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 fibrillationBlocks 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 CYP2D6Renal 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 - BronchospasmCategory 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 inhibitorsStrongly 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.Get Coupon Code
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