Metoprolol vs Propranolol

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For patients with hypertension or other types of heart-related conditions, certain drugs that alter the concentrations of compounds in the body can help manage symptoms and stabilize overall cardiac health. Metoprolol and Propranolol are two such drugs often prescribed for these conditions. Both fall under beta-blockers, which work by blocking adrenaline's effects on your heart. This helps reduce blood pressure and relaxes the heartbeat.

Metoprolol is a selective beta-1 blocker used mainly to treat high blood pressure (hypertension), angina (chest pain), abnormal rhythms of the heart, and some neurologic conditions. It works by relaxing blood vessels and slowing heart rate to improve blood flow.

On the other hand, Propranolol is a non-selective beta-blocker affecting both type 1(beta-1) receptors found predominantly in cardiac tissue as well as type 2(beta-2) receptors present in smooth muscle like bronchial passages. Apart from treating similar conditions as metoprolol it also has applications in reducing migraines frequency.

What is Metoprolol?

Metoprolol (brand names include Lopressor and Toprol XL) is a member of the cardioselective beta-blockers class, signifying an important shift from the earlier generation of non-selective beta-blockers like Propranolol. Metoprolol was first approved by the FDA in 1978. It works by selectively blocking beta1 receptors in the heart, which helps to reduce heart rate, blood pressure levels and strain on your cardiovascular system. This drug is regularly prescribed for managing hypertension, angina pectoris (chest pain), heart failure and arrhythmias.

In contrast with Propranolol that affects both beta1 and beta2 receptors indiscriminately throughout your body – including those found in lungs, liver, pancreas etc., Metoprolol specifically targets only those located within cardiac tissues thereby limiting its scope of potential side effects. However, it's always recommended to discuss any concerns related to these medications with your healthcare provider before making a decision about therapy.

What conditions is Metoprolol approved to treat?

Metoprolol is approved for the treatment of various cardiovascular conditions, including:

How does Metoprolol help with these illnesses?

Metoprolol helps to manage hypertension, heart failure, and angina by reducing the amount of work the heart has to do. It does this by blocking certain receptors (beta-1 adrenergic receptors), which prevents adrenaline from binding to these areas. This slows down your heartbeat and allows your heart to pump blood around your body more easily. Adrenaline is a hormone that plays an important role in the body's fight or flight response, increasing heart rate, blood pressure, cardiac output and metabolism. By decreasing the effect of adrenaline on the heart, Metoprolol can limit strain on the organ and help patients manage their condition while stabilizing their cardiovascular system.

What is Propranolol?

Propranolol, marketed under various brand names including Inderal, is a non-selective beta blocker. This means it blocks the action of epinephrine (also known as adrenaline) on both β1- and β2-adrenergic receptors in the heart, blood vessels, and other organs in the body. By blocking these receptors, propranolol slows down heart rate and reduces blood pressure. It also helps to reduce symptoms of anxiety due to its action on the nervous system. Propranolol was first approved by the FDA in 1967.

Unlike metoprolol which primarily targets β1 receptors found mainly in cardiac tissue - hence having less impact on lung function - propranolol's non-selectivity means it may affect airway resistance making it potentially problematic for people with asthma or chronic obstructive pulmonary disease (COPD). However, this broad scope can be beneficial for patients dealing with tremors or performance anxiety since these conditions can be improved through blockade of β2-adrenergic receptors as well.

What conditions is Propranolol approved to treat?

Propranolol, a non-selective beta-blocker, is approved for the treatment of various conditions including:

How does Propranolol help with these illnesses?

Propranolol, like metoprolol, belongs to the class of medications known as beta blockers which affect the body's response to certain nerve impulses. This action reduces the heart rate and blood pressure, relieving symptoms of conditions such as angina (chest pain) or hypertension. The unique aspect about propranolol is its non-selective nature; it can block both beta-1 and beta-2 receptors whereas metoprolol primarily blocks only beta-1 receptors located mainly in the heart. This broad spectrum activity allows propranolol to not just manage cardiovascular issues but also help with additional conditions like migraines and anxiety disorders by dampening the physical responses associated with 'fight or flight' stress reactions. However, this versatility comes at a price: Propranolol may yield more side effects compared to selective counterparts like Metoprolol due to its broader receptor interaction profile.

How effective are both Metoprolol and Propranolol?

Both metoprolol and propranolol are beta-blockers with a long history of use in treating cardiovascular conditions. They were approved by the FDA several years apart, with propranolol obtaining approval in 1967 and metoprolol being approved later in 1978. Their primary mode of action involves inhibiting the effects of adrenaline on the heart and blood vessels, which helps to lower blood pressure, heart rate, and reduces strain on the heart.

Metoprolol is often prescribed when patients require medication that primarily affects the β1 receptors located mainly within cardiac tissue. This selectivity makes it less likely to induce bronchoconstriction (narrowing of airways), making it generally safer for patients with mild to moderate respiratory disorders such as asthma or chronic obstructive pulmonary disease (COPD).

Propranolol, however, is non-selective; meaning it equally blocks both β1 and β2 receptors located not only in cardiac tissue but also smooth muscle like bronchial passages making it more likely to cause bronchoconstriction than Metoprolol. Propranolol has an additional role as a treatment option for anxiety disorders due its ability to block physical symptoms associated with anxiety.

A meta-analysis conducted by Bangalore et al., published in The Lancet journal indicated that atenololu similar drug type was found inferior compared to other drugs used for hypertension therapy including angiotensin receptor blockers (ARBs). While this does not directly apply neither metapropol nor propanalul since they have different characteristics from atenloloulo it indeed raises questions about beta blockers' overall effectiveness as first-line treatments for high blood pressure especially among older adults who may be prone side effects.

However despite these challenges both medications remain valuable tools managing variety medical conditions beyond just hypertension including angina migraines certain types arrhythmias hypertrophic cardiomyopathy post-myocardial infarction care prevention secondary strokes thyroid storm management essential tremor glaucoma akathisia related antipsychotic use cirrhosis variceal bleeding pheochromocytoma perioperative risk reduction surgery performance anxiety even hemangiomas children thus reinforcing their importance therapeutically.

abstract image of a researcher studying a bottle of drug.

At what dose is Metoprolol typically prescribed?

Oral dosages of Metoprolol for hypertension usually start at 25-100 mg/day in single or divided doses. However, studies have shown that a starting dosage of 50 mg/day is often sufficient to control high blood pressure in most people. The dosage can be increased every week if the desired response is not achieved. For Propranolol, the typical oral dosage for hypertension ranges from 80-320 mg/day given in two to four divided doses. In either case, it's important to note that these medications should always be taken under the supervision of a healthcare provider and their guidelines on maximum daily dosages must strictly be followed.

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At what dose is Propranolol typically prescribed?

Propranolol therapy usually commences at a dosage of 40–80 mg/day. The dose can then be increased to 160 mg/day, divided into two doses, spaced approximately 12 hours apart. If necessary, the maximum dose is typically around 320 mg/day divided into two doses of 160 mg each and spaced about 12 hours apart; this may be tested if there is no response to treatment at the lower dosages after several weeks. Like any medication, Propranolol needs to be taken strictly as directed by your healthcare provider and it's important not to exceed the prescribed dose without professional consultation.

What are the most common side effects for Metoprolol?

The common side effects of metoprolol in comparison to propranolol are as follows:

  • Fatigue (general weakness and tiredness)
  • Dizziness or lightheadedness
  • A slower heart rate than normal
  • Diarrhea or constipation
  • Dry mouth, nausea, vomiting, or gastric discomfort
  • Insomnia and unusual dreams
  • Shortness of breath
  • Swelling in the hands, feet, ankles, or lower legs (fluid retention)
  • Depression and anxiety symptoms
  • Decreased libido (sex drive) or other changes in sexual desire/functioning.

It's important to note that while these medications have similar effects due to their function as beta blockers, individual reactions can vary significantly. Always consult with a healthcare professional for accurate information.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Metoprolol?

Metoprolol and Propranolol can cause serious side effects, although they are rare. These include:

  • Shortness of breath or wheezing
  • Allergic reactions such as skin rash, itching or hives, swelling of the face, lips, or tongue
  • Cold hands or feet
  • Slow or irregular heartbeats
  • Sudden weight gain
  • Swelling of the legs or ankles

In rare cases, severe liver problems have been reported. Watch out for symptoms such as:

  • Upper right belly pain
  • Fatigue
  • Loss of appetite
  • Dark urine
  • Yellowing of the skin or the whites of the eyes

In very rare cases, metoprolol and propranolol can affect the nervous system, leading to symptoms like:

  • Mood changes
  • Trouble sleeping
  • Nightmares
  • Memory problems
  • Feeling anxious, nervous, or restless
  • Unusual tiredness or weakness

If you experience any of these symptoms, stop taking metoprolol or propranolol and contact your healthcare provider immediately.

What are the most common side effects for Propranolol?

Propranolol may cause some of the following side effects:

  • Fatigue or weakness
  • Cold hands and feet
  • Upset stomach, nausea, vomiting, diarrhea or constipation
  • Shortness of breath
  • Sleep disturbances including insomnia and nightmares
  • Slow heartbeat
  • Dizziness or lightheadedness Please note that while these are possible side effects, they do not occur in every individual who takes this medication. It's also important to remember that Propranolol is widely used because its benefits generally outweigh potential risks. Always consult your healthcare provider before starting any new medication regimen.

Are there any potential serious side effects for Propranolol?

While Propranolol is generally considered safe, it can have severe side effects in certain cases. Watch out for the following symptoms:

  • Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue or throat.
  • Unusually slow heartbeats that have caused you to faint.
  • Shortness of breath (even with mild exertion), swelling, rapid weight gain.
  • Sudden weakness or ill feeling, fever, chills, sore throat
  • Cold feeling in your hands and feet.

If any of these symptoms present themselves while taking Propranolol it's crucial to seek medical attention immediately. This list might not include all possible side effects that could occur with Propranolol use so always consult a healthcare professional for advice tailored specifically to your health needs.

Contraindications for Metoprolol and Propranolol?

Both Metoprolol and Propranolol, like other beta-blockers, can sometimes exacerbate symptoms of heart failure or asthma. If you notice a worsening in your breathing or experience swelling of the hands, feet, ankles or abdomen please seek immediate medical attention.

Neither Metoprolol nor Propranolol should be taken if you are taking or have been taking medications that slow heart rate (such as digoxin) without discussing with your doctor first. Always communicate all current medications to your physician; certain drugs may require a period to clear from the system to prevent dangerous interactions with Metoprolol and Propranolol.

Moreover, sudden discontinuation of either drug could lead to serious cardiac issues including angina and myocardial infarction. Therefore, always follow the health care provider's guidance when stopping use of these medicines.

How much do Metoprolol and Propranolol cost?

The brand name versions of these two medications, Lopressor for metoprolol and Inderal for propranolol, are priced as follows:

  • A pack of 60 tablets (50 mg each) of Lopressor costs around $240, which works out to between $4–8/day depending on your dosage.
  • The price for a pack of 30 tablets (10 mg each) of Inderal is about $70. This translates to approximately $2.33/day.

If you require higher doses of metoprolol (i.e., 200 mg/day or more), then the per-day cost will be higher than that for propranolol. However, please keep in mind that cost should not be the only factor when choosing between these two drugs; their therapeutic effects and potential side effects must also be considered.

For generic versions:

  • Metoprolol tartrate can come in packs ranging from 15 up to several hundred tablets (50 mg), with daily treatment costs usually under a dollar, even if you're taking typical dosages close to 100 or even 200mg/day.
  • Propranolol is available in similar quantities and strengths as metoprolol but tends to run somewhat cheaper - often well below a dollar per day regardless of whether you are at the lower end or upper end of regular dosage ranges.

Popularity of Metoprolol and Propranolol

Metoprolol, in generic form as well as brand names such as Lopressor and Toprol XL, was estimated to have been prescribed to about 80 million people in the US in 2020. It accounted for just over 15% of beta-blocker prescriptions in the country. Metoprolol is often used for treating high blood pressure, chest pain due to poor blood flow to the heart, and a number of conditions involving an abnormally fast heart rate. The prevalence of metoprolol has been increasing since it entered the market.

Propranolol, including brand versions such as Inderal, was prescribed to approximately 27 million people in the USA during 2020. In terms of total beta blocker prescriptions within that year, propranolol accounted for around 7%. This medication is predominantly used to treat high blood pressure; it's also employed in managing irregular heart rates and other cardiovascular-related symptoms. Propranolol's usage has remained relatively stable over recent years.


Both metoprolol and propranolol have established histories of usage in patients with heart conditions, and are supported by numerous clinical studies indicating that they are more effective than placebo treatments. In certain situations, the drugs may be used together under careful monitoring by a physician due to their similar but not identical mechanisms of action. Metoprolol primarily blocks beta-1 receptors which are mostly found in the heart, whereas propranolol non-selectively blocks both beta-1 and beta-2 receptors located throughout the body.

Metoprolol is often considered as a first-line treatment for hypertension or angina because it's less likely to affect lung function compared to propranolol. On the other hand, Propranolol would usually be chosen for use in cases of anxiety disorders or migraine prevention due its broader spectrum of action.

Both medications can also be found as generics which represents significant cost savings especially for patients who must pay out-of-pocket. Both metoprolol and propranolol may require an adjustment period meaning that effects may not be noticeable immediately.

The side effect profile is somewhat different between these two drugs; while both can cause fatigue, dizziness, slow heartbeat, cold hands and feet; propranolal has additional side effects related to its non-selective blockade like shortness of breath or wheezing particularly in people with pre-existing breathing issues. For both drugs, patients should monitor their pulse rate regularly when starting treatment and contact medical help if they notice any severe symptoms such as fainting or chest pain.