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Atenolol vs Metoprolol


Common name: Atenolol, Metoprolol
Drug category: Cardioselective beta-blockers


atenolol vs metoprololAtenolol and metoprolol can be used for the treatment of a variety of kinds of heart-related disorders, such as angina pectoris as well as hypertension that is, high blood pressure. Angina pectoris refers back to the condition that causes symptoms of chest discomfort or pain. It is caused by your heart not getting sufficient oxygen-rich blood. It is more likely to happen in times of tension or exercise. Hypertension is the term used to describe high blood pressure when the blood flows into your blood vessels is higher pressure than normal.

Atenolol and metoprolol belong to the same class of drugs and treat the same conditions however there are some distinctions between these two drugs. We will examine them here.

What is the primary difference between atenolol and metoprolol?

Metoprolol is a prescription-only medication and is classified as cardioselective, beta-1-selective adrenergic antagonist, also known as beta-blockers. Beta 1 receptors play a role in heart stimulation, which results in an increased heart rate as well as stronger cardiac contractions. Blocking these receptors, which is what metoprolol can do causes a slowing of heart rate, and less intense contractions. Metoprolol is a cardioselective drug, meaning that the drug is likely to alter beta 1 receptors within the heart. Additionally, it has a lower chance to affect other kinds of beta receptors found in the body, for instance in the airways.

Metoprolol can be found in tablets that are immediate-release in 25 mg, 37.5 mg, 50 mg, 75 mg in 100 mg and 75 mg tablets. It is also referred to by its generic name, metoprolol tartrate. Extended-release metoprolol, also known as metoprolol succinate is sold in doses of 25, 50, 100 mg 50 mg, 100 mg and 200 mg. The extended-release capsules can be purchased in similar strengths to tablets. There’s also one mg/ml injectable solution, as in the powder for oral consumption. The half-life for metoprolol tartrate is approximately three hours. The time-to-live of metoprolol succinate can be as long as seven hours. This means that the extended-release formula doesn’t need to be administered as often.

Atenolol is also a prescription drug and is classified as a cardioselective beta-1-selective adrenergic antagonist. It operates similarly to metoprolol inside the body. The half-life of atenolol ranges from approximately six to seven hours which means it can last longer than other metoprolol dosages. Atenolol comes in doses of 25 mg, 50 mg as well as 100 mg tablets.

Main differences between metoprolol and atenolol

Metoprolol Atenolol
Drug class Cardioselective beta-1-selective adrenergic agonist (beta blocker) Cardioselective beta-1-selective adrenergic agonist (beta blocker)
Brand/generic status Brand and generic available Brand and generic available
What is the brand name? Lopressor, Toprol XL Tenormin
What form(s) does the drug come in? Immediate and extended-release oral tablets and capsules, injectable solution, oral powder Immediate-release oral tablets
What is the standard dosage? 50 mg twice a day 50 mg once a day
How long is the typical treatment? Long term Long term
Who typically uses the medication? Children and adults Children and adults


Conditions treated with atenolol vs metoprolol

Atenolol and metoprolol are both employed for the treatment of the condition known as angina pectoris or hypertension. They can be utilized in angina that is stable, chronic and unstable angina. Chronic stable angina happens in predictable ways when you exert your body or experience significant stress. Unstable angina isn’t always easily predicted and can occur even in a state of the moment of rest.

In treating hypertension metoprolol and atenolol can be taken on their own or in conjunction with other antihypertensive medicines. When these drugs are used in the treatment plan for an active, suspected, or confirmed myocardial infarction, or heart attack, they are part of a multi-drug regimen which may also include angiotensin-converting enzyme inhibitors (ACE inhibitors) and diuretics. In myocardial ischemia, beta-blockers can reduce the demand for oxygen in the myocardial muscles and possess antiarrhythmic properties.

Atenolol and metoprolol are both off-label and are used for certain indications. Off-label usage refers to the use for a condition that is not cleared by FDA. Food and Drug Administration (FDA). These are typically used to treat migraines and manage tremors.

This is not the complete list of applications for these medications. Only your doctor or cardiology specialist can determine whether any of these medications are suitable for your particular condition.

Condition Metoprolol Atenolol
Angina pectoris (including chronic angina, stable angina, as well as unstable angina) Yes Yes
Hypertension Yes Yes
Heart failure Yes No
Myocardial infarction Yes Yes
Control of heart rate in atrial fibrillation or flutter Off-label Off-label
Tremor Off-label Off-label
Prophylactic treatment for migraine Off-label Off-label
Paroxysmal supraventricular tachycardia prophylaxis No Off-label
The withdrawal from alcohol No Off-label


Atenolol vs metoprolol, which is more efficient?

Atenolol vs metoprolol was thoroughly studied and compared in a number of studies with respect to various outcomes and indications. A study published in 2017 assessed the effectiveness of the two beta-blockers in conjunction with propranolol, oxprenolol, and studied the outcomes of numerous clinical studies. Metoprolol demonstrated a greater reduction in the risk of heart mortality compared to atenolol. Metoprolol has also shown a decrease in risk of death from all causes and coronary heart diseases. When analyzed for a decrease in stroke risk metoprolol was superior to atenolol too. There is evidence that suggests both drugs are equally effective as placebo and that there isn’t any significant difference between metoprolol and atenolol in their capacity to lower blood pressure (hypertension).

Metoprolol is found to reduce both diastolic and systolic blood pressure. Atenolol can influence systolic blood pressure more than diastolic pressure, particularly during times of exercise.

Based on this data Your doctor could decide to start with metoprolol when deciding on an agent that is suitable for you. Only your doctor will be able to determine the beta-blocker therapy suitable for you.

Cost comparison and coverage of atenolol vs metoprolol

Metoprolol is a prescription drug that is included in all commercial insurance plans as well as Medicare health insurance programs. If you purchase cash for metoprolol prescriptions it could cost you around $31 for a month’s supply.

Atenolol is a prescribed medication that is covered under commercial as well as Medicare policies. Without insurance, you’ll spend about $30 for a 30 day supply comprising 50 mg of tablets.

Metoprolol Atenolol
Typically, is it covered in insurance? Yes Yes
Typically, is it covered in Medicare Part D? Yes Yes
Quantity 60mg and 50 mg tablets 30-50 mg tablets
Typical Medicare copay $0-$9 $0-$10
SingleCare Cost $4-$22 $9-$25

Common side effects of atenolol vs metoprolol

Beta-blockers with cardioselective properties like atenolol and metoprolol reduce the rate at which heart beats and the force at which it beats. The slowing of heart rate could result in bradycardia, which is a lower heart rate. If your heart doesn’t beat as vigorously the blood flow may not reach the extremities at the intensity we’d prefer, resulting in extremities that are cold to the touch.

The less forceful flow of blood and lower arterial pressure could result in adverse effects like postural hypotension, which can cause lightheadedness and dizzy feeling when sitting, standing or lying down. Headaches are also common when patients are taking metoprolol or atenolol.

This list is not meant to provide a complete list of possible side effects. Consult your physician or pharmacist for the complete list.

Atenolol vs metoprolol drug interactions 

Beta-blockers, like metoprolol and atenolol both, affect the force of heartbeats and contractions. When they are administered together patients are at a greater danger of hypotension and bradycardia. Blood pressure, heart rate and other indicators of cardiac dysfunction need to be checked regularly in the event that they are combined.

Metoprolol and Atenolol in combination along with calcium channel inhibitors like amlodipine can cause an additional decrease in cardiac contractility that could be risky. In the event that the mixture is needed for you, it is essential to obtain baseline measurements of function and follow-up on a consistent basis.

Common antidepressants, such as fluvoxamine, clomipramine and selective serotonin Reuptake Inhibitors (SSRIs) block the enzyme (CYP2D6) which is responsible for metoprolol’s metabolism. If given in conjunction with metoprolol, they could cause a rise in blood levels of metoprolol. This could result in increased effects of metoprolol on the heart.

This list is not meant to be an exhaustive list of all possible interactions between drugs. Consult your doctor to get an exhaustive list.

Drug The class of drug Metoprolol Atenolol
Alpha Adrenergic antagonists Yes Yes
Monoamine oxidase inhibitors (MAOIs) Yes Yes
Digoxin Digitalis glycosides/antiarrhythmic Yes Yes
Calcium channel blockers Yes Yes
Antidepressants Yes No
Selective serotonin-reuptake inhibitors (SSRIs) Yes No
Hydralazine Vasodilator Yes Yes
Dipyridamole Platelet inhibitor Yes Yes
Ergot alkaloids Yes Yes

Atenolol and metoprolol cautions

Beta-blockers trigger a deficiency in heart contractility. For some patients who have specific danger factors, they can cause heart failure. If this happens heart failure must be treated in accordance with the current guidelines.

Beta-blockers shouldn’t be abruptly stopped, particularly for patients suffering from coronary artery disease. Heart arrhythmias and heart attacks have been observed in patients who abruptly stop beta-blockers.

If it is possible, beta-blocking drugs are advised to avoid in patients suffering from bronchospastic illnesses like asthma. Combining use can worsen lung disease. If you must take beta-blockers, then those that are cardioselective are recommended. Utilizing non-cardioselective beta-blockers, like carvedilol is not advised.

Dosing for Atenolol should be reduced in patients suffering from renal impairment or kidney disease because the excretion of the drug slows down.

A controlled and randomized clinical study conducted in The Lancet suggests that patients who undergo surgery while taking beta-blockers (metoprolol in particular) are at greater risk of having a fatal outcome like stroke or heart attack. But, it’s not recommended to stop the beta-blocker during surgery if the patient is stabilized by the medication for a long time.

It is vital to understand that it is possible be difficult to detect signs of hypoglycemia among diabetics, like tachycardia because they can be hidden due to the effects of beta-blockers.

The hypotension and dizziness induced by metoprolol and atenolol may increase the chance and frequency of falls. These can cause danger or head injuries. It is important to be cautious when it comes to seniors who are more susceptible to falling.

Only your physician can determine whether metoprolol or the atenolol treatment is suitable for you.



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