Metoprolol vs. Olmesartan
See how Metoprolol and Olmesartan compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Metoprolol is a beta-blocker approved for high blood pressure, angina, and heart failure, while olmesartan is an ARB approved only for hypertension.
Metoprolol needs a multi-week titration schedule to reach its maintenance dose, while olmesartan reaches its ceiling dose in as few as three weeks.
Metoprolol's generic price is far lower than olmesartan's, but it also carries stricter warnings about abrupt discontinuation and slow heart rate.
Metoprolol vs. Olmesartan 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 raised gradually over several weeks to a maintenance level between 100 mg and 400 mg.
Olmesartan
Olmesartan medoxomil is an angiotensin II receptor blocker used to treat high blood pressure in adults and children six and older. It is taken as an oral tablet once daily, typically starting around 20 mg and adjusted up to a maximum of 40 mg.
Metoprolol vs. Olmesartan Side Effects
Metoprolol
Olmesartan
Metoprolol vs. Olmesartan Dosage
Metoprolol
Olmesartan
| 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 | 40 mg once daily | Week 3 onward |
| Maximum dose | 40 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
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 |
Olmesartan
| STAGE | DOSE | WHEN |
| Starting dose | 40 mg once daily | Week 3 onward |
| Maximum dose | 40 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Metoprolol vs. Olmesartan Indications
Metoprolol
Metoprolol is FDA-approved for hypertension, angina, and stable heart failure, making it useful when a patient needs more than blood pressure control alone. Doctors also prescribe it off-label for atrial fibrillation rate control, migraine prevention, and essential tremor.
Hypertension, to lower blood pressure
Angina pectoris
Heart failure (stable, NYHA Class II-IV)
Off-label: atrial fibrillation rate control
Olmesartan
Olmesartan is FDA-approved specifically for hypertension in adults and children six years and older, alone or combined with other blood pressure medications. It does not carry FDA approval for angina, heart failure, or other cardiovascular conditions.
Hypertension in adults
Hypertension in children 6 years and older
Can be combined with other blood pressure drugs
Not approved as initial therapy in patients over 75
Metoprolol vs. Olmesartan Pros and Cons
Metoprolol
Metoprolol's broader FDA approval and long track record make it a practical choice when high blood pressure occurs alongside angina or heart failure. It requires careful tapering and is not suitable for people with certain slow heart rhythms.
Pros
Also approved for angina and heart failure, not just blood pressure
Decades of clinical use since FDA approval in 1992
Off-label options for tremor, migraine, and AFib rate control
Cons
Must be tapered slowly, cannot be stopped abruptly
Contraindicated in severe bradycardia and certain heart blocks
Requires several titration steps to reach a maintenance dose
Not approved for acute decompensated heart failure
Olmesartan
Olmesartan offers straightforward, low-step dosing and is approved for children as young as six, but its use is limited to blood pressure treatment. Its boxed pregnancy warning and higher price are important considerations for many patients.
Pros
Reaches its full dose in as few as three weeks
Approved for use in children 6 years and older
Doses above 40 mg add no extra benefit, simplifying dosing
Cons
Boxed warning for fetal toxicity during pregnancy
Risk of hyperkalemia and reduced kidney function
Rare risk of sprue-like enteropathy with severe diarrhea
Costs roughly $115 to $205 a month, several times metoprolol's price
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