Do beta-blockers cause erectile dysfunction?

Do beta-blockers cause erectile dysfunction? They can, but less often than their reputation suggests. Several Australian beta-blocker leaflets list sexual problems among the side effects. Yet across 15 placebo-controlled trials with more than 35,000 people, beta-blockers added about one extra report of sexual dysfunction for every 199 people treated for a year — and in one trial, men told about the side effect were far more likely to report it.

What do the Australian beta-blocker leaflets say?

Most list it, in different places. Both metoprolol leaflets name "problems with sexual function" among the rare, serious side effects to call your doctor about straight away (Minax CMI, August 2024; Toprol-XL CMI, September 2024). The atenolol leaflet lists "sexual problems" among its less serious side effects (Noten CMI, August 2026), and so does the leaflet for bisoprolol, which is used for heart failure (Bicor CMI, July 2024). Australian Prescriber lists "antihypertensives (e.g. diuretics, alpha and beta blockers)" among the medicines behind erectile dysfunction (Australian Prescriber). Metoprolol has its own page: does metoprolol cause erectile dysfunction?

How much do beta-blockers raise the risk?

A little. A review in JAMA pooled 15 randomised, placebo-controlled trials of beta-blockers for heart attack, heart failure and high blood pressure. Beta-blockers were linked with "a small, significant annual increase" in reported sexual dysfunction — 5 per 1,000 patients a year — and the belief in substantial risks "is not supported by data from clinical trials" (Ko et al., JAMA 2002). The Treatment of Mild Hypertension Study followed 557 men for up to four years, and erection problems on acebutolol, a beta-blocker, were about as common as on a placebo (Grimm et al., Hypertension 1997). A 2022 network meta-analysis found that no class of blood-pressure medicine, beta-blockers included, changed erectile function significantly compared with placebo, though most of its studies carried a "concerning or high" risk of bias (Farmakis et al., Cardiovasc Drugs Ther 2022).

Can knowing about the side effect bring it on?

It can. In an Italian trial, 96 men with newly diagnosed cardiovascular disease and no erection problems took atenolol for three months. Of the men who were not told which medicine they had, 3.1% reported erectile dysfunction; of those told its name but not its side effects, 15.6%; of those told it could affect erections, 31.2%. When the men who reported the problem were then given sildenafil or a placebo in turn, the two "were equally effective in reversing erectile dysfunction in all but one patient" (Silvestri et al., Eur Heart J 2003). The authors put it down to anxiety about the side effect — a cause in its own right: can anxiety cause erectile dysfunction?

Is nebivolol better for erections?

Against older beta-blockers, the trials suggest so. Nebivolol also widens blood vessels through nitric oxide. In a 12-week trial of 131 men with newly diagnosed high blood pressure, satisfactory intercourse fell from 7.0 to 3.7 times a month on atenolol but held steady on nebivolol, at 6.4 before and 6.0 after (Boydak et al., Clin Drug Investig 2005). A 2025 meta-analysis of four trials against metoprolol, with 397 men, found erection scores 1.81 points higher on nebivolol, though the trials varied widely (Lu et al., J Sex Med 2025). Against placebo, the network meta-analysis found no clear benefit (Farmakis et al.). Whether a switch suits your condition is your doctor's decision.

Could the heart condition be the cause instead?

Often it could. healthdirect counts high blood pressure and cardiovascular disease among the conditions that contribute to erectile dysfunction, and notes that it is often their first sign (healthdirect). In the four-year trial, 12.2% of the men already had erection problems before treatment began, and the authors warned against "routine attribution of erection problems to antihypertensive medication" (Grimm et al.). More in can high blood pressure cause erectile dysfunction?

Should you stop a beta-blocker if your erections change?

No — see your doctor first. The leaflets are blunt: "DO NOT STOP TAKING MINAX TABLETS SUDDENLY", because stopping suddenly "may worsen your angina or cause other heart complications" (Minax CMI), and the bisoprolol leaflet says the same for heart failure (Bicor CMI). What a GP looks at is the timeline between starting a medicine and the start of the problem (Australian Prescriber). The same question for other blood-pressure tablets: can high blood pressure medication cause erectile dysfunction? and can amlodipine cause erectile dysfunction?

Can you take Viagra or Cialis with a beta-blocker?

That is a separate question: can Viagra be taken with beta-blockers? In short, beta-blockers did not change how the body handles sildenafil (EMA — Viagra), and the medicines that must never be taken with it are nitrates for angina (healthdirect — sildenafil). And for one beta-blocker: can carvedilol and Viagra be taken together?

The short answer

Beta-blockers can cause erection problems, but in placebo-controlled trials the extra risk was small, and men who knew about the side effect were more likely to report it. Heart disease and high blood pressure are causes in their own right. Do not stop the tablet; tell your doctor. More medicines, one by one, are in our guide to which medicines and conditions can cause erectile dysfunction.