Propranolol vs Metoprolol
PropranololMetoprolol
Non-selective beta-blockerClassBeta-1 selective blocker
Inderal, Inderal LA, HemangeolBrand NamesLopressor, Toprol XL
Blocks beta-1 (heart) and beta-2 (lungs, vascular smooth muscle) adrenergic receptors, reducing heart rate and contractility.Mechanism of ActionSelectively blocks beta-1 adrenergic receptors in the heart, reducing heart rate and contractility.
Hypertension, angina, arrhythmias, migraine prophylaxis, essential tremor, anxiety, hypertrophic cardiomyopathy, thyrotoxicosis, portal hypertension.UsesHypertension, angina, heart failure, post-myocardial infarction management, supraventricular tachycardia.
Oral (immediate and extended-release), IVFormulationsOral (immediate and extended-release), IV
10–320 mg/day (divided doses)Dosage Range25–400 mg/day (divided doses)
3–6 hours (immediate-release)Half-life3–7 hours (immediate-release), 7–24 hours (extended-release)
Immediate-release: 2–4 times daily; Extended-release: once dailyFrequencyImmediate-release: 1–2 times daily; Extended-release: once daily
Liver (CYP2D6 enzyme)MetabolismLiver (CYP2D6 enzyme)
Urine (renal clearance of metabolites)ExcretionUrine (renal clearance of metabolites)
Fatigue, dizziness, bradycardia, hypotension, bronchospasm, depression, cold extremities, gastrointestinal discomfort.Side EffectsFatigue, dizziness, bradycardia, hypotension, gastrointestinal discomfort, sleep disturbances.
Avoid in asthma, severe COPD, bradycardia, and uncontrolled heart failure. May mask symptoms of hypoglycemia.Special PrecautionsCaution in asthma, bronchospasm, bradycardia, and uncontrolled heart failure. May mask symptoms of hypoglycemia.
C (Risk cannot be ruled out)Pregnancy CategoryC (Risk cannot be ruled out)
Small amounts excreted; generally considered safe.BreastfeedingSmall amounts excreted; generally considered safe.
Additive effects with other antihypertensives; increased risk of bradycardia with calcium channel blockers like verapamil.Drug InteractionsSimilar to propranolol, with additional interaction caution due to selective beta-1 blocking.
Non-selective, making it more suitable for conditions like migraine and essential tremors.Unique FeaturesBeta-1 selectivity reduces risk of bronchospasm in respiratory conditions.
Frequently used for performance anxiety or situational anxiety.Efficacy for AnxietyOccasionally used but less effective than propranolol for anxiety.
Generally inexpensive, widely available.CostSlightly higher cost than propranolol but also widely available.
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