Propranolol vs Bystolic

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For patients with hypertension or other types of cardiovascular conditions, certain drugs that alter the concentrations of compounds in the body related to heart rate and blood pressure can help manage these symptoms. Propranolol and Bystolic are two such drugs that are often prescribed for these conditions. They each impact different pathways but both have a role in controlling high blood pressure (hypertension) as well as reducing the risk of further complications like stroke or heart attack. Propranolol is a non-selective beta blocker, affecting levels of epinephrine and norepinephrine throughout the body, whereas Bystolic is more selective and primarily targets beta-1 adrenergic receptors located mainly in cardiac tissues.

What is Propranolol?

Propranolol (sold under the brand name Inderal) was one of the first beta-blocker medications developed and has been used since the 1960s. It's a non-selective beta-blocker that works by blocking the action of adrenaline on both β1- and β2-receptors, effectively reducing heart rate, blood pressure, and stress on your heart. Propranolol is often prescribed for conditions such as hypertension, angina pectoris, irregular heartbeat, migraine prevention and anxiety disorders.

On the other hand, Nebivolol (known by its brand name Bystolic) represents a newer class of selective β1-receptor blockers. Approved by FDA in 2007 for treating hypertension initially but later found effective in managing heart failure too. As it selectively targets only β1-receptors primarily located in cardiac tissues leading to fewer side effects related to bronchoconstriction or cold extremities compared to non-selective beta-blockers like propranolol. Additionally,Bystolic also causes vasodilation (widening of blood vessels), further helping reduce blood pressure through a mechanism not seen with most other beta blockers.

What conditions is Propranolol approved to treat?

Propranolol is approved for the treatment of a wide variety of cardiovascular conditions:

  • High blood pressure, also known as hypertension
  • Angina pectoris (chest pain usually caused by lack of oxygen to the heart due to clogged arteries)
  • Preventive measure for recurrent heart attacks
  • Management of tremors
  • Control of symptoms caused by thyroid overactivity (hyperthyroidism)
  • Prevention and reduction in frequency and severity of migraines.

Meanwhile, Bystolic is primarily used for:

  • Management and treatment of high blood pressure or hypertension.

How does Propranolol help with these illnesses?

Propranolol helps manage conditions such as hypertension, angina, and arrhythmias by reducing the heart rate and lowering blood pressure. It does this by blocking beta-adrenergic receptors in the body that respond to epinephrine (adrenaline). These receptors are present on cells of the heart muscles, smooth muscles, airways, arteries, kidneys, and other tissues that are part of the sympathetic nervous system. By antagonizing these receptors i.e., preventing them from being activated by adrenaline or noradrenaline - Propranolol inhibits sympathetic activity resulting in slower heart rates and lower blood pressure.

Bystolic operates similarly but is more selective than Propranolol. While both medications block beta-adrenergic receptors; Bystolic specifically targets a subtype known as Beta-1 located predominantly in cardiac tissue. This selectivity offers an advantage for patients with respiratory issues like asthma or chronic obstructive pulmonary disease because it lessens potential negative impact on lung function which can occur due to non-selective blockade of Beta-2 adrenergic receptors found in bronchial muscle tissue which could constrict when blocked.

What is Bystolic?

Bystolic, also known by its generic name Nebivolol, is a beta blocker that functions primarily through the inhibition of beta-1 adrenergic receptors in the heart and blood vessels. This action results in a lowering of heart rate, blood pressure, and strain on the heart. Bystolic was first approved by the FDA in 2007.

Unlike Propranolol which inhibits both beta-1 and beta-2 receptors leading to more systemic adverse effects such as bronchial constriction, Bystolic selectively targets only beta-1 receptors. This means it has less impact on lung function making it safer for people with respiratory problems like asthma.

Also unlike propranolol's significant potential side effects like cold extremities or worsening of Raynaud's syndrome due to peripheral vasoconstriction caused by non-selective blockade of β-adrenoceptors; Bystolic does not exhibit this property thereby reducing these specific side-effects.

The use of Bystolic can be especially beneficial for managing conditions such as hypertension (high blood pressure), angina (chest pain), certain types of irregular heartbeat, and along with other medicines to improve survival after a patient suffers from a heart attack.

What conditions is Bystolic approved to treat?

Bystolic is an FDA-approved medication for the management of:

  • Hypertension (high blood pressure)

This beta-blocker can help to reduce cardiovascular risk by controlling high blood pressure, and it does so by slowing heart rate and reducing the force with which the heart muscle contracts, both of which lower blood pressure.

How does Bystolic help with these illnesses?

Nebivolol, commonly known as Bystolic, and propranolol are both beta-blockers that work by affecting the response to certain nerve impulses in your heart. This action subsequently reduces heart rate, blood pressure, and strain on the heart. Bystolic specifically works by blocking beta-1 receptors predominantly found in the heart muscle cells, thereby reducing the impact of adrenaline and noradrenaline on these sites. This leads to a decrease in heartbeat strength and overall workload for your cardiac system. Unlike propranolol which has non-selective beta-blocking effects, Bystolic's selectivity allows it to lower blood pressure with less likelihood of triggering asthma symptoms or causing cold hands and feet side effects typically associated with older generation beta-blockers like Prozac or combined SSRIs.

How effective are both Propranolol and Bystolic?

Both propranolol and nebivolol (Bystolic) are beta blockers with established records of effectiveness in treating hypertension and other heart-related conditions. Propranolol, one of the first beta-blockers to be synthesized, was approved by the FDA in 1967 while nebivolol received its approval much later, in 2007. Given their varying mechanisms of action - propranolol is non-selective while nebivolol is selective for the β1 receptor - they may be preferred under different circumstances.

The efficacy of both these drugs in managing symptoms of hypertension has been directly studied; a randomized controlled trial conducted in 2010 found that both drugs had similar effectiveness at reducing blood pressure. However, it's interesting to note that Bystolic was found slightly superior regarding influence on parameters like heart rate and lipid profile.

A systematic review published in 2015 demonstrated that propranolol effectively manages symptoms associated with cardiovascular diseases from the onset of treatment. It also exhibited a favorable safety profile compared to some other antihypertensive agents although caution must be exercised when prescribing it for patients suffering from asthma due to its non-selectivity.

On the other hand, a meta-analysis conducted in 2014 indicated that Bystolic seems more effective than placebo but showed similar efficacy as most common antihypertensives for controlling high blood pressure. Its advantage lies within its unique pharmacological properties which allow it fewer respiratory side effects when compared to non-selective beta blockers such as propranolol making it an optimal choice among patients who require Beta-blocker therapy but have concomitant pulmonary issues.

abstract image of a researcher studying a bottle of drug.

At what dose is Propranolol typically prescribed?

Oral dosages of Propranolol vary widely, from 20–240 mg/day, depending on the condition being treated. For hypertension in adults, initial dosage usually starts at 80 mg per day divided into smaller doses. Children's dose is determined by weight and should be administered under a doctor's guidance. For both populations, dosage can be adjusted after a few weeks if there is inadequate response to treatment. Conversely, Bystolic (Nebivolol) for managing high blood pressure typically begins with an initial dosage of 5 mg/day for most adults and adjustments are made based on patient response and tolerance to the drug. It’s important to note that Bystolic isn't recommended for children or adolescents due to lack of data regarding its safety and effectiveness in this age group.

At what dose is Bystolic typically prescribed?

Bystolic treatment usually commences at a dosage of 5 mg/day, taken once daily. Depending on how your body responds to the medication and based on the doctor's evaluation, this can be increased steadily to 10 mg/day or even up to a maximum dose of 40 mg/day. However, any changes in dosing should always be under the careful supervision of your healthcare provider. The medicine is taken orally with or without food. If you find that there is no significant improvement after several weeks on Bystolic therapy at 5-10 mg per day, consult with your physician about possibly increasing the dosage.

What are the most common side effects for Propranolol?

Common side effects associated with Propranolol include:

  • Fatigue and weakness
  • Cold hands or feet
  • Weight gain
  • Shortness of breath (in severe cases)
  • Slow heart rate
  • Nausea, vomiting, and diarrhea
  • Insomnia or other sleep disturbances

On the other hand, Bystolic can cause:

  • Headache
  • Dizziness due to a drop in blood pressure
  • Tiredness/fatigue
  • Slow heartbeat
    -Stomach pain
    -Swelling in your legs or ankles (edema)

Both medications can potentially decrease libido as they affect the cardiovascular system. Always consult your healthcare provider if you experience any unexpected side effects while on medication.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Propranolol?

In rare instances, Propranolol can cause serious side effects such as:

  • Worsening of heart failure symptoms, including sudden weight gain, swelling in the ankles or legs, coughing up white or pink mucus
  • Signs of allergic reactions like skin rash; itching or hives; swelling of the face, lips, or tongue
  • Breathing problems
  • Changes in blood sugar levels - resulting in excessive thirst and hunger with frequent urination.
  • Cold hands and feet
  • Disturbed sleep and nightmares
  • Dry peeling skin

On the other hand, Bystolic might lead to certain adverse effects which include:

  • Lightheadedness and dizziness due to a slow heartbeat (bradycardia)
  • Shortness of breath
  • Swelling in your ankles or feet (indicating possible heart failure)
    -A severe allergic reaction: Symptoms could involve difficulty breathing; swellings on your face,lips,tongue,and throat;a severe rash with peeling skin.

If you experience any of these symptoms while taking either medication, seek immediate medical attention.

What are the most common side effects for Bystolic?

Bystolic, known generically as nebivolol, is a beta-blocker often used to treat hypertension. Potential side effects may include:

  • Shortness of breath
  • Swelling in the hands or feet
  • Slow heart rate (bradycardia)
  • Lightheadedness or dizziness
  • Headache
  • Fatigue and feeling weak
  • Nausea, upset stomach, or diarrhea It's important to note that while these symptoms can occur they are less common and Bystolic is generally well-tolerated with fewer overall side-effects compared to older generation beta-blockers like propranolol. However, any new symptoms should be reported to your healthcare provider.

Are there any potential serious side effects for Bystolic?

Bystolic, like all medications, can cause potential side effects. Some may be severe and require immediate medical attention. Noteworthy symptoms include:

  • Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue or throat
  • A light-headed feeling as if you might pass out
  • Shortness of breath even with mild exertion or while lying down
  • Swelling in your ankles or feet
  • Sudden weight gain
  • Slow or uneven heartbeats
  • Confusion, mood changes
  • Little to no urination

If you notice any of these signs after taking Bystolic, seek immediate medical help.

Contraindications for Propranolol and Bystolic?

Just like Wellbutrin and Prozac, both propranolol and Bystolic, which are beta-blockers used to treat hypertension and other heart disorders, may have certain side effects. If you notice your symptoms worsening or experience any severe reactions such as slow or uneven heartbeats, swelling of the ankles or feet, sudden weight gain, shortness of breath etc., please seek immediate medical attention.

Neither propranolol nor Bystolic should be taken if you are taking or have been consuming medications like reserpine or monoamine oxidase (MAO) inhibitors. Always disclose to your physician all the medications you are taking; MAOIs will require a period of about two weeks to clear from the system before safe initiation of treatment with either propranolol or Bystolic in order to avoid potentially dangerous interactions.

How much do Propranolol and Bystolic cost?

For the brand name versions of these drugs:

  • The price of 60 tablets of Bystolic (5 mg) averages around $165, which works out to approximately $2.75/day.
  • The price for 30 capsules of Propranolol (40 mg) typically ranges from about $85 to $100, working out to roughly $2.80-$3.33/day.

Thus, if you are in the higher dosage range for Propranolol (i.e., 160 mg/day or higher), then brand-name Bystolic is less expensive on a per-day treatment basis. However, remember that cost should not be your primary consideration when choosing between these two medications.

As for generic versions:

  • Generic Nebivolol (Bystolic's chemical name) costs can range from about $0.30 to over a dollar per day depending on dosages and where you purchase it.
  • Generic Propranolol is considerably cheaper with prices as low as just under a dime ($0.10) up to around fifty cents ($0.50) per day depending again on dosage and location purchased.

It's important to bear in mind though that everyone responds differently to different medications so although one may seem more attractive due its lower cost this doesn't necessarily mean it will be the best option for you personally; always consult your doctor before making any decisions regarding medication changes or choices based primarily on cost factors alone.

Popularity of Propranolol and Bystolic

Propranolol, available in generic form as well as under brand names such as Inderal, was estimated to have been prescribed to approximately 7 million people in the US in 2019. Propranolol accounted for roughly 12% of beta blocker prescriptions in the US. Being one of the first successful beta blockers developed, it has a long history of use and is often preferred due to its established safety profile and low cost.

Nebivolol (brand name Bystolic), on the other hand was prescribed to about 3.8 million people in the USA during that same year. Accounting for just over 6% of total beta-blocker prescriptions, nebivolol has gained popularity since its introduction thanks to its unique properties such as vasodilation which can help lower blood pressure without decreasing heart rate significantly. Despite being relatively newer compared to propranolol, nebivolol's usage has seen consistent growth annually.


Both Propranolol and Bystolic (nebivolol) have been proven effective in treating high blood pressure and angina, supported by numerous clinical studies indicating that they work better than placebo treatments. They are both beta blockers, but their mechanisms of action differ slightly: while propranolol blocks beta-1 and beta-2 receptors equally, thereby affecting heart rate as well as bronchial muscle tone, Bystolic is more selective for beta-1 receptors located mainly in the heart.

While Propranolol has a longer history of use and is available in generic form which represents significant cost savings especially for patients who must pay out of pocket; Bystolic's more targeted mechanism can be beneficial to people with certain conditions such as asthma or chronic obstructive pulmonary disease where non-selective blockade could worsen symptoms.

Both drugs may require an adjustment period meaning that optimal effects may not occur immediately upon starting the medication. The side effect profile is similar between the two medications, with common side effects including fatigue, dizziness, slow heartbeat among others. However due to its selectivity nebivolol tends to cause fewer respiratory side effects compared to propranolol. For both drugs patients should monitor their blood pressure regularly when starting treatment or changing dose levels.