Sex Rx: beta-blockers and your sex life

Medications:

Beta-adrenergic blocking agents, more commonly called beta-blockers

Beta-blockers and their commonly used brand names

What they are most often prescribed for:

• Hypertension
• Angina
• Arrhythmia/ irregular heartbeat
• Treatment after a heart attack; to help prevent further heart attacks
• Diseased heart muscle (cardiomyopathy)
• Migraine prevention
• Tremors/trembling, usually associated with hyperthyroidism
• Performance anxiety
• Bleeding esophageal varices (in liver cirrhosis)

How they work:

Beta-blockers interfere with the usual response to nerve impulses in certain parts of the body, most notably the cardiovascular system. This reduces the heart's workload and helps it beat more regularly. It also diminishes some of the symptoms associated with increased nervous system activity.

Possible sexual side effects:

Among people taking beta-blockers, men appear to experience more sexual side effects than women.

• Decreased sexual desire, in both men and women
• Impotence
• Depression, which can contribute to decreased libido and other manifestations of sexual dysfunction

Beta-blockers should be avoided by anyone with a history of:

• Desire disorders
• Impotence
• Ejaculatory problems
• Peyronie's disease
• Unexplained infertility
• Moderate to severe depression

Although not necessarily related to their adverse effects on sexual function, beta-blockers should be used with caution in patients with the following conditions:

• Congestive heart failure
• Heart block (slow heart beat)
• Diabetes mellitus
• Asthma, chronic bronchitis or emphysema
• Peripheral vascular disease
• High triglycerides

How they cause sexual problems:

It is not known exactly how beta-blockers cause sexual dysfunction. It may be because they increase constriction of peripheral blood vessels; for an erection to occur, blood vessels in the penis should be dilated, rather than constricted.

Beta-blockers also increase the brain chemical, serotonin. High levels of serotonin, which travels down the spinal cord and may affect sexual reflex centers, may decrease sex drive in both men and women, and impair erection and ejaculation in men.

Treatment options:

If you are experiencing sexual dysfunction that you believe is related to your medication, talk to your doctor. Never change or stop taking any medication without first discussing it with your doctor. Your options include the following:

Decrease the dosage
People taking up to160 mg of a beta-blocker per day are less likely to report sexual dysfunction. However, once levels reach 320 mg/day, decreased libido and other dysfunction is reported more often.

Switch medications
The medication options that are appropriate for you depend on why you were prescribed a beta-blocker. To treat hypertension, your doctor may recommend switching to an ACE inhibitor, alpha1 blocker or thiazide diuretic. To treat hypertension or an arrhythmia, your doctor may recommend switching to a calcium channel blocker.

Treat the impotence
If your doctor determines that a beta-blocker is the best medical treatment for your condition, there are options to manage impotence. These include:

Sildenafil (Viagra) - a commonly known treatment for male impotence. This option is not recommended for everyone, especially people with heart disease; people who take nitrate medications to manage angina and other heart problems should never use sildenafil.

Yohimbine - this is the only herbal supplement to have shown usefulness in the treatment of impotence, thus far. However, it can raise blood pressure and therefore should not be used by people taking a beta-blocker to manage hypertension.

Intrapenile injections - a self-administered injection can help men to maintain and sustain an erection, however, there is some discomfort associated with the injection.

Vacuum devices - these devices help to bring blood into the penis in order to bring about an erection. However, the mechanics of these devices do not allow for ejaculation.