Can metoprolol (beta blocker) be switched for propranolol (beta blocker)?

From the Guidelines

Metoprolol can be switched for propranolol, but this should only be done under medical supervision, considering their differences in selectivity and potential side effects. These medications are both beta blockers that work similarly to reduce blood pressure and heart rate, but they have important differences. Metoprolol is cardioselective, primarily affecting the heart, while propranolol is non-selective and affects both the heart and lungs 1. When switching, dosages must be adjusted appropriately as they are not equivalent - typically 100mg of metoprolol is roughly equivalent to 80mg of propranolol, though individual needs vary, as indicated in the guidelines for the management of high blood pressure in adults 1.

Key Considerations for Switching

• The transition should be gradual to avoid rebound effects like increased heart rate or blood pressure.
• Patients with asthma or lung conditions should be particularly cautious with propranolol as it may trigger bronchospasm.
• Side effect profiles differ slightly between the medications, with propranolol more likely to cause sleep disturbances and metoprolol potentially causing more fatigue, as noted in the properties of beta blockers in clinical use 1.
• Patients should monitor for changes in symptoms, blood pressure, and heart rate during the transition and report any concerns to their healthcare provider immediately.

Dosage and Administration

• The usual dose range for metoprolol is 100–200 mg per day, while for propranolol it is 80–160 mg per day, as outlined in the guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
• The choice of beta blocker for an individual patient is based primarily on pharmacokinetic and side effect criteria, as well as on physician familiarity, considering the properties of beta blockers in clinical use 1.

From the FDA Drug Label

In controlled, comparative, clinical studies, metoprolol has been shown to be as effective an antihypertensive agent as propranolol, methyldopa, and thiazide-type diuretics, to be equally effective in supine and standing positions A controlled, comparative, clinical trial showed that metoprolol was indistinguishable from propranolol in the treatment of angina pectoris.

Switching from metoprolol to propranolol may be considered since both drugs have been shown to be equally effective in certain clinical studies 2. However, it is crucial to note that this decision should be made under the guidance of a healthcare professional, as individual patient responses may vary. Key factors to consider include:

• The patient's specific medical condition (e.g., hypertension, angina pectoris)
• The dosage and administration of each medication
• Potential interactions with other medications or underlying health conditions

It is essential to consult a healthcare professional before making any changes to a patient's medication regimen.

From the Research

Switching Between Metoprolol and Propranolol

• Metoprolol and propranolol are both beta blockers, but they have different properties and uses 3, 4.
• Metoprolol is a selective beta1 blocker, while propranolol is a non-selective beta blocker that blocks both beta1 and beta2 receptors 3, 4.
• The decision to switch between metoprolol and propranolol should be based on the individual patient's needs and medical history 5, 6, 7.
• When switching between beta blockers, it is essential to consider the differences in pharmacology, receptor biology, hemodynamic effects, and tolerability 5, 7.

Considerations for Switching

• The rationale for switching between metoprolol and propranolol may include changes in the patient's clinical status, such as the development of new cardiac-related disease or noncardiac diseases 6.
• The switch should be made in a manner that takes into account the pharmacologic differences between the two agents, including receptor subtype blockade and ancillary properties 5, 7.
• Protocols for switching between carvedilol (a non-selective agent with vasodilatory properties) and a beta1-selective agent (e.g., metoprolol) have been described to simplify the process and maximize safety and tolerability 5, 7.

Clinical Evidence

• Studies have demonstrated the efficacy and safety of metoprolol and propranolol in various clinical settings, including hypertension, angina pectoris, and congestive heart failure 3, 4.
• However, the clinical benefits of beta blockers are not consistent across the class, and specific agents are preferred for certain indications 3, 6.
• Guidelines on how to best switch to a different beta blocker are lacking, and most hospital-based formularies and guidelines do not provide recommendations around common challenges 6.