Lisinopril vs. Metoprolol
See how Lisinopril and Metoprolol compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Lisinopril is a once-daily ACE inhibitor and metoprolol is a once-daily beta-blocker, and both are standard first-line treatments for high blood pressure.
Lisinopril more often causes a dry cough and raised potassium, while metoprolol more often causes a slower heart rate and tiredness, so the side effect profiles differ.
Metoprolol must be tapered slowly to avoid rebound chest pain or an irregular heartbeat, while lisinopril can typically be stopped without a taper.
Lisinopril vs. Metoprolol Drug Summary
Lisinopril
Lisinopril is an ACE inhibitor that relaxes blood vessels so the heart doesn't have to work as hard. It's FDA-approved for high blood pressure, heart failure, and improving survival after a heart attack, and it's taken as one tablet by mouth once a day.
Metoprolol
Metoprolol succinate is a beta-blocker that slows the heart rate and eases the heart's workload. It's FDA-approved for high blood pressure, angina, and stable heart failure, and the extended-release tablet is also taken once a day.
Lisinopril vs. Metoprolol Side Effects
Lisinopril
Metoprolol
Lisinopril vs. Metoprolol Dosage
Lisinopril
Metoprolol
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once daily | At the start |
| Maximum dose | 40 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 12.5 mg once daily | Weeks 1-2 |
| Maximum dose | 400 mg once daily | If needed |
| Dose changes | 5 increases | Every 2 weeks |
Lisinopril
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once daily | At the start |
| Maximum dose | 40 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
Metoprolol
| STAGE | DOSE | WHEN |
| Starting dose | 12.5 mg once daily | Weeks 1-2 |
| Maximum dose | 400 mg once daily | If needed |
| Dose changes | 5 increases | Every 2 weeks |
Lisinopril vs. Metoprolol Indications
Lisinopril
Lisinopril is FDA-approved to treat high blood pressure in adults and children age 6 and older. It's also approved for heart failure and to improve survival after a heart attack. Some doctors prescribe it off-label to help slow kidney damage in people with diabetes.
High blood pressure in adults and children 6+
Heart failure, as add-on therapy
Improving survival after a heart attack
Off-label: slowing kidney damage in diabetic kidney disease
Metoprolol
Metoprolol succinate is FDA-approved to lower blood pressure, treat angina (chest pain), and manage stable heart failure. Doctors also prescribe it off-label for atrial fibrillation rate control, migraine prevention, and essential tremor.
High blood pressure in adults
Angina pectoris (chest pain)
Stable heart failure (NYHA Class II-IV)
Off-label: atrial fibrillation rate control
Lisinopril vs. Metoprolol Pros and Cons
Lisinopril
Lisinopril doesn't slow the heart rate, so it fits patients who need to avoid that effect, and it can generally be stopped without a taper. It carries its own risks, including a persistent dry cough and elevated potassium levels that need monitoring.
Pros
Doesn't slow heart rate, useful for athletes or those prone to bradycardia
Can usually be stopped without a gradual taper
Safe to use with asthma or COPD, unlike beta-blockers
May offer added kidney protection in diabetic patients
Cons
Can cause a persistent dry cough in some patients
Requires potassium monitoring due to hyperkalemia risk
Not safe during pregnancy
Rare but serious risk of angioedema (swelling)
Metoprolol
Metoprolol covers a broader set of cardiac conditions, including angina and chronic heart failure, but stopping it suddenly can be dangerous. It also tends to cause more fatigue and a slower heart rate than lisinopril.
Pros
Also FDA-approved for angina and chronic heart failure
Doesn't cause a chronic cough
Useful when heart rate control is also needed
One of the lowest-cost generic beta-blockers available
Cons
Must be tapered slowly to avoid rebound chest pain or arrhythmia
Can cause bradycardia (an overly slow heart rate)
Contraindicated in decompensated heart failure and certain heart block
Fatigue and low blood pressure are common early on
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