What dose of Metoprolol (beta blocker) is equivalent to Nebivolol (beta blocker) 5 mg?

Nebivolol 5 mg to Metoprolol Dose Equivalence

Nebivolol 5 mg is approximately equivalent to metoprolol tartrate 100 mg twice daily or metoprolol succinate 100-200 mg once daily. 1

Dose Equivalence Rationale

According to the ACC/AHA guidelines, the usual dose ranges for these beta blockers are:

• Nebivolol: 5-40 mg once daily
• Metoprolol tartrate: 100-200 mg twice daily
• Metoprolol succinate: 50-200 mg once daily 1

The starting dose of nebivolol (5 mg) falls at the lower end of its therapeutic range, while equivalent metoprolol dosing would be:

• Metoprolol tartrate: 100 mg twice daily
• Metoprolol succinate: 100-200 mg once daily

Formulation Considerations

Metoprolol Tartrate vs. Succinate

• Metoprolol tartrate is an immediate-release formulation requiring twice-daily dosing
• Metoprolol succinate is an extended-release formulation allowing once-daily dosing
• A 100 mg metoprolol succinate tablet contains 95 mg of metoprolol succinate and is considered equivalent to 100 mg metoprolol tartrate 2

Clinical Implications

• Metoprolol succinate provides more consistent plasma concentrations over 24 hours
• Once-daily dosing with metoprolol succinate improves medication adherence compared to twice-daily regimens with metoprolol tartrate 3

Pharmacological Differences

Despite both being beta-blockers, nebivolol and metoprolol have important differences:

1. Mechanism of action:

   • Nebivolol is a highly selective β1-blocker with additional nitric oxide-mediated vasodilation properties
   • Metoprolol is a selective β1-blocker without vasodilatory effects 4, 5

2. Metabolic effects:

   • Metoprolol may decrease insulin sensitivity and increase oxidative stress
   • Nebivolol has been shown to have neutral metabolic effects 6

3. Beta-blocking potency:

   • Peak beta-blocking effects of bisoprolol appear stronger than nebivolol and carvedilol
   • Nebivolol exhibits a higher trough-to-peak ratio than bisoprolol 5

Clinical Considerations

When switching between these medications:

• Monitor blood pressure and heart rate closely after changing medications
• Consider that nebivolol may have better tolerability than metoprolol, with adverse event rates similar to placebo 7
• Be aware that the vasodilatory properties of nebivolol may provide additional benefits in certain patient populations

Cautions and Contraindications

Both medications are contraindicated in:

• Severe bradycardia
• High-grade AV block without pacemaker
• Cardiogenic shock
• Decompensated heart failure 1

Use with caution in patients with:

• Asthma or COPD
• Diabetes
• Compensated heart failure 3

Remember that abrupt cessation of either beta-blocker should be avoided to prevent rebound hypertension or worsening of underlying cardiac conditions.