Metoprolol vs. Losartan
See how Metoprolol and Losartan compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Metoprolol is a beta-blocker also approved for angina and heart failure, while losartan is an ARB approved only for blood-pressure-related conditions.
Both are inexpensive daily generics, but current guidelines favor ARBs like losartan as first-line therapy for uncomplicated high blood pressure.
Metoprolol must be tapered slowly before stopping, while losartan can typically be discontinued without a step-down schedule.
Metoprolol vs. Losartan Drug Summary
Metoprolol
Metoprolol succinate is a beta-1 selective beta-blocker used to lower blood pressure, treat angina, and manage stable heart failure. It comes as an extended-release tablet taken once a day, starting at a low dose that is gradually increased. Metoprolol also has off-label uses such as atrial fibrillation rate control and migraine prevention.
Losartan
Losartan is an angiotensin II receptor blocker (ARB) used to lower blood pressure, reduce stroke risk in patients with hypertension and heart enlargement, and slow kidney damage in type 2 diabetes. It is taken as a tablet once a day, usually starting at 50 mg. Losartan does not require tapering when treatment is stopped.
Metoprolol vs. Losartan Side Effects
Metoprolol
Losartan
Metoprolol vs. Losartan Dosage
Metoprolol
Losartan
| STAGE | DOSE | WHEN |
| Starting dose | 12.5 mg once daily | Weeks 1-2 |
| Maximum dose | 100 mg once daily | Week 5 onward |
| Dose changes | 3 increases | Every 2 weeks |
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg once daily | At the start |
| Maximum dose | 100 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 | 100 mg once daily | Week 5 onward |
| Dose changes | 3 increases | Every 2 weeks |
Losartan
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg once daily | At the start |
| Maximum dose | 100 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Metoprolol vs. Losartan Indications
Metoprolol
Metoprolol is FDA-approved to lower blood pressure, relieve chest pain from angina, and treat stable heart failure. Doctors also prescribe it off-label for atrial fibrillation rate control, migraine prevention, and essential tremor.
Hypertension (lowering blood pressure)
Angina pectoris (chest pain)
Heart failure, NYHA Class II-IV
Off-label: atrial fibrillation rate control
Losartan
Losartan is FDA-approved to lower blood pressure, cut the risk of stroke in people who have both hypertension and left ventricular hypertrophy, and slow kidney damage in type 2 diabetics with protein in their urine. It is not approved for angina or heart failure.
Hypertension (lowering blood pressure)
Stroke risk reduction with hypertension and LVH
Diabetic nephropathy in type 2 diabetes
Not indicated for angina or heart failure
Metoprolol vs. Losartan Pros and Cons
Metoprolol
Metoprolol covers more ground than losartan, with FDA approval for angina and heart failure in addition to high blood pressure. It has decades of clinical use and is available as an inexpensive generic, but it cannot be stopped abruptly and carries strict heart-rhythm precautions.
Pros
Also approved for angina and heart failure, not just blood pressure
Long track record with decades of clinical use
Available as a low-cost generic extended-release tablet
Useful for patients whose blood pressure is tied to a fast heart rate
Cons
Must be tapered over 1-2 weeks, cannot be stopped abruptly
Contraindicated in bradycardia, heart block, and decompensated heart failure
Can cause more fatigue and low mood than an ARB
No longer a first-choice drug for uncomplicated high blood pressure alone
Losartan
Losartan is a guideline first-line choice for straightforward high blood pressure and adds kidney-protective benefits for people with type 2 diabetes. It is generally easier to tolerate than metoprolol, but it does not treat angina or heart failure and carries a pregnancy warning.
Pros
Guideline first-line therapy for uncomplicated hypertension
Slows kidney damage in type 2 diabetics with protein in urine
Side effect rate close to placebo in clinical trials
Can be stopped without a tapering schedule
Cons
Not approved for angina or heart failure
Carries a boxed warning against use during pregnancy
Requires monitoring of kidney function and potassium levels
Less useful for patients who also need heart-rate control
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