Metoprolol vs. propranolol

Metoprolol vs. propranolol: What’s the difference?

• Metoprolol and propranolol are beta-blockers used to treat high blood pressure (hypertension), heart pain (angina), abnormal heart rhythms, and some neurologic conditions.
• Metoprolol is also used to treat congestive heart failure and hyperthyroidism, and to prevent migraine headaches.
• Brand names for metoprolol include Lopressor and Toprol XL.
• Brand names for propranolol include Hemangeol, Inderal, Inderal XL, Inderal LA, and Innopran XL.
• Side effects of metoprolol and propranolol that are similar include abdominal cramps, diarrhea, constipation, fatigue, insomnia, nausea, depression, dreaming, memory loss, fever, impotence, lightheadedness, low blood pressure, shortness of breath, cold extremities, sore throat, or wheezing.
• Side effects of metoprolol that are different from propranolol include indigestion, decreased exercise tolerance, increased triglycerides, and bronchospasm.
• Side effects of propranolol that are different from metoprolol include slow heart rate.

What are metoprolol and propranolol?

Metoprolol is a beta-blocker (beta-adrenergic blocking agent) that blocks the action of the sympathetic nervous system and is used to treat high blood pressure (hypertension), heart pain (angina pectoris), congestive heart failure, abnormal heart rhythms, hyperthyroidism, and some neurologic conditions. Metoprolol is also used to prevent migraine headaches.

Propranolol is a beta-adrenergic blocking agent used to treat high blood pressure, heart pain (angina), abnormal heart rhythms, and some neurologic conditions. Propranolol inhibits the sympathetic nervous system by blocking the beta-receptors on the nerves. Stimulation of the sympathetic nervous system is responsible for increasing the heart rate, and blocking the action of these nerves reduces the heart rate and is useful in treating abnormally rapid heart rhythms. Propranolol also reduces the force of contraction of heart muscle and thereby lowers blood pressure, which reduces the need for oxygen by heart muscle. Since heart pain (angina pectoris) occurs when oxygen demand of the heart muscle exceeds the supply of oxygen, propranolol is helpful in treating heart pain.

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What are the side effects of metoprolol and propranolol?

Metoprolol

Metoprolol is generally well tolerated. Side effects include:

• Abdominal cramps
• Diarrhea
• Constipation
• Fatigue
• Insomnia
• Indigestion
• Nausea
• Depression
• Dreaming
• Memory loss
• Fever
• Impotence
• Lightheadedness
• Low blood pressure
• Decreased exercise tolerance
• Increased triglycerides
• Bronchospasm
• Cold extremities
• Sore throat
• Shortness of breath or wheezing

Possible serious adverse effects include:

• Slow heart rate
• Raynaud's phenomenon
• Hepatitis
• Increased insulin resistance

Metoprolol can aggravate breathing difficulties in patients with asthma, chronic bronchitis, or emphysema.

WARNING:

• In patients with existing slow heart rates (bradycardias) and heart blocks (defects in the electrical conduction of the heart), metoprolol can cause dangerously slow heart rates, and even shock. Metoprolol reduces the force of heart muscle contraction and can aggravate symptoms of heart failure. In patients with coronary artery disease, abruptly stopping metoprolol can suddenly worsen angina, and occasionally precipitate heart attacks. If it is necessary to discontinue metoprolol, its dosage should be reduced gradually over several weeks.
• Initiation of high-dose extended release metoprolol in patients undergoing non-cardiac surgery is associated with bradycardia (slow heart rate), hypotension, stroke, and death. However, long-term therapy with metoprolol should not be routinely withdrawn prior to major surgery. Impaired ability of the heart to respond to reflex adrenergic stimuli may increase the risks of general anesthesia and surgery.

Propranolol

Common side effects are:

• Abdominal cramps
• Diarrhea
• Constipation
• Fatigue
• Insomnia
• Nausea
• Depression
• Dreaming
• Memory loss
• Fever
• Impotence
• Lightheadedness
• Slow heart rate
• Low blood pressure
• Cold extremities
• Sore throat
• Shortness of breath or wheezing

Propranolol can aggravate breathing difficulties in patients with asthma, chronic bronchitis, or emphysema. In patients with existing slow heart rates (bradycardias) and heart blocks (defects in the electrical conduction of the heart), propranolol can cause dangerously slow heart rates, and even shock. Propranolol reduces the force of heart muscle contraction and can aggravate symptoms of heart failure.

In patients with coronary artery disease, abruptly stopping propranolol can suddenly worsen angina, and occasionally precipitate heart attacks. If it is necessary to discontinue propranolol, its dosage should be reduced gradually over several weeks.

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What is the dosage of metoprolol vs. propranolol?

Metoprolol

• Metoprolol should be taken before meals or at bedtime.
• The dose for treating hypertension is 100 to 450 mg daily in single or divided doses.
• Angina is treated with 100 to 400 mg daily in two divided doses.
• Heart attack (acute myocardial infarction) is treated with three 5 mg injections administered 2 minutes apart followed by treatment with 50 mg oral metoprolol every 6 hours for 48 hours. After 48 hours, patients should receive 100 mg orally twice daily for at least 3 months.
• The dose for congestive heart failure is 25 mg/daily initially. Then the dose is increased every 2 weeks to reach a target dose of 200 mg/daily orally.
• Hyperthyroidism is treated with 25 to 30 mg by mouth every 6 hours.

Propranolol

• The recommended dose for hypertension using short-acting formulations is 80 to 240 mg twice daily. The maximum dose is 640 mg daily.
• The usual dose using long-acting formulations is 80 to 160 mg daily.
• The recommended dose for chest pain is 80 to 320 mg daily using short-acting formulations and 80 to 160 mg daily using long-acting formulations.
• The usual dose for treatment of abnormal heart rhythms is 10 to 30 mg 3 to 4 times daily of short-acting formulations.
• The recommended dose for preventing migraines is 80 to 240 mg daily.

What drugs interact with metoprolol and propranolol?

Metoprolol

• Calcium channel blockers and digoxin (Lanoxin) can lower blood pressure and heart rate to dangerous levels when administered together with metoprolol.
• Metoprolol can mask the early warning symptoms of low blood sugar (hypoglycemia) and should be used with caution in patients receiving treatment for diabetes.
• Fluoxetine (Prozac) can increase blood levels of metoprolol by reducing breakdown of metoprolol, and increase the side effects from metoprolol.

Propranolol

• Calcium channel blockers and digoxin (Lanoxin) can lower of blood pressure and heart rate to dangerous levels when administered together with propranolol.
• Propranolol can mask the early warning symptoms of low blood sugar (hypoglycemia) and should be used with caution in patients receiving treatment for diabetes.
• Propranolol reduces the metabolism of thioridazine (Mellaril), increasing the concentration of thioridazine in the body and potentially causing abnormal heart beats.

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Are metoprolol and propranolol safe to use while pregnant or breastfeeding?

Metoprolol

• Safe use of metoprolol during pregnancy has not been established.
• Small quantities of metoprolol are excreted in breast milk and may potentially cause adverse effects in the infant.

Propranolol

• Safe use during pregnancy has not been established. Growth retardation and congenital abnormalities have been reported in infants whose mothers received propranolol during pregnancy. Infants whose mothers received propranolol during labor have exhibited slow heart rate, hypoglycemia, and/or respiratory depression.
• Propranolol is secreted into breast milk and should be avoided or used with caution in nursing women.