Metoprolol vs. Atenolol
See how Metoprolol and Atenolol compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Metoprolol succinate is FDA-approved for heart failure, while atenolol is not, making it the better choice for patients who need a beta-blocker for both blood pressure and heart failure.
Both drugs are inexpensive generic beta-blockers, but metoprolol's extended-release form requires several titration steps while atenolol's dosing is simpler.
Atenolol is cleared by the kidneys and needs dose adjustment in renal impairment, while metoprolol is metabolized by the liver.
Metoprolol vs. Atenolol Drug Summary
Metoprolol
Metoprolol succinate is a beta-1 selective beta-blocker used to treat high blood pressure, angina, and stable heart failure. It comes as an extended-release tablet taken once a day, with the dose slowly increased over several weeks.
Atenolol
Atenolol is a beta-1 selective beta-blocker used to treat high blood pressure, angina, and stable patients recovering from a heart attack. It is taken as a standard oral tablet once daily, usually starting at a fixed dose with one step up if needed.
Metoprolol vs. Atenolol Side Effects
Metoprolol
Atenolol
Metoprolol vs. Atenolol Dosage
Metoprolol
Atenolol
| 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 |
| STAGE | DOSE | WHEN |
| Starting dose | 50 mg once daily | At the start |
| Maximum dose | 200 mg once daily | If needed |
| Dose changes | 2 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 |
Atenolol
| STAGE | DOSE | WHEN |
| Starting dose | 50 mg once daily | At the start |
| Maximum dose | 200 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Metoprolol vs. Atenolol Indications
Metoprolol
Metoprolol is FDA-approved for hypertension, angina, and stable heart failure across NYHA classes II through IV. It is also used off-label for atrial fibrillation rate control, migraine prevention, and essential tremor.
Hypertension
Angina pectoris
Heart failure (NYHA Class II-IV)
Off-label: atrial fibrillation rate control
Off-label: migraine prevention, essential tremor
Atenolol
Atenolol is FDA-approved for hypertension, angina, and use in hemodynamically stable patients after a heart attack. It is also used off-label for migraine prevention and tremor.
Hypertension
Angina pectoris
Acute myocardial infarction (stable patients)
Off-label: migraine prevention
Off-label: tremor
Metoprolol vs. Atenolol Pros and Cons
Metoprolol
Metoprolol's extended-release formulation and FDA approval for heart failure make it a versatile option for patients with overlapping cardiac conditions. It requires a multi-step titration schedule before reaching a maintenance dose.
Pros
FDA-approved for heart failure, not just blood pressure
Once-daily extended-release form smooths out blood levels
Metabolized by the liver, no renal dose adjustment needed
Cons
Requires several titration steps to reach maintenance dose
Not approved for acute decompensated heart failure or cardiogenic shock
Higher maximum maintenance dose may mean more pills at higher strengths
Atenolol
Atenolol offers a simpler dosing path with fewer titration steps, and it carries a specific approval for use after a heart attack. It is not approved for heart failure and needs dose adjustment in kidney disease.
Pros
Simpler dosing schedule with just one step-up
Specifically approved for use after a heart attack
Longer track record, approved by the FDA since 1981
Cons
Not approved for heart failure
Requires dose adjustment in patients with kidney impairment
Higher rate of fatigue reported than metoprolol's tiredness rate
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