Carvedilol vs. metoprolol: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Carvedilol and metoprolol are prescription medications used to treat high blood pressure (hypertension) and heart problems, such as heart failure. These medications can also be used to reduce the risk of death after a heart attack (myocardial infarction).

Both carvedilol and metoprolol are classified as beta-blockers, also known as beta-adrenergic blocking agents. They work by blocking beta receptors, which block the effects of norepinephrine and epinephrine in the heart and blood vessels. Beta-blockers help lower blood pressure and slow heart rate to relieve stress on the heart.

Carvedilol and metoprolol are both generic medications. Although they share similarities, they also have differences in dosage, formulation, and side effects.

What are the main differences between carvedilol and metoprolol?

Carvedilol is considered a non-selective beta-blocker. This means that carvedilol can block both beta-1 receptors and beta-2 receptors. Beta-1 receptors are found in the heart while beta-2 receptors are primarily found in the smooth muscles. Carvedilol also blocks alpha receptors in the arteries, which helps lower blood pressure.

Carvedilol is the generic name for Coreg. It is usually taken as a 3.125 mg, 6.25 mg, 12.5 mg, or 25 mg oral tablet twice daily. Carvedilol is also available in an extended-release form (Coreg CR) that can be taken once daily.

Metoprolol is a beta-1 selective blocker that primarily blocks the beta-1 receptors in the heart. However, it also blocks beta-2 receptors, although to a lesser degree. Selective beta-blockers may have slightly different effects compared to non-selective beta-blockers.

Metoprolol comes in two different salt forms: metoprolol tartrate and metoprolol succinate. Metoprolol tartrate, also known by the brand name Lopressor, is an immediate-release oral tablet that comes in strengths of 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg. Metoprolol succinate, also known by the brand name Toprol XL, is an extended-release oral tablet that comes in strengths of 25 mg, 50 mg, 100 mg, and 200 mg.

RELATED: Metoprolol vs. Atenolol

Conditions treated by carvedilol and metoprolol

Both carvedilol and metoprolol succinate are FDA approved to treat heart failure caused by ischemia, hypertension, or cardiomyopathy. Both beta-blockers are also approved to treat hypertension.

Beta-blockers are typically used in addition to other medications like angiotensin-converting enzyme (ACE) inhibitors and diuretics. Lowering systolic or diastolic blood pressure can help lower the risk of a cardiovascular event like a heart attack or stroke.

Carvedilol and metoprolol can be used to reduce the risk of morbidity and mortality following a heart attack. These medications can also treat left ventricular dysfunction after a heart attack.

Both medications can be used to treat angina pectoris, or chest pain, caused by coronary heart disease. Carvedilol or metoprolol may be prescribed to reduce angina attacks and improve exercise capabilities in those with heart disease or heart failure.

Off-label uses of carvedilol and metoprolol include the treatment of arrhythmias, or abnormal heart rhythms, such as atrial fibrillation.

Is carvedilol or metoprolol more effective?

The Carvedilol or Metoprolol European Trial (COMET) was a randomized controlled trial that compared carvedilol and metoprolol in patients with chronic heart failure. The trial was conducted over almost five years in more than 1,500 patients. Results, which were published in the Lancet, showed an all-cause mortality of 34% for carvedilol versus 40% for metoprolol. In other words, carvedilol was found to increase survival in heart failure patients more than metoprolol.

A 2021 comparative study from the American Journal of Cardiology found that there was no significant difference in survival rates after a heart attack with carvedilol versus metoprolol in patients with a left ventricular ejection fraction over 40%. However, in those with a left ventricular ejection fraction less than 40%, carvedilol may be a more effective beta-blocker.

According to a meta-analysis, carvedilol and metoprolol are similar in effectiveness when used after a heart attack. When compared to placebo, both beta-blockers were found to significantly reduce cardiovascular events and subsequent heart attacks. However, no significant benefits on all-cause mortality, revascularization, and hospitalization were found for either carvedilol or metoprolol.

Both carvedilol and metoprolol can be effective treatment options. Treatment may be personalized based on the treated condition, potential side effects, and cost. Consult a healthcare provider on the best treatment for you.

Coverage and cost comparison of carvedilol vs. metoprolol

Carvedilol is covered by most Medicare and insurance plans. The copay will depend on the plan’s formulary and coverage. The average cash price of carvedilol is around $160. Even with insurance, carvedilol can be expensive. Using a SingleCare discount card for carvedilol may be able to lower the out-of-pocket cost to around $5.

Metoprolol is also covered by most Medicare and insurance plans. Consult your pharmacist or insurance plan to find out what the copay for metoprolol would be. The average cash price of metoprolol is around $168. A SingleCare discount card for metoprolol tartrate or metoprolol succinate could help you save significantly on the cost of the prescription.

Common side effects of carvedilol vs. metoprolol

Carvedilol and metoprolol share similar side effects. The most common side effects of carvedilol are dizziness, fatigue, weakness, low blood pressure (hypotension), diarrhea, high blood sugar (hyperglycemia), slow heart rate (bradycardia), and weight gain. The most common side effects of metoprolol tiredness, dizziness, diarrhea, itching, and depression.

Serious side effects of carvedilol and metoprolol may occur, such as allergic reactions, dangerously low blood pressure, and bronchospasms or shortness of breath. Seek immediate medical attention if you experience severe rash, swelling, or trouble breathing after taking carvedilol or metoprolol.

*not reported
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Carvedilol), DailyMed (Metoprolol)

Drug interactions of carvedilol vs. metoprolol

Both carvedilol and metoprolol can lower blood pressure and slow heart rate. Therefore, they can interact with other medications that have similar effects. Both carvedilol and metoprolol, like most beta-blockers, can interact with blood pressure lowering agents, monoamine oxidase inhibitors (MAOIs), and calcium channel blockers. Taking these medications together can increase the risk of dangerously low blood pressure or slowed heart rate.

Carvedilol and metoprolol are mainly processed in the liver by the CYP2D6 enzyme. Drugs that inhibit this enzyme can interact with carvedilol and metoprolol, which can lead to increased levels of carvedilol or metoprolol. Increased blood levels of carvedilol or metoprolol can lead to an increased risk of side effects.

Beta-blockers may increase the blood-sugar-lowering effects of oral hypoglycemic medications like glipizide, metformin, or insulin. Caution should be advised when these medications are taken together.

See the table below for other possible drug interactions.

Consult a healthcare professional for other possible drug interactions

Warnings of carvedilol and metoprolol

Beta-blockers should not be abruptly discontinued. Instead, they should be gradually tapered to lower doses. There may be an increased risk of worsened coronary artery disease, angina, myocardial infarction, and ventricular arrhythmias after abruptly discontinuing a beta-blocker.

Beta-blockers can mask the symptoms of hypoglycemia or hyperthyroidism, such as fast heart rate. Diabetic patients and those with thyroid problems may need to use caution with beta-blockers.

Both carvedilol and metoprolol carry warnings of bronchospasm, especially in those with chronic obstructive pulmonary disease (COPD) or other breathing problems. However, studies have shown that beta-blockers may actually reduce exacerbations and increase survival in those with COPD.

Tell your healthcare provider if you have a history of congestive heart failure, asthma, slow heartbeat, liver problems, or allergic reactions to ingredients in carvedilol or metoprolol. Consult a healthcare provider for other warnings and precautions associated with the use of carvedilol or metoprolol.

Frequently asked questions about carvedilol vs. metoprolol

What is carvedilol?

Carvedilol is a beta-blocker medication that is used to treat heart failure and hypertension. It can also be used to increase survival after a heart attack. Carvedilol comes in immediate-release and extended-release forms. It was FDA approved in 1995.

What is metoprolol?

Metoprolol is a beta-blocker medication that can treat heart failure, hypertension, and chronic chest pain. Metoprolol succinate, the extended-release form of metoprolol is also FDA approved to treat heart failure. Immediate-release metoprolol contains metoprolol tartrate. Metoprolol was initially FDA approved in 1978.

Are carvedilol and metoprolol the same?

Both carvedilol and metoprolol are beta-adrenergic receptor blockers, or beta-blockers. They are both used to treat chronic heart failure and hypertension. However, they contain different active ingredients and work in slightly different ways. Carvedilol is a non-selective beta-blocker and metoprolol is a beta-1 selective beta-blocker.

Is carvedilol or metoprolol better?

Carvedilol and metoprolol are both highly effective medications when compared to placebo. Carvedilol may be better for certain patients with heart failure, according to the COMET trial. Carvedilol and metoprolol are similarly effective for increasing survival after a heart attack. Guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) recommend the use of either carvedilol, metoprolol succinate, or bisoprolol for patients with heart failure with reduced ejection fraction. Consult a healthcare provider for the best treatment option for your specific condition.

Can I use carvedilol or metoprolol while pregnant?

Beta-blockers are commonly used in pregnant women with heart conditions. However, there is no evidence that suggests that beta-blockers are completely safe or harmful during pregnancy. Both carvedilol and metoprolol may carry a risk of fetal harm. Consult a healthcare provider for medical advice before using a beta-blocker during pregnancy.

Can I use carvedilol or metoprolol with alcohol?

There may be an increased risk of side effects when combining a beta-blocker with alcohol. Taking carvedilol or metoprolol with alcohol may increase the risk of drowsiness, dizziness, and low blood pressure. Alcohol may also decrease the effectiveness of beta-blockers.

Does carvedilol lower blood pressure more than metoprolol?

Carvedilol may lower blood pressure more than metoprolol. This is because carvedilol has vasodilating properties that help relax blood vessels and lower blood pressure. No studies have directly compared the blood pressure lowering effects of carvedilol and metoprolol. However, carvedilol may help prevent cardiovascular events more than metoprolol in hypertensive patients.

Can you switch from metoprolol to carvedilol? / Is it safe to switch beta blockers?

It is generally safe to switch beta-blockers if needed or as recommended by a healthcare provider. Depending on the beta-blocker, the switch can be immediate or the dose of the initial beta-blocker can be weaned while the dose of the new beta-blocker is gradually increased to a target dose. Follow-up visits may be needed to assess the effectiveness of the new beta-blocker.

What is a good replacement for carvedilol?

The best replacement for carvedilol will depend on the condition being treated. There are only two medications FDA-approved to treat heart failure other than carvedilol: bisoprolol and metoprolol succinate. Other examples of beta-blockers include atenolol, nebivolol, and propranolol.

Is there a better beta blocker than metoprolol?

Possible alternatives to metoprolol succinate for treating heart failure include bisoprolol and carvedilol. The better beta blocker will be the one that works best for you. Other factors may play a role in choosing a beta blocker, such as cost, side effects, and other medications you may be taking.