Metoprolol vs. Valsartan
See how Metoprolol and Valsartan compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Metoprolol is a once-daily beta-blocker that also treats angina and heart failure, while valsartan is an ARB used for hypertension, heart failure, and post-heart-attack recovery.
Metoprolol must be tapered slowly before stopping, while valsartan can typically be stopped without a taper schedule.
Valsartan avoids the dry cough linked to ACE inhibitors, while metoprolol has established off-label uses for migraine prevention and essential tremor.
Metoprolol vs. Valsartan Drug Summary
Metoprolol
Metoprolol succinate is a beta-1 selective blocker that lowers blood pressure by slowing the heart rate and reducing the force of each heartbeat. It is FDA-approved for hypertension, angina, and stable heart failure, and comes as an extended-release tablet taken once a day.
Valsartan
Valsartan is an angiotensin II receptor blocker (ARB) that relaxes blood vessels by blocking a hormone that narrows them. It is FDA-approved for hypertension, heart failure, and improving survival after a heart attack, and is taken as an oral tablet once daily for most patients.
Metoprolol vs. Valsartan Side Effects
Metoprolol
Valsartan
Metoprolol vs. Valsartan Dosage
Metoprolol
Valsartan
| 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 | 80 mg once daily | At the start |
| Maximum dose | 320 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 |
Valsartan
| STAGE | DOSE | WHEN |
| Starting dose | 80 mg once daily | At the start |
| Maximum dose | 320 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Metoprolol vs. Valsartan Indications
Metoprolol
Metoprolol succinate is FDA-approved to lower blood pressure, relieve chest pain from angina, and improve survival in people with stable heart failure. It is also prescribed off-label for conditions such as atrial fibrillation, migraine prevention, and essential tremor.
Hypertension
Angina pectoris
Heart failure (NYHA Class II-IV)
Off-label: atrial fibrillation rate control
Valsartan
Valsartan is FDA-approved to lower blood pressure, reduce hospitalizations in people with heart failure, and improve survival after a heart attack. It is also approved for hypertension in children age one and older.
Hypertension (adult and pediatric)
Heart failure (NYHA Class II-IV)
Post-myocardial infarction survival
Reduces cardiovascular mortality post-MI
Metoprolol vs. Valsartan Pros and Cons
Metoprolol
Metoprolol has decades of real-world use and is one of the least expensive generic blood pressure medications available. It requires a gradual taper before stopping and is not recommended for people with certain heart rhythm conditions.
Pros
Decades of established real-world safety data
Also treats angina and stable heart failure
One of the lowest-cost generic beta-blockers
Off-label options for tremor and migraine
Cons
Must be tapered slowly, never stopped abruptly
Contraindicated in certain heart block and bradycardia
Can cause fatigue or low mood in some people
May mask low blood sugar symptoms in diabetics
Valsartan
Valsartan avoids the persistent dry cough that limits ACE inhibitor use and had a low rate of treatment discontinuation in clinical trials. It carries a pregnancy warning and requires monitoring of kidney function and potassium.
Pros
Does not cause the dry cough seen with ACE inhibitors
Low discontinuation rate in clinical trials
Also approved to improve survival after a heart attack
Can typically be stopped without a taper
Cons
Not recommended during pregnancy due to fetal harm
Requires monitoring of kidney function and potassium
Cannot be combined with aliskiren in diabetics
Dizziness increases at the highest approved dose
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