Beta-Blocker Therapy and Peyronie's Disease: A Rare but Documented Association
Beta-blockers can cause Peyronie's disease, though this is a rare adverse effect documented primarily in case reports and FDA labeling, with propranolol being the most commonly implicated agent. 1
Evidence from FDA Drug Labeling
The FDA-approved prescribing information for propranolol explicitly lists Peyronie's disease under genitourinary adverse reactions, alongside male impotence. 1 This represents the highest-quality evidence linking beta-blocker therapy to Peyronie's disease, as drug labels reflect post-marketing surveillance and regulatory review of adverse events.
Clinical Evidence and Mechanism
The association between beta-blockers and Peyronie's disease has been documented in the medical literature since the late 1970s, with case reports describing the condition developing during treatment with:
Proposed Pathophysiologic Mechanisms
Two potential mechanisms have been suggested for beta-blocker-induced Peyronie's disease:
Impaired balance between alpha- and beta-receptors in connective tissue, which may promote abnormal fibrous tissue production 3
Immunological basis for fibrosis, though this remains speculative 3
Clinical Characteristics
In documented cases, Peyronie's disease developed approximately 8 months after initiation of beta-blocker therapy, with one patient receiving high-dose labetalol (2400 mg daily) for 2 months before symptom onset. 3 Importantly, cessation of the drug did not result in improvement in this case, suggesting that once the fibrotic process is established, it may be irreversible. 3
Important Clinical Caveats
Age Consideration
The ages of reported cases fall within the typical range where Peyronie's disease most commonly develops spontaneously (middle-aged men), making it difficult to definitively establish causation versus coincidence in individual cases. 2, 3 This overlap complicates the attribution of Peyronie's disease to beta-blocker therapy in clinical practice.
Rarity of the Association
While documented in FDA labeling and case reports, this adverse effect appears to be uncommon, as it is not mentioned in comprehensive 2022 guidelines reviewing approximately 50 indications and adverse effects of beta-blockers in hypertension. 4
Clinical Management Recommendations
When evaluating a patient on beta-blocker therapy who develops penile curvature or plaque formation:
- Consider beta-blocker therapy as a potential contributing factor, particularly with propranolol or labetalol 1, 3
- Recognize that discontinuation may not reverse established disease 3
- Manage Peyronie's disease according to standard treatment algorithms, which prioritize conservative management in the active phase and surgical correction for stable disease causing functional impairment 4
- Do not routinely discontinue effective beta-blocker therapy solely based on this rare association, especially in patients with compelling cardiovascular indications 4
Treatment Considerations
If Peyronie's disease develops during beta-blocker therapy and the cardiovascular indication is strong, consider switching to a cardioselective beta-1 blocker if the patient is on a non-selective agent, though evidence supporting this strategy is limited. 4 The decision should weigh the cardiovascular benefits of continued beta-blockade against the potential (though unproven) benefit of drug discontinuation.