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

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

Losartan

Most common
Upper respiratory infection (up to 8%)
Dizziness (up to 3%)
Nasal congestion (up to 2%)
Back pain (up to 2%)

Metoprolol vs. Losartan Dosage

Metoprolol

Dosage
Dosage Table
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

Dosage
Dosage Table
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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