor. They may lower your dosage or switch you to another drug.

You can also ask your doctor about possibly switching to the beta-blocker nebivolol. Research suggests it may be one of the best options for treating high blood pressure while also preventing ED.

If these strategies don’t help, a drug to treat ED may be an option for you.

It’s also important to talk with a doctor before stopping any of your medications or adding any other supplements or herbal remedies to your regimen. This way, you can avoid possible drug interactions or other adverse health effects.

Can you take Viagra with beta-blockers?

Yes, you can take sildenafil (Viagra) with beta-blockers. Viagra may be taken once a day as needed, ideally 1 hour before sexual activity.

While Viagra doesn’t interact with beta-blockers, it may interact with other medications used to treat high blood pressure and heart disease, including:

  • alpha-blockers
  • nitrates
  • ritonavir
  • amlodipine

You also shouldn’t take these medications while drinking alcohol.

Is ED caused by beta-blockers reversible?

Depending on the underlying cause, ED can be reversed.

If you suspect that beta-blockers are the cause of your ED, talk with your doctor about possibly switching to nebivolol. Ongoing research suggests this beta-blocker may have a lower risk of ED than other types of beta-blockers.

Additionally, you may want to consider talking with a doctor about possibly adding medication to directly treat your ED. Most ED medications work by improving penile blood flow to induce and maintain erections.

Do beta-blockers affect testosterone?

Beta-blockers may contribute to ED because of a decrease in nitric oxide (except for nebivolol). However, it’s not clear whether these medications affect testosterone levels more specifically.

While you may gradually experience decreasing testosterone levels with age, uncommonly low levels may contribute to a reduced sex drive, ED, fatigue, and other symptoms.

Talk with your doctor if you think you may have low testosterone, and what you may be able to do to help treat it.

Beta-blockers are commonly discussed as a contributor to ED. While previous research indicated that such connections weren’t common, more recent studies are revealing that ED as a side effect of beta-blockers may have a higher likelihood than once thought.

The good news is there are strategies to manage medication-induced ED without having to sacrifice your heart health.

You may consider talking with a doctor about switching to another beta-blocker or possibly adding an ED medication to your regimen.

Also remember that certain lifestyle strategies, such as diet and exercise, may also help ED and your heart health.