From the Research
Propranolol and metoprolol are both effective beta-blockers, but metoprolol is generally preferred for patients with respiratory conditions like asthma or COPD due to its cardioselectivity, which reduces the risk of bronchospasm, as noted in studies such as 1.
Key Differences
- Propranolol is a non-selective beta-blocker that blocks both beta-1 and beta-2 receptors, making it effective for conditions like hypertension, angina, arrhythmias, essential tremor, anxiety, and migraine prevention.
- Metoprolol, on the other hand, is a cardioselective beta-blocker that primarily blocks beta-1 receptors, making it preferable for patients with respiratory conditions.
Typical Uses and Dosing
- Propranolol is typically dosed at 10-40 mg twice daily for hypertension, with adjustments based on response.
- Metoprolol is commonly used for hypertension, heart failure, and post-myocardial infarction care, with typical dosing of 25-100 mg twice daily for metoprolol tartrate or 50-200 mg once daily for the extended-release succinate form.
Side Effects and Considerations
- Both medications can cause side effects like fatigue, dizziness, and bradycardia, and neither should be abruptly discontinued due to potential rebound effects, as discussed in 2.
- The choice between propranolol and metoprolol should be based on the individual patient's condition, with consideration of factors such as respiratory status, as metoprolol's cardioselectivity makes it a safer choice for patients with asthma or COPD, as supported by 3 and 1.
Evidence-Based Recommendation
- Based on the most recent and highest quality evidence, metoprolol is recommended for patients with hypertension, heart failure, or post-myocardial infarction, especially those with respiratory conditions, due to its cardioselectivity and proven efficacy in reducing mortality and morbidity, as demonstrated in studies such as 1.