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

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

Benazepril

Most common
Headache (6%)
Dizziness (4%)
Somnolence (2%)
Postural dizziness (2%)

Metoprolol vs. Benazepril Dosage

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

Benazepril

Dosage
Dosage Table
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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