Propranolol Erectile Dysfunction: An Overview

Propranolol is a beta-blocker medication used to treat a wide variety of medical conditions, including, in extremely rare cases, erectile dysfunction (ED) secondary to anxiety. However, it is more likely for propranolol to cause ED than to treat it.

This article will consider the use of propranolol to treat ED, the associated health conditions, some of the adverse reactions to look out for, and when it is time to see a doctor. 

What is propranolol?

Propranolol is a beta-blocker developed over 50 years ago to treat angina (chest pain), but it soon became a popular tool to treat many cardiovascular and noncardiovascular conditions. 

These include hypertension, cardiac arrhythmia, heart attacks, migraines, high blood pressure, anxiety, tremors, hyperthyroidism, and pheochromocytoma (a hormone-secreting tumor typically in the adrenal gland).

Propranolol is a type of beta-blocker that non-selectively antagonizes beta-1 and beta-2 receptors typically found in the heart and vasculature. Because of its non-selective antagonization of multiple receptors, it can play an important role in treating various medical conditions. 

Propranolol can also be considered a cost-effective treatment option compared to other corresponding treatment options as it’s commonly generic and cheaper, being an older drug.

Uses

Propranolol¹ can slow contractility (the heart’s ability to contract), decrease heart rate, lower blood pressure, and reduce the heart's oxygen demand. For example, performance anxiety caused by phobias causes symptoms such as increased heart rate, sweating, and flushing when the sympathetic nervous system is activated. 

Propranolol is administered orally or intravenously (injected into the vein), and the doses vary depending on the treatment required. 

How effective is propranolol in treating ED?

There are mixed responses to propranolol when attempting to treat ED, as propranolol is typically thought to cause ED as a possible side effect but may be useful in rare circumstances of ED caused by particular anxieties, etc.

A normal erectile function² requires smooth muscle relaxation and vasodilation (widening of blood vessels) for blood flow to increase in the penis. This drives the ability to obtain and maintain an erection.

Propranolol, especially in high doses, has a negative impact³ on erectile function, seemingly due to its effects on the sympathetic nervous system and leading to reductions in serum testosterone levels.

Propranolol has been known to reduce social performance anxiety³ by blocking the association between fear memories and anxiety symptoms such as sweating, shaking, and tachycardia (increased heart rate).

What are the side effects associated with its use?

Adverse reactions may include:

• bradycardia

• gastrointestinal issues

• abdominal pain

• nausea

• erectile dysfunction

• wheezing

• drowsiness

• fatigue

• cold extremities

• allergic reactions

• insulin resistance

• hallucinations

Propranolol should not be prescribed to some patients with pre-existing health conditions as it may worsen or mask symptoms. Such conditions include;

Diabetes mellitus

Propranolol should be prescribed with extreme caution, as it can mask the symptoms of hypoglycemia, which include:

• Flushing

• Tachycardia (raised heart rate)

• Sweating

• Dizziness

Bradycardia

Because propranolol decreases heart rate, it should not be prescribed to those with bradycardia (decreased heart rate of fewer than 60 beats per minute).

Lung issues (Asthma)

Patients with underlying lung issues such as asthma, emphysema, and COPD may experience worsened respiratory function due to the beta-blockers constrictive action on smooth muscles in the lungs, ultimately worsening the condition.

Kidney and liver issues

Patients with pre-existing kidney or liver impairments should have adjusted doses of propranolol to allow the medication to be safely metabolized from the body.

Is propranolol a safe treatment in ED?

Propranolol administered for hypertension⁴ has been reported to have a negative impact on erectile function. The effect of propranolol on ED appears to be dose-dependent since a dose of 180mg per day leads to three times the prevalence of ED compared with lower doses. 

In one study,⁵ those with no sexual complaints took a mean daily dose of 83mg. A threshold of 160–180mg per day was identified as causing a greater incidence and progressive worsening of erectile dysfunction, and doses above this should be avoided for patients suffering from ED. 

How long does it take for propranolol to start working?

Propranolol usually starts to take effect on the body within a few hours,⁶ but for heart conditions, it may take up to a couple of days to take full effect. To reduce anxiety relating to sexual performance, allow this time to pass before getting discouraged by the effects of propranolol on ED.

How long will it continue to be effective?

The elimination half-life of propranolol is approximately 3 to 6 hours. Regular long-term use of propranolol has been found to be effective in treating anxiety and heart-related conditions and should be continued for as long as your doctor recommends.

This may be several months or possibly a lifetime, but it should only be taken for as long as you need it. Your dosage rate and length of administration will depend on your physical condition and should be determined by your doctor.

Other treatment alternatives for ED

PDE5 inhibitor treatments⁷ are typically prescribed as a relatively fast-acting treatment for ED. Multiple medicines are available with varying effectiveness times to help improve the sexual function needed for satisfactory sexual intercourse. 

These treatments include:

• Sildenafil (Viagra)

• Vardenafil (Levitra)

• Tadalafil (Cialis)

These drugs have varying peak absorption hours and half-lives and can be used to time erectile performance with planned sexual intercourse. 

These drugs initiate a cascade of biological events that slow down the metabolic cascade that breaks down an erection. 

When to visit your doctor

If you are experiencing a frequent inability to obtain or maintain an erection, it may be time to see a doctor. 

After a clinical and psychological examination, your doctor will identify the cause of your ED and provide treatment specific to your needs. ED is common in males⁸ and can be driven by fears around sexual performance or a pre-existing health condition. 

Having an open and honest discussion with your doctor about your experiences with ED will achieve the best treatment results.

The lowdown

Propranolol is used for various physical and psychological treatments and may aid in the anxiety component of ED, although the literature is lacking. However, at high doses, it has been reported to actually induce ED.

If you are struggling with obtaining and maintaining an erection, get in touch with your doctor to identify the cause of your ED and the best treatment plan for your condition.