Based on NIH | Does taking Metoprolol in the evening affect sexual performance or cause erectile dysfunction during sex at night?

Taking metoprolol in the evening does not appear to uniquely worsen sexual performance at night compared with taking it at other times, but beta blockers, including metoprolol, can be associated with sexual side effects such as reduced libido and erectile dysfunction (ED) in some people. ^[1] Beta blockers as a class have been linked to sexual problems, though this risk varies by individual, drug, dose, and contributing health factors like high blood pressure itself. ^[2]

Key takeaways

• Metoprolol can be associated with decreased sexual interest and difficulty getting or keeping an erection in some users, regardless of dosing time. ^[1]
• Older evidence and clinical experience suggest beta blockers and diuretics are the blood pressure medicines most often linked with sexual side effects, although not everyone is affected. ^[2]
• The timing (evening vs. morning) is not proven to independently increase ED risk; factors like overall cardiovascular health, anxiety about side effects, and the specific beta blocker matter more. ^[3]

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What the evidence says about metoprolol and sexual function

• Metoprolol has recognized sexual side effects in some men, including erectile dysfunction and reduced sexual drive; users are advised to contact their clinician if these occur. ^[1]
• Across blood pressure drugs, beta blockers and “water pills” (diuretics) have been most commonly associated with sexual difficulties, while some other classes tend to be neutral or even favorable. ^[2]
• Research suggests part of the ED sometimes reported with metoprolol may be influenced by expectation and anxiety (a “nocebo” or Hawthorne effect), meaning concern about ED can itself contribute to symptoms. ^[4]
• Comparative and review data indicate beta blockers can be associated with sexual side effects, though not uniformly; some agents (for example, nebivolol) may be less likely to impair erectile function than others. ^[3]

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Does evening dosing specifically worsen nighttime sex?

• There is no strong clinical evidence showing that taking metoprolol in the evening uniquely causes ED during sex at night compared with morning dosing. ^[3]
• In controlled settings, ED risk with beta blockers appears related more to the medication class and individual susceptibility than to the time of day taken. ^[3]
• Practical considerations (such as peak/trough effects) have not been shown to systematically worsen nocturnal sexual performance with standard metoprolol regimens. ^[3]

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Other contributors to consider

• High blood pressure itself can reduce sexual function by affecting blood flow and hormone balance, so not all ED in people taking beta blockers is caused by the medication. ^[2]
• Anxiety about possible sexual side effects can meaningfully impact performance, and reassurance or counseling can help. ^[4]

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Safe use of ED medications with metoprolol

• Phosphodiesterase‑5 inhibitors (like tadalafil) can generally be used with beta blockers, but they may lower blood pressure a bit further; in people taking metoprolol, tadalafil 10 mg produced a small average blood pressure drop (about 5/3 mmHg). ^{[5] [6]}
• If considering ED treatment, it’s sensible to start at a low dose, avoid excess alcohol, and review all heart medications with your clinician. ^{[5] [6]}

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Practical tips if you notice sexual side effects

• Do not stop metoprolol suddenly; abrupt discontinuation can be dangerous for the heart. ^[1]
• Discuss symptoms with your clinician; options may include dose adjustment, switching to a blood pressure medicine with fewer sexual side effects, or addressing ED directly. ^[2]
• Manage modifiable factors: limit alcohol before sex, optimize sleep, exercise regularly, and address stress and relationship factors, which can all influence erections. ^[2]

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Comparison at a glance

Topic	What we know
Metoprolol and ED	ED and reduced libido are possible side effects for some users. [1]
Beta blocker class effect	Beta blockers are commonly linked with sexual problems compared with some other BP drug classes. [2]
Timing (evening vs. morning)	No clear evidence that evening dosing specifically worsens nighttime sexual function. [3]
Role of expectations	Anxiety/expectation can contribute to ED reports with metoprolol. [4]
ED meds with metoprolol	Generally compatible; may cause small additional BP drop, so use thoughtfully. [5] [6]
Do not stop suddenly	Metoprolol should not be stopped abruptly; consult your clinician for changes. [1]

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Bottom line

It’s possible for metoprolol to contribute to sexual side effects, including ED, but the available evidence does not show that taking it in the evening specifically causes erectile problems during nighttime sex more than other dosing times. ^{[1] [3]} If ED occurs, there are several safe, effective strategies ranging from medication adjustments to targeted ED treatments that you can discuss with your clinician. ^{[2] [5] [6]}