Do antihypertensive (blood pressure) medications, such as beta-blockers (e.g. propranolol) or alpha-blockers (e.g. prazosin), cause premature ejaculation?

From the Guidelines

Antihypertensive medications like beta-blockers and alpha-blockers do not typically cause premature ejaculation, and in some cases, may even delay ejaculation as a side effect. According to the most recent guideline on disorders of ejaculation, published in 2022 1, the focus is on treating premature ejaculation with daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics, rather than addressing it as a side effect of antihypertensive medications.

Some key points to consider:

• Beta-blockers such as propranolol can cause sexual dysfunction, including erectile difficulties and delayed ejaculation, rather than premature ejaculation 1.
• Alpha-blockers like prazosin are not generally associated with causing premature ejaculation.
• Sexual side effects vary among individuals and depend on the specific medication, dosage, and individual factors.
• If experiencing premature ejaculation while taking these medications, it's more likely due to other factors such as stress, anxiety, or underlying health conditions.
• The 2022 guideline 1 recommends daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics as first-line agents of choice in treating premature ejaculation, with a strong recommendation and evidence level of Grade B.

It's essential to discuss any sexual side effects with your healthcare provider, as they can adjust your medication regimen if necessary. Never stop taking prescribed blood pressure medications without medical consultation, as uncontrolled hypertension poses significant health risks. Your doctor might consider switching to a different class of antihypertensive medication if sexual side effects are problematic.

From the Research

Blood Pressure Medicines and Premature Ejaculation

• There is evidence to suggest that certain blood pressure medicines, specifically alpha-blockers, may be used to treat premature ejaculation (PE) 2, 3.
• Alpha-blockers, such as silodosin, have been shown to be effective in increasing intravaginal ejaculation latency time (IELT) and improving quality of life (QoL) in patients with PE 2, 3.
• However, beta-blockers, such as propranolol, have not been found to be effective in treating PE 4.
• The current treatment guidelines for PE recommend the use of selective serotonin reuptake inhibitors (SSRIs), such as dapoxetine, as the first-line treatment 5, 6.
• Alpha-blockers, such as silodosin, may be considered as an alternative treatment option for PE, especially in patients who cannot tolerate SSRIs or have contraindications to their use 3.

Mechanism of Action

• Alpha-blockers, such as silodosin, work by relaxing the smooth muscle in the prostate and bladder neck, which helps to increase IELT and improve QoL in patients with PE 2, 3.
• Beta-blockers, such as propranolol, work by blocking the beta-adrenergic receptors, which can help to reduce anxiety and stress, but have not been found to be effective in treating PE 4.

Side Effects

• Alpha-blockers, such as silodosin, may cause side effects such as reduced semen ejaculation, but have been found to have a relatively safe profile compared to other treatments for PE 3.
• Beta-blockers, such as propranolol, may cause side effects such as dizziness, fatigue, and erectile dysfunction, but have not been found to be effective in treating PE 4.