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Bisoprolol vs Metoprolol

BisoprololMetoprolol
Beta-1 selective beta-blocker

Drug Class

Beta-1 selective beta-blocker
- Hypertension - Chronic heart failure - Stable angina

Indications

- Hypertension - Chronic heart failure - Angina - Myocardial infarction prevention - Atrial fibrillation
Blocks beta-1 adrenergic receptors, reducing heart rate and cardiac workload.

Mechanism of Action

Blocks beta-1 adrenergic receptors, reducing heart rate, cardiac output, and oxygen demand.
Oral tablets (e.g., 5 mg, 10 mg)

Dosage Forms

Oral tablets (e.g., 25 mg, 50 mg, 100 mg); Extended-release tablets (e.g., 25 mg, 50 mg, 100 mg, 200 mg)
Once daily

Dosing Frequency

Immediate-release: 2–3 times daily Extended-release: Once daily
~80%

Bioavailability

~50% (immediate-release); ~60–70% (extended-release)
~9–12 hours

Half-life

~3–7 hours (immediate-release); ~5–7 hours (extended-release)
Liver metabolism via CYP3A4

Metabolism

Liver metabolism via CYP2D6
Renal and fecal (50% unchanged in urine)

Excretion

Renal and fecal (mostly as metabolites)
Requires dose adjustment in renal impairment.

Special Populations

Caution in severe hepatic impairment.
- Fatigue - Bradycardia - Dizziness - Cold extremities - Nausea

Common Side Effects

- Fatigue - Bradycardia - Dizziness - Hypotension - Depression
- Severe bradycardia - Heart block - Bronchospasm

Serious Side Effects

- Severe bradycardia - Heart block - Worsening heart failure - Bronchospasm
Category C (Risk cannot be ruled out)

Pregnancy Category

Category C (Risk cannot be ruled out)
Use with caution; limited data available.

Lactation

Use with caution; excreted in breast milk.
- Calcium channel blockers (e.g., Verapamil, Diltiazem) - Digoxin - Insulin - NSAIDs - CYP3A4 inhibitors

Drug Interactions

- Calcium channel blockers - Digoxin - Insulin - NSAIDs - CYP2D6 inhibitors
Strongly decreases heart rate

Effect on Heart Rate

Decreases heart rate (may vary between forms)
Often preferred for chronic heart failure due to longer half-life and once-daily dosing.

Preferred Usage

Often used post-MI or in atrial fibrillation due to immediate-release forms and higher flexibility.
Zebeta (common brand)

Brand Names

Lopressor (immediate-release), Toprol-XL (extended-release)
Generally affordable

Cost (Generic)

Generally affordable, extended-release forms may cost more.
Longer half-life and steady effect make it suitable for once-daily dosing.

Key Differences

More flexibility in dosing frequency; extended-release offers smoother effect.

Coupon code

CMP30

Coupon code

Coupon code

CMP30