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Key takeaways
Metoprolol tartrate, also known by the brand name Lopressor, is a prescription beta blocker pill used mostly to control high blood pressure and chest pain.
Treatment guidelines and side effects are a couple of the reasons why people look to change from metoprolol tartrate to another option.
Alternative beta blockers or a completely different drug class could be a better choice, but with diverse choices and scenarios in which metoprolol could be preferred, a healthcare provider must provide medical advice for the decision.
Lopressor (metoprolol tartrate) is a brand-name medication in a well-known drug class called beta blockers. It is approved by the Food and Drug Administration (FDA) for use in the management of several cardiovascular conditions, including high blood pressure (hypertension), chest pain (angina), and myocardial infarction (MI, or a heart attack). Off-label use occurs in the setting of heart arrhythmias like atrial fibrillation (AFib), hyperthyroidism, and migraine prevention. Being that there are numerous potential uses, there are plentiful alternatives to Lopressor, which could have advantages based on the underlying condition, drug interactions, or adverse effects. Here, we will discuss the reasons why a patient may need to seek an alternative to Lopressor.
What can I take instead of metoprolol?
Options to replace metoprolol start within the beta blocker class. Differences between beta blockers are significant, including the risk of adverse effects and their duration of action. Other drug classes used to treat similar conditions as beta blockers include angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), aldosterone antagonists, calcium channel blockers (CCBs), vasodilators, diuretics, and medications that control the heart rate or heart rhythm. Besides comparing the beneficial effects and risks among these alternatives, price should also be considered.
Compare metoprolol alternatives |
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|---|---|---|---|
| Drug name | Price without insurance | SingleCare price | Savings options |
| Lopressor | $190 per 60, 50 mg tablets | $7 per 60, 50 mg tablets of generic metoprolol tartrate, immediate-release | See latest prices |
| Toprol XL | $160 per 90, 25 mg tablets | $9 per 90, 25 mg tablets of generic metoprolol succinate, extended-release | See latest prices |
| Coreg | $97 per 60, 12.5 mg tablets | $6 per 60, 12.5 mg tablets of generic carvedilol | See latest prices |
| Tenormin (atenolol) | $480 per 30, 25 mg tablets | $4 per 30, 25 mg tablets of generic atenolol | See latest prices |
| Bystolic (nebivolol) | $700 per 90, 5 mg tablets | $32 per 90, 5 mg tablets of generic nebivolol | See latest prices |
| Corgard (nadolol) | $100 per 30, 20 mg tablets | $12 per 30, 20 mg tablets of generic nadolol | See latest prices |
| Inspra (eplerenone) | $500 per 30, 25 mg tablets | $20 per 30, 25 mg tablets of generic eplerenone | See latest prices |
| Aldactone (spironolactone) | $110 per 30, 25 mg tablets | $4 per 30, 25 mg tablets of generic spironolactone | See latest prices |
| Zestril | $1,420 per 90, 10 mg tablets | $7 per 90, 10 mg tablets | See latest prices |
| Diovan (valsartan) | $1,130 per 90, 160 mg tablets | $29 per 90, 160 mg tablets of generic valsartan | See latest prices |
| Hydrochlorothiazide | $20 per 30, 25 mg tablets | $4 per 30, 25 mg tablets of generic hydrochlorothiazide | See latest prices |
| Norvasc (amlodipine) | $420 per 30, 10 mg tablets | $4 per 30, 10 mg tablets of generic amlodipine | See latest prices |
| Cardizem CD (diltiazem, extended-release) | $3,130 per 90, 120 mg capsules | $10 per 30, 120 mg capsules of generic diltiazem, extended-release | See latest prices |
| Verelan
(verapamil, extended-release) |
$350 per 30, 240 mg capsules | $30 per 30, 240 mg capsules of generic verapamil, extended-release | See latest prices |
Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. The listed price without insurance references the price of brand-name drugs (unless otherwise specified). The listed SingleCare price references the price of generic drugs if available. Click the link under “Savings options” to see the latest drug prices.
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Top 5 metoprolol alternatives
The following are some of the most common alternatives to metoprolol.
1. Toprol XL
Toprol XL (metoprolol succinate extended-release) is a beta blocker that has an FDA-approved indication for the management of heart failure. Beta blockers in the setting of heart failure are generally indicated for those with heart failure with reduced ejection fraction (HFrEF). Unlike metoprolol tartrate, Toprol XL is an extended-release formulation of metoprolol succinate. Toprol XL demonstrated a reduction in cardiovascular complications and hospitalization in HFrEF when compared to placebo. Toprol XL is a preferred beta blocker (over immediate-release metoprolol tartrate) in the management of HFrEF. In comparison to immediate-release metoprolol, it can be administered once daily.
2. Coreg
Coreg (carvedilol) is an agent with some alpha blocker activity in addition to its beta-blockade and is an alternative to metoprolol tartrate for hypertension. It is also indicated for the management of HFrEF. Coreg has demonstrated a reduction in mortality in both moderate to severe stages of heart failure, with the most substantial evidence for benefit in severe failure. Since it does exhibit some alpha blocker activity, it can cause peripheral vasodilation (or relaxation of blood vessels) and lower blood pressure more in comparison to metoprolol.
The beta blocker drug class can be further subclassified as non-selective agents, cardio-selective agents, and agents with alpha-1 antagonist activity. Metoprolol is a cardio-selective beta blocker and may be a preferred agent to manage patients with underlying conditions like hypertension or heart disease who also suffer from chronic obstructive pulmonary disease (COPD) or asthma. Being cardio-selective, metoprolol will mostly block beta receptors on the heart. Beta receptors are also found throughout pulmonary tissue, and if blockage of those receptors occurs, it can exacerbate lung conditions like COPD. Carvedilol is non-selective, so it may cause these patients problems.
3. Norvasc
Beta blockers are not a preferred or first-line drug for most people with hypertension. Norvac (amlodipine), which is a dihydropyridine calcium channel blocker, is a more common pick, according to guidelines from the World Health Organization. Guidelines such as these are generally based on efficacy and safety findings from clinical trials. Side effects of metoprolol that may require seeking alternative therapy, such as amlodipine, include a decreased heart rate (bradycardia) and a tendency to cause mild weight gain.
4. Zestril
Other first-line antihypertensive classes, ARBs, like Diovan (valsartan), and ACEi, such as Zestril (lisinopril), may be suitable alternatives to metoprolol when trying to lower blood pressure. Lisinopril can help meet American College of Cardiology guideline recommendations to achieve a systolic blood pressure of less than 130 mmHg and a diastolic blood pressure of less than 80 mmHg. In patients with underlying kidney disease resulting in proteinuria, lisinopril can be a good option for therapy as well. Combining an ACEi with a thiazide diuretic like hydrochlorothiazide is frequently done.
5. Verelan
Verelan (verapamil) and Cardizem CD (diltiazem extended-release) are two calcium channel blockers from the non-dihydropyridine subcategory. Guidelines for hypertension management do not recommend their use in most cases. However, they can have a dual benefit when angina treatment or heart rate control is important, too. Atrial fibrillation, an irregular heart rhythm that often goes too fast, is common, and a heart rate-controlling medication like verapamil can be helpful. It is usually preferred over metoprolol in the setting of COPD or bronchospasm for this use, but is typically avoided in the management of HFrEF.
Natural alternatives to metoprolol
For the conditions in which metoprolol is used as pharmacologic management, many lifestyle changes and diet modifications can be undertaken simultaneously to improve long-term outcomes. In the setting of hypertension, the American College of Cardiology guidelines suggest that each kilogram of weight lost can reduce systolic blood pressure (SBP) by 1 mmHg, a heart-healthy diet can reduce SBP by 11 mmHg, cutting dietary sodium intake by 25% can reduce SBP by 5 mmHg, and following a structured exercise program of at least 150 minutes of aerobic activity each week can reduce SBP by 5 mmHg. As always, one should seek the medical advice of healthcare professionals before seeking natural alternatives to metoprolol tartrate.
How to switch to a metoprolol alternative
Before switching metoprolol to one of its alternatives, it is best to do so in conjunction with the medical advice of a healthcare professional. Reasons for alternatives to be considered suboptimal therapeutic options based on your unique situation may not be obvious, and it is important to have these alternatives evaluated carefully by a healthcare provider who knows the entirety of your medical history. In addition, abrupt discontinuation of long-term use of beta blockers like metoprolol can cause withdrawal-like symptoms, resulting in rebound hypertension, tachycardia, heart arrhythmias, or an angina attack. Therefore, beta blocker must be slowly tapered off over the course of a week or longer, at which time alternative medications can then be added. Using a prescription discount card from SingleCare may help reduce the cost of metoprolol and its alternatives at participating pharmacies.
Choosing the right path for hypertension treatment
Antihypertensives come from several different drug classes. Beta blockers, like metoprolol, are only one option and are not preferred for blood pressure control alone. Nevertheless, they have their niche, particularly when other forms of heart disease are present. Deciding on the best choice for hypertension treatment is complex, so a detailed conversation with your healthcare provider is essential when comparing metoprolol and the alternatives.
- Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure, JAMA (2000)
- Effect of carvedilol on the morbidity of patients with severe chronic heart failure, Circulation (2002)
- Hypertension pharmacological treatment in adults: A World Health Organization guideline executive summary, Hypertension (2021)
- Body weight changes with beta-blocker use: Results from GEMINI, The American Journal of Medicine (2007)
- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, Hypertension (2017)
- Beta-blocker rebound phenomenon in an adolescent with Graves’ disease, Journal of Clinical Research in Pediatric Endocrinology (2022)