Can you take Viagra with a beta-blocker? Usually yes, if the doctor who prescribes Viagra knows you take one. Beta-blockers did not change how the body handles sildenafil, and men on blood-pressure medicines, beta-blockers among them, had no more side effects on sildenafil than on placebo. What matters more is why you take the beta-blocker: if it is for angina and you also use a nitrate spray or tablets, Viagra is ruled out.
Do beta-blockers interact with Viagra?
Not in the way the label measured. In sildenafil's population data, beta-blockers had no effect on its pharmacokinetics — how it is absorbed, broken down and cleared — and pooling the main blood-pressure classes, beta-blockers included, showed "no difference in the side effect profile" compared with placebo (EMA — Viagra). The Australian Viagra leaflet does not name beta-blockers; the blood-pressure medicines it singles out are alpha-blockers (Viagra CMI). The metoprolol leaflet does not name sildenafil either (Minax CMI). healthdirect still lists blood pressure medicines among those that interact with sildenafil (healthdirect — sildenafil), so each prescriber should know about the other medicine. For carvedilol: can carvedilol and Viagra be taken together?
What about Cialis and metoprolol?
No clinically significant interaction: the tadalafil label tested metoprolol. In men on several blood-pressure medicines the extra drop was minimal when their blood pressure was well controlled, and daily tadalafil may call for a change in the blood-pressure dose (EMA — Cialis). The Australian Cialis leaflet lists "medicines used to treat hypertension (high blood pressure) such as metoprolol" among the medicines that may interfere with it (Cialis CMI).
Why does it matter what the beta-blocker is for?
Because the heart condition, not the beta-blocker, decides whether an ED tablet is safe. Beta-blockers are used for high blood pressure, angina, after a heart attack, for an irregular heartbeat and for heart failure (Minax, Noten and Bicor CMIs). Sildenafil should not be used by men for whom sex is inadvisable, such as those with "unstable angina or severe cardiac failure" (EMA — Viagra), and the Viagra leaflet rules it out within 6 months of a heart attack or stroke, or if your blood pressure "is unusually high or low or is not effectively treated" (Viagra CMI). Tadalafil is ruled out after a heart attack in the last 90 days, with unstable angina or uncontrolled arrhythmias (EMA — Cialis), and the Australian Cialis leaflet's "Do not use" list includes "heart problems such as angina, arrhythmias (change in rhythm or rate of heart beat), heart failure" (Cialis CMI). More in Viagra after a heart attack or with heart medicines and Viagra with atrial fibrillation.
What if you also use a nitrate for angina?
Then neither tablet is for you. Nitrates — glyceryl trinitrate sprays, tablets or patches, isosorbide mononitrate or dinitrate, nicorandil — must never be combined with Viagra: "IT MAY LEAD TO A SEVERE DROP IN YOUR BLOOD PRESSURE, WHICH MAY BE DIFFICULT TO TREAT" (Viagra CMI). Tadalafil is ruled out with any form of organic nitrate (EMA — Cialis). The Viagra leaflet adds: "If you get an angina attack, do not take nitrate medicines to relieve the pain but tell your doctor immediately." In an emergency for a suspected heart problem, tell the ambulance or hospital staff that you take Cialis (Cialis CMI).
Will you feel dizzy?
You might, especially when you stand up. The metoprolol leaflet says "If you feel light-headed, dizzy or faint when getting out of bed or standing up, get up slowly", and lists dizziness or fainting on standing up quickly, "which may be due to low blood pressure", among the side effects to report (Minax CMI). Viagra can cause dizziness too; if it does, do not drive, and fainting is a reason to call your doctor (Viagra CMI). If your blood pressure already runs low: can you take Viagra with low blood pressure?
Do you need a lower dose of Viagra?
The label sets no special dose for beta-blockers. Its 25 mg starting dose is for men on alpha-blockers, who should be stable on the alpha-blocker first (EMA — Viagra). That matters if you also take an alpha-blocker such as prazosin, which the metoprolol leaflet lists among the medicines that may interfere with it (Minax CMI): can alfuzosin and sildenafil be taken together? Otherwise the usual start is 50 mg, and your doctor sets the dose (EMA — Viagra overview); never take more than one tablet in 24 hours (healthdirect — sildenafil). See also safe medicines for erectile dysfunction with high blood pressure.
Could the beta-blocker be causing the erection problem?
Possibly, though less often than its reputation suggests. Whether a beta-blocker is behind erectile dysfunction is a separate question: do beta-blockers cause erectile dysfunction? Do not stop a beta-blocker to make room for Viagra: "DO NOT STOP TAKING MINAX TABLETS SUDDENLY" (Minax CMI).
The short answer
A beta-blocker on its own is not a reason to avoid Viagra or Cialis: the labels found no change in sildenafil levels and no clinically significant interaction between tadalafil and metoprolol. The heart condition behind the beta-blocker is what counts, nitrates rule both tablets out, and both prescribers should know everything you take. Other blood-pressure medicines: amlodipine and ramipril; every other combination is in our guide to taking Viagra or Cialis with other medicines.
