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

Most common
Headache (up to 3.8%)
Dizziness (up to 3.5%)
Cough (up to 2.5%)
Hyperkalemia (up to 2.2%)

Metoprolol

Most common
Hypotension (up to 27.4%)
Bradycardia (up to 15.9%)
Tiredness (up to 10%)
Dizziness (about 10%)

Lisinopril vs. Metoprolol Dosage

Lisinopril

Dosage
Dosage Table
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

Dosage
Dosage Table
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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