Metoprolol vs. Benazepril
See how Metoprolol and Benazepril compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Metoprolol is a beta-blocker also approved for angina and heart failure, while benazepril is an ACE inhibitor approved only for hypertension.
Both drugs are inexpensive, well-established generics that are typically taken once a day.
Metoprolol must be tapered off slowly to avoid rebound effects, while benazepril carries a boxed warning against use during pregnancy.
Metoprolol vs. Benazepril 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 daily, with the dose slowly increased over several weeks to reach a maintenance level.
Benazepril
Benazepril is an ACE inhibitor approved to treat high blood pressure. It is taken as an oral tablet once daily, with the dose gradually increased from a starting dose up to a maximum of 80 mg based on response and blood pressure control.
Metoprolol vs. Benazepril Side Effects
Metoprolol
Benazepril
Metoprolol vs. Benazepril Dosage
Metoprolol
Benazepril
| 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 | 5 mg once daily | At the start |
| Maximum dose | 80 mg once daily | If needed |
| Dose changes | 4 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 |
Benazepril
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once daily | At the start |
| Maximum dose | 80 mg once daily | If needed |
| Dose changes | 4 increases | As tolerated |
Metoprolol vs. Benazepril Indications
Metoprolol
Metoprolol is FDA-approved for hypertension, angina pectoris, and stable heart failure (NYHA Class II-IV). It is also used off-label for atrial fibrillation rate control, migraine prevention, and essential tremor.
Hypertension
Angina pectoris
Heart failure (stable, NYHA Class II-IV)
Atrial fibrillation rate control (off-label)
Benazepril
Benazepril's only FDA-approved use is to lower blood pressure in adults with hypertension. It is often prescribed alone or combined with other antihypertensive medications such as diuretics.
Hypertension (sole FDA-approved use)
Often combined with a diuretic
Used long-term for blood pressure control
Not approved for heart failure or angina
Metoprolol vs. Benazepril Pros and Cons
Metoprolol
Metoprolol has decades of use across several heart conditions, giving it broader flexibility than a hypertension-only drug. Its extended-release formula allows once-daily dosing, though it requires careful tapering if stopped.
Pros
Also approved for angina and heart failure, not just hypertension
Long track record since 1992 with a well-understood safety profile
Extended-release formula allows once-daily dosing
No boxed warning for fetal harm, unlike benazepril
Cons
Must be tapered gradually, cannot stop abruptly
Contraindicated in bradycardia, heart block, and decompensated heart failure
Can cause fatigue or depression in some patients
Not appropriate for cardiogenic shock or acute heart failure
Benazepril
Benazepril works well for blood pressure control alone but is not approved for other cardiac conditions. It carries specific risks, including angioedema and fetal harm, that require monitoring during use.
Pros
May offer added kidney-protective benefits typical of ACE inhibitors
Lower rates of fatigue and mood-related side effects than beta-blockers
Simple titration schedule from 5 mg to 80 mg
Discontinuation due to side effects occurs in only about 5% of patients
Cons
Boxed warning for fetal toxicity; must stop immediately if pregnancy occurs
Risk of angioedema, including rare fatal reactions
Less effective as monotherapy in Black patients
Approved only for hypertension, with no other FDA-labeled uses
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