Carvedilol vs. metoprolol: Differences and similarities explained

In this article:

• Key differences
• Conditions treated
• Is metoprolol better than carvedilol?
• Coverage and cost
• Side effects
• Intereactions and warnings
• Can you take carvedilol and metoprolol together?

In this article

• Key differences
• Conditions treated
• Is metoprolol better than carvedilol?
• Coverage and cost
• Side effects
• Intereactions and warnings
• Can you take carvedilol and metoprolol together?

Carvedilol and metoprolol are prescription drugs that help treat cardiovascular problems like high blood pressure and heart failure. If you or a loved one has ever been diagnosed with one of these conditions, you might have noticed your healthcare provider choosing between these two medications. Since they’re both beta blockers, people often wonder if one is better than the other. 

A healthcare provider may prescribe carvedilol if you need additional help lowering blood pressure, while metoprolol may be prescribed in other situations. Even though these medicines work in similar ways, they aren’t the same. Because they may have different health benefits, prices, and side effects, it’s helpful to know your options.

Carvedilol and metoprolol are FDA approved to manage heart problems and high blood pressure (hypertension). These medications help the heart work more efficiently, which may, in turn, help reduce blood pressure. 

Healthcare providers might prescribe these drugs for various heart conditions like chronic heart failure, chest pain (angina pectoris), and an irregular heartbeat, such as atrial fibrillation. They are also commonly used after someone has had a heart attack to help protect the heart and lower the risk of another one. In some cases, these beta blockers may be prescribed off-label for migraine headaches.

Is metoprolol better than carvedilol? 

Metoprolol and carvedilol are both effective treatment options. However, the answer to which one is better really depends on why someone is taking the medication and their overall health.

First, it’s important to know how these medications work in the body. Beta receptors are found throughout the body and respond to signals, such as adrenaline, to help control functions like heart rate and breathing. Beta-1 receptors are mainly found in the heart, while beta-2 receptors are mostly located in the lungs and the smooth muscles of blood vessels. Metoprolol is a selective beta blocker that mainly targets beta-1 receptors in the heart, while carvedilol is a nonselective beta blocker that blocks both beta-1 and beta-2 receptors throughout the body.

Here’s how the differences in how these medications work can affect their advantages:

• Because it mainly targets beta receptors in the heart, metoprolol may be a better choice for some people with asthma or lung disease, as it typically has lesser impact on the lungs than carvedilol.
• Carvedilol directly helps relax blood vessels, which means it might lower blood pressure a bit more than metoprolol for some people. Clinical trials have shown that carvedilol lowered blood pressure better than metoprolol, both at rest and during exercise.
• Carvedilol has been found to have more favorable effects on blood sugar levels than metoprolol. One study found that carvedilol improved insulin sensitivity more than metoprolol in people with Type 2 diabetes.
• Metoprolol is more likely to increase triglyceride levels than carvedilol, which may make carvedilol a better choice for people worried about cholesterol or lipid levels. 

Never switch or start these medicines without a healthcare provider’s guidance. The proper dosage and individual response both make a difference, so always get medical advice before taking these medications.

Carvedilol vs. metoprolol: Insurance coverage and cost comparison

Carvedilol and both forms of metoprolol are available as generics. That’s good news for most people since generics are less expensive than brand-name drugs. Most insurance plans, including Medicare Part D plans, cover both carvedilol and metoprolol, although copays and coinsurance vary by plan.

The retail cost for each medicine isn’t set in stone. It can change based on the dose, how many pills you get, and which pharmacy you use. For example, carvedilol and metoprolol have different prices when purchasing a 30-day supply versus a 90-day supply. Prices at big chains or local drugstores can be higher or lower, so it pays to shop around.

You can also check for discounts before paying for medicines. Online services like SingleCare offer coupons for carvedilol and metoprolol that can lower the price, sometimes even more than insurance does.

Carvedilol vs. metoprolol side effects

As beta blockers, carvedilol and metoprolol share many of the same potential side effects. However, these side effects are more likely to occur when treatment is first started or the dosage is increased.

Common side effects of these medications include: 

• Slow heart rate
• Low blood pressure
• Palpitations
• Tiredness or fatigue
• Dizziness
• Diarrhea
• Shortness of breath
• Headaches

Some side effects tend to show up more with one drug than the other. For example, weight gain is more likely to occur with carvedilol, while metoprolol might make someone feel more anxious or have heart palpitations.

Serious side effects, such as allergic reactions, are also possible. Seek medical help if you experience shortness of breath, rash, or trouble breathing while taking these medications. 

Carvedilol and metoprolol drug interactions and warnings

Carvedilol and metoprolol can interact with medications of similar types, especially those that affect heart rate, blood pressure, and drug metabolism. 

• Certain antidepressants, such as Paxil (paroxetine) and Prozac (fluoxetine)
• Blood pressure medications, such as Catapres (clonidine) and Cardizem (diltiazem) 
• Antiarrhythmic agents, such as Lanoxin (digoxin), Cordarone (amiodarone), Rythmol (propafenone), and Tambocor (flecainide) 
• Monoamine oxidase inhibitors (MAOIs), such as Nardil (phenelzine), Parnate (tranylcypromine), and Marplan (isocarboxazid)

Carvedilol can also increase the effects of diabetes medications, like insulin or sulfonylureas, increasing the risk of low blood sugar levels (hypoglycemia). This type of drug interaction isn’t listed on the metoprolol drug label. 

Warnings to consider with carvedilol and metoprolol

The use of beta blockers can come with serious risks, especially if stopped suddenly or used while having certain medical conditions.

Carvedilol and metoprolol may cause the following problems:

• Heart complications from stopping abruptly: Stopping these drugs suddenly may worsen chest pain or trigger heart problems. The dose should always be reduced gradually under a doctor’s care.
• Slow heart rate and low blood pressure: These effects may occur, especially when starting or increasing the dose. Your healthcare provider may need to adjust your medication if symptoms like dizziness or fatigue develop.
• Worsening heart failure or fluid buildup: Carvedilol and metoprolol may initially worsen symptoms of heart failure before improving them. A healthcare provider will recommend watching for any side effects during dose changes.
• Breathing problems in people with lung conditions: People with chronic bronchitis, emphysema, or other non-allergic lung diseases may experience worsened breathing. These medications should be started at the lowest dose and with caution with these breathing problems.
• Diabetes complications: Both medications can mask signs of low blood sugar, such as a rapid heartbeat, nervousness, and sweating, and may impact blood sugar control. If you have diabetes, you may need to keep an eye on blood sugar levels while taking a beta blocker.
• Thyroid problems: These drugs may hide signs of an overactive thyroid, such as a fast heartbeat, sweating, and restlessness, and stopping them suddenly may trigger a dangerous thyroid reaction.

This is not a complete list of potential warnings and precautions. It’s best to visit a healthcare provider to see whether these medications are safe and appropriate for your condition.

Can you take carvedilol and metoprolol together?

You shouldn’t take carvedilol and metoprolol together because both drugs slow heart rate and lower blood pressure in the same way, which can intensify their effects. Combining them can cause a severe and unsafe drop in heart rate (bradycardia), extreme dizziness, fainting, or even heart block. You may also experience severe fatigue, cold extremities, and shortness of breath. Consult a healthcare provider about potentially changing your dosage or medication if you’re not getting the expected benefits from one or the other.