Atenolol vs Metoprolol
AtenololMetoprolol
Beta-1 Selective BlockerDrug ClassBeta-1 Selective Blocker
Tenormin, OthersBrand NamesLopressor, Toprol-XL, Others
Blocks beta-1 adrenergic receptors in the heart, reducing heart rate and blood pressureMechanism of ActionSimilar to Atenolol, but with potential central nervous system penetration
Hypertension, Angina Pectoris, Post-Myocardial InfarctionIndicationsHypertension, Angina Pectoris, Post-Myocardial Infarction, Heart Failure (Metoprolol Succinate), Arrhythmias
Oral (tablet)AdministrationOral (tablet, extended-release tablet)
25–100 mg once dailyDosage50–200 mg daily (divided doses or once daily for extended-release forms)
1–2 hoursOnset of Action1–2 hours (immediate release); 6 hours (extended-release)
24 hoursDuration of Action6–12 hours (immediate release); 24 hours (extended-release)
6–7 hoursHalf-Life3–7 hours (immediate release); 7–8 hours (extended-release)
Minimally metabolized; excreted primarily by kidneysMetabolismMetabolized by liver (CYP2D6)
RenalExcretionHepatic and renal
Limited evidenceUse in Heart FailureWell-established use for heart failure (Metoprolol Succinate)
Fatigue, Dizziness, Cold extremities, Bradycardia, Hypotension, Depression (rare)Adverse EffectsFatigue, Dizziness, Cold extremities, Bradycardia, Hypotension, Depression (more common)
Less likely (poor CNS penetration)Central Nervous System EffectsMore likely (better CNS penetration)
Dose adjustment needed in renal impairment, May be less effective for arrhythmiasSpecial ConsiderationsDose adjustment may be required in hepatic impairment, More commonly used for arrhythmias
Severe bradycardia, Heart block, Cardiogenic shock, Severe hypotensionContraindicationsSevere bradycardia, Heart block, Cardiogenic shock, Severe hypotension
Category C (risk not ruled out)Pregnancy CategoryCategory C (risk not ruled out)
Other antihypertensives (additive effects), NSAIDs (reduced antihypertensive effect), Risk of hypoglycemia with insulin or sulfonylureasInteractionsSimilar interactions as Atenolol, Increased risk of bradycardia with digoxin
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