Metoprolol sexual side effects

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Metoprolol and Sexual Side Effects: A Comprehensive Overview

Introduction to Beta-Blockers and Sexual Dysfunction

Beta-blockers, a class of medications commonly used to manage hypertension and other cardiovascular conditions, have been associated with various side effects, including sexual dysfunction. Among these, metoprolol, a selective beta-1 adrenergic receptor blocker, has been studied for its impact on sexual health.

Metoprolol and Erectile Dysfunction

Research indicates that hypertensive men treated with beta-blockers frequently report erectile dysfunction (ED). A study comparing the effects of metoprolol and nebivolol on erectile function found that metoprolol significantly decreased the International Index of Erectile Function (IIEF) erectile function subscore by 0.92 within the first eight weeks of treatment. In contrast, nebivolol did not have this adverse effect and even improved secondary sexual activity scores and other IIEF subscores . This suggests that while metoprolol effectively lowers blood pressure, it may contribute to ED in male patients.

Hormonal Changes and Sexual Function

Another study evaluated the effects of various beta-blockers, including metoprolol, on hormonal levels and sexual function. The research found significant reductions in both total and free testosterone levels during treatment with beta-blockers, including metoprolol. However, the study noted that nonselective beta-blockers like propranolol and pindolol were associated with a greater reduction in testosterone compared to selective ones like metoprolol . This hormonal change could potentially contribute to sexual dysfunction, although the study's results on nocturnal penile tumescence (NPT) and self-reported sexual function were inconclusive due to confounding factors such as sleep disruption and short treatment duration.

Genetic Factors and Tolerability

The impact of genetic polymorphisms on the tolerability of metoprolol has also been explored. Specifically, the cytochrome P450 (CYP) 2D6 genotype can influence the occurrence of adverse effects, including sexual dysfunction, during metoprolol treatment. This suggests that individual genetic differences may play a role in the extent to which patients experience sexual side effects from metoprolol .

Conclusion

In summary, metoprolol, while effective in managing hypertension, has been associated with sexual side effects, particularly erectile dysfunction. This is likely due to its impact on testosterone levels and possibly influenced by genetic factors. Comparatively, other beta-blockers like nebivolol may offer similar antihypertensive benefits without the same degree of sexual dysfunction. Patients experiencing these side effects should consult their healthcare provider to discuss potential alternatives or adjunct therapies.

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Most relevant research papers on this topic

Beta-blocker effects on sexual function in normal males

Beta-blockers can reduce testosterone levels in healthy males, with nonselective drugs (pindolol and propranolol) showing the greatest reduction.

RCTHighly Cited

1988·

87citations

·R. Rosen et al.

Impact of CYP2D6 genotype on adverse effects during treatment with metoprolol: A prospective clinical study

CYP2D6 genotype significantly impacts the tolerability of metoprolol in a real-life primary care setting, with potential adverse effects related to central nervous system, cardiovascular effects, and sexual dysfunction.

Observational StudyHighly Cited

2005·

126citations

·R. Fux et al.

NITRIC OXIDE, ERECTILE DYSFUNCTION AND BETA‐BLOCKER TREATMENT (MR NOED STUDY): BENEFIT OF NEBIVOLOL VERSUS METOPROLOL IN HYPERTENSIVE MEN

Nebivolol may offer additional benefits by avoiding erectile dysfunction in male hypertensive patients on long-term beta-blocker therapy, while metoprolol may have similar antihypertensive efficacy.

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2007·

141citations

·K. Brixius et al.

CNS-related side-effects with metoprolol and atenolol

Metoprolol is associated with a higher incidence of CNS side-effects compared to atenolol, while both drugs effectively control blood pressure.

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2004·

42citations

·J. Cove-Smith et al.

Effects of beta-blockers on sexual performance in men with coronary heart disease. A prospective, randomized and double blinded study

Metoprolol treatment did not affect sexual performance in men with coronary heart disease.

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2001·

57citations

·D. Franzen et al.

The impact of CYP2D6 mediated drug–drug interaction: a systematic review on a combination of metoprolol and paroxetine/fluoxetine

The drug-drug interaction between metoprolol and paroxetine/fluoxetine can lead to adverse clinical consequences, and alternative treatments are available.

Systematic ReviewVery Rigorous Journal

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·M. A. Bahar et al.

Metoprolol in acute myocardial infarction (MIAMI). A randomised placebo-controlled international trial. The MIAMI Trial Research Group.

Metoprolol may reduce mortality in high-risk acute myocardial infarction patients, but its effect on overall mortality and morbidity remains unclear.

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·J. Herlitz et al.

Metoprolol for the Prevention of Acute Exacerbations of COPD.

Metoprolol treatment for moderate or severe COPD patients without established indications showed similar time to first exacerbation but more hospitalization for exacerbation.

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·M. Dransfield et al.

Metoprolol

Metoprolol is a well-established first-line drug for treating mild to moderate hypertension and stable angina, and is beneficial in post-infarction patients.

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·P. Benfield et al.

Metoprolol in Critically Ill Patients With COVID-19

Metoprolol administration is a safe, cost-effective strategy to reduce lung inflammation and improve oxygenation in COVID-19 patients on invasive mechanical ventilation.

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52citations

·A. Clemente-Moragón et al.

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