From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diltiazem is the most effective beta blocker alternative for rate control in patients with atrial fibrillation, as it has been shown to reduce levels of NT-proBNP and improve symptoms compared to metoprolol in recent studies 1. When considering the management of atrial fibrillation (AFib), the primary goal is to control the ventricular rate and prevent rapid ventricular response.
- Beta-blockers, such as metoprolol, atenolol, bisoprolol, and carvedilol, are commonly used for this purpose.
- However, recent evidence suggests that diltiazem, a calcium channel blocker, may be a more effective option for rate control in patients with AFib 1, 2.
- Diltiazem has been shown to reduce levels of NT-proBNP, a marker of cardiac stress, and improve symptoms in patients with permanent AFib compared to metoprolol 1.
- Additionally, diltiazem has been found to be more effective in achieving rate control in emergency department patients with AFib or flutter compared to metoprolol, with no increased incidence of adverse effects 2.
- Metoprolol, on the other hand, is typically started at 25-50mg twice daily and can be titrated up to 100-200mg daily as needed for heart rate control.
- It is essential to monitor heart rate and blood pressure regularly, especially when starting therapy or adjusting doses, to minimize the risk of side effects such as fatigue, dizziness, and bradycardia.
- The choice of medication should be individualized based on the patient's specific needs and medical history, taking into account factors such as heart failure, hypertension, and coronary artery disease.
- Overall, diltiazem appears to be a viable alternative to beta-blockers for rate control in patients with AFib, offering improved efficacy and symptom management in certain cases 1, 2.