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

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

Valsartan

Most common
Viral infection (up to 3%)
Fatigue (up to 2%)
Dizziness (up to 2%)
Headache (up to 2%)

Metoprolol vs. Valsartan 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

Valsartan

Dosage
Dosage Table
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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