Carvedilol vs Metoprolol
CarvedilolMetoprolol
Non-selective beta-blocker with alpha-1 blocking activityDrug ClassBeta-1 selective beta-blocker (cardioselective)
Blocks beta-1, beta-2, and alpha-1 adrenergic receptors; reduces heart rate, blood pressure, and peripheral resistanceMechanism of ActionBlocks beta-1 adrenergic receptors in the heart, reducing heart rate and cardiac output
- Heart failure - Hypertension - Left ventricular dysfunction post-myocardial infarctionIndications- Hypertension - Angina - Heart failure - Post-myocardial infarction
Oral tabletsFormulationsOral tablets, extended-release tablets (metoprolol succinate), injection (metoprolol tartrate)
- Hypertension: 6.25–25 mg BID - Heart Failure: Start 3.125 mg BID, titrate to max 25–50 mg BIDDosing- Hypertension: 50–200 mg/day (succinate) - Angina: 50–200 mg BID (tartrate) - Heart failure: 12.5–200 mg/day (succinate)
~6–10 hoursHalf-life- Tartrate: 3–7 hours - Succinate: ~12 hours
Hepatic (via CYP2D6)MetabolismHepatic (via CYP2D6)
Feces (~60%), urine (~16%)ExcretionUrine (mostly as metabolites)
Non-selective (beta-1, beta-2, alpha-1)SelectivityCardioselective (beta-1)
Shown to improve survival and reduce hospitalizations in heart failure patientsUse in Heart FailureAlso improves survival in heart failure, especially when using extended-release (succinate) formulations
- Fatigue - Dizziness - Bradycardia - Hypotension - Weight gain - Peripheral edemaSide Effects- Fatigue - Bradycardia - Dizziness - Depression - Cold extremities - Hypotension
- Severe asthma or COPD - Severe hepatic impairment - Bradycardia or AV block - Cardiogenic shockContraindications- Severe bradycardia or AV block - Decompensated heart failure - Cardiogenic shock
May cause more peripheral vasodilation due to alpha-1 blockadeSpecial ConsiderationsLess likely to affect peripheral vasodilation; preferred in patients with asthma due to beta-1 selectivity
Category C (risk cannot be ruled out)Pregnancy CategoryCategory C (risk cannot be ruled out)
- CYP2D6 inhibitors (e.g., fluoxetine) - Additive effects with other antihypertensives - Risk of bradycardia with digoxinDrug Interactions- CYP2D6 inhibitors - Additive effects with other beta-blockers or antihypertensives - Interaction with calcium channel blockers (e.g., verapamil)
- Additional alpha-1 blockade reduces vascular resistance - Useful in patients with coexisting hypertension and heart failureAdvantages- Beta-1 selectivity minimizes respiratory side effects - Well-studied for arrhythmias and post-MI care
- Non-selectivity may increase risk of bronchospasm in asthma patients - Risk of orthostatic hypotensionDisadvantages- May not provide the same peripheral benefits as Carvedilol in heart failure
Typically low-cost generic availableCostTypically low-cost generic available
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