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

In this article:

• Main differences between losartan and metroprolol
• Conditions treated
• Efficacy
• Coverage and cost comparison
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences between losartan and metroprolol
• Conditions treated
• Efficacy
• Coverage and cost comparison
• Side effects
• Interactions
• Warnings
• FAQs

Losartan and metoprolol are commonly prescribed blood pressure medications, or antihypertensives, used to treat hypertension (high blood pressure) and other heart-related conditions. Losartan is classified in a group of medications called angiotensin II receptor blockers, or ARBs, similar to drugs such as Diovan (valsartan) and Benicar (olmesartan). Losartan is a generic for the brand-name drug Cozaar. It works by blocking the action of a hormone called angiotensin II, which helps relax blood vessels and lower blood pressure.

Metoprolol is a beta blocker, similar to drugs such as Tenormin (atenolol) and Inderal (propranolol). It comes in two formulations: an immediate-release formulation called metoprolol tartrate, which is generic for Lopressor, and an extended-release formulation called metoprolol succinate, which is generic for Toprol XL. Metoprolol helps lower blood pressure and reduce heart strain by blocking beta receptors in the heart that control heart rate.

While both medications lower blood pressure and can treat other conditions, they are in different drug classes and are not the same. Continue reading to learn more about losartan and metoprolol. 

What are the main differences between losartan and metoprolol?

Losartan is a generic angiotensin receptor blocker (ARB), also known by the brand name Cozaar. It is available as an oral tablet. Metoprolol, a beta blocker, is known by brand names such as Lopressor and Toprol XL. It is available in oral immediate-release (IR) tablets, extended-release (ER) tablets, capsules, and injectable form. 

For reference, these medications are also available as combination medications with a diuretic (water pill). For example, the medication Hyzaar combines losartan and hydrochlorothiazide (HCTZ), and Lopressor HCT combines metoprolol tartrate and HCTZ. This article will focus on the single-ingredient medications, losartan vs. metoprolol.

Main differences between losartan and metoprolol
	Losartan	Metoprolol
Drug class	Angiotensin receptor blocker (ARB)	Beta-blocker
Brand/generic status	Generic	Generic
What is the brand name?	Cozaar	Lopressor (metoprolol tartrate) Toprol XL (metoprolol succinate extended-release) Kapspargo (metoprolol succinate extended-release)
What form(s) does the drug come in?	Oral tablets: 25 mg, 50 mg, 100 mg	Metoprolol tartrate Oral tablets: 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg Injection Metoprolol succinate ER Oral extended-release tablets: 25 mg, 50 mg, 100 mg, 200 mg Kapspargo:  Oral extended-release capsules: 25mg, 50mg, 100mg, 200mg
What is the standard dosage?	Varies; a typical dose may be 50 mg or 100 mg by mouth daily	Varies; a typical dose may be metoprolol succinate ER 25 to 100 mg by mouth daily
How long is the typical treatment?	Long-term	Long-term
Who typically uses the medication?	Hypertension: adults and children older than 6 years of age All other uses: adults	Metoprolol IR: adults Metoprolol ER: adults and children 6 years and older for hypertension; adults only for all other uses

Conditions treated by losartan and metoprolol

Losartan is approved by the U.S. Food and Drug Administration (FDA) for the following uses:

• To treat hypertension in adults and children over 6 years old, helping to lower the risk of cardiovascular events like stroke and heart attack
• To lower the risk of stroke in people with hypertension and left ventricular hypertrophy
• To treat diabetic nephropathy in people with Type 2 diabetes and a history of hypertension

Metoprolol IR is approved by the FDA for the following uses:

• To treat hypertension in adults, helping to lower the risk of cardiovascular events like stroke and heart attack
• To treat angina pectoris (chest pain)
• To improve survival after a heart attack

Metoprolol ER is approved by the FDA for the following uses:

• To treat hypertension in adults and children 6 years and older, helping to lower the risk of cardiovascular events like stroke and heart attack
• To treat angina pectoris
• To lower the risk of death and hospitalizations in people with heart failure

Is losartan or metoprolol more effective?

The effectiveness of losartan versus metoprolol largely depends on individual factors such as your medical history, current health conditions, and other medications you may be taking.

Since losartan and metoprolol have different FDA-approved uses, comparing them directly can be challenging. Additionally, there is limited data comparing these two medications head-to-head.

For treating high blood pressure, clinical guidelines typically recommend starting with one of the following categories of medications:

• A thiazide diuretic, such as hydrochlorothiazide
• A calcium channel blocker, such as amlodipine
• An ACE inhibitor, such as lisinopril
• An ARB, such as losartan

However, treatment decisions involve more than simply choosing from these categories. For instance, guidelines often suggest using a calcium channel blocker or thiazide diuretic as a first choice for Black patients. Beta blockers are generally not recommended as a first-line treatment for high blood pressure. Additionally, patients with kidney issues are usually prescribed an ACE inhibitor or ARB.

Ultimately, the best medication for you will depend on various individual considerations. Only your healthcare provider can determine the most appropriate treatment plan. Consult your provider for personalized medical advice.

Coverage and cost comparison of losartan vs. metoprolol

For individuals paying out of pocket, a one-month supply of losartan is about $77. However, you can use a free SingleCare discount to pay as low as $9. 

A one-month supply of metoprolol ER is about $36, but a free SingleCare discount can lower the price to about $3.

	Losartan	Metoprolol
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	Yes	Yes
Quantity	30, 100 mg tablets of losartan	30, 100 mg tablets of metoprolol succinate ER
Typical Medicare copay	$0-20	$0-20
SingleCare cost	$9	$12

Common side effects of losartan vs. metoprolol

While common side effects vary slightly, both drugs may cause adverse effects like dizziness, tiredness, and hypotension (low blood pressure). In rare cases, a serious allergic reaction may occur with any drug. Get emergency medical help if you have symptoms of hives, difficulty breathing, or swelling of the face, lips, tongue, or throat. 

Losartan	Metoprolol
Upper respiratory infection/cold/stuffy nose Back pain Dizziness  Tiredness  Diarrhea  Low blood sugar Chest pain High potassium levels Low blood pressure	Tiredness Dizziness Depression Shortness of breath Slow heart rate Low blood pressure Diarrhea Itching  Rash

Drug interactions of losartan vs. metoprolol

Before you take losartan or metoprolol, tell your healthcare provider about all your medications, including prescription drugs, over-the-counter medicines, vitamins, and supplements. The chart below outlines some of the drug interactions of losartan and metoprolol. However, this is not a complete list of all possible drug interactions. Consult your healthcare provider for more information about drug interactions and how they may affect you.

Drug	Drug Class	Interacts with losartan?	Interacts with metoprolol?
Potassium-sparing diuretics such as spironolactone Potassium supplements such as potassium chloride	Drugs that increase potassium levels	Yes	No
Lithium	Antimanic	Yes	No
Aleve (naproxen) Celebrex (celecoxib) Motrin (ibuprofen)	Nonsteroidal anti-inflammatory drugs (NSAIDs)	Yes	No
Aliskiren	Direct renin inhibitor	Yes (avoid the combination of aliskiren and losartan in people with diabetes or kidney disease)	No
Altace (ramipril) Vasotec (enalapril)	Angiotensin-converting enzyme inhibitors, or ACE inhibitors	Yes	No
Benicar (olmesartan) Diovan (valsartan)	ARBs	Yes	No
Phenelzine  Tranylcypromine	MAOIs	No	Yes
Epinephrine  Epi-Pen	Sympathomimetic agents	No	Yes
Fluoxetine Paroxetine  Propafenone  Quinidine	Drugs that interfere with an enzyme called CYP2D6	No	Yes
Clonidine  Digoxin  Diltiazem  Verapamil	Drugs that can increase the risk of slow heart rate	No	Yes

Warnings of losartan and metoprolol

Before you take losartan or metoprolol, tell your healthcare professional about your medical conditions and medical history, including if you are pregnant, planning to become pregnant, or breastfeeding. If you are going to have any type of surgical procedure, make sure your prescribing healthcare provider knows what medicines you are taking.

Losartan warnings

Losartan has a black box warning, the most serious warning required by the FDA. The warning states that losartan should not be used during pregnancy because it could cause harm or death to the unborn baby. 

Other warnings and serious side effects include:

• Losartan can cause low blood pressure, which can cause dizziness and fainting. If you feel dizzy or faint, lie down and call your healthcare provider right away. 
• For certain people with kidney problems, losartan may worsen kidney function. Call your healthcare provider right away if you have unexplained weight gain or swelling in the hands, ankles, or feet.
• Losartan may cause high potassium levels. Your healthcare provider will monitor your potassium levels.
• Drugs that may interact with losartan include nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE) inhibitors, potassium-sparing diuretics, and beta blockers.

Metoprolol warnings

Like many drugs, metoprolol carries potential risk factors and side effects. 

• Do not suddenly stop taking metoprolol, as doing so can cause problems such as heart attack (myocardial infarction) or worsening of chest pain. 
• Do not drive or operate machinery until you know how this medication affects you. 
• Call your healthcare provider immediately if you have difficulty breathing or rapid weight gain. 
• In some cases, such as if you are not eating enough or if you are vomiting, or in patients with diabetes, hypoglycemia (low blood sugar) may be more likely to occur. Talk to your doctor about your risk for hypoglycemia and know what actions you should take to monitor your blood sugar levels and treat low blood sugar.

Frequently asked questions about losartan vs. metoprolol

What is losartan?

Losartan is an angiotensin receptor blocker (ARB) used to treat high blood pressure, lower the risk of stroke in certain patients, and treat diabetic nephropathy in people with Type 2 diabetes and high blood pressure. It is available as a tablet that is taken by mouth.

What is metoprolol?

Metoprolol is a beta blocker for treating high blood pressure and chest pain. The immediate-release formulation (metoprolol tartrate) is also used to improve survival after a heart attack, and the extended-release formulations are used to lower the risk of death and hospitalizations in people with heart failure.

Are losartan and metoprolol the same?

They are not the same. Losartan is an angiotensin receptor blocker, while metoprolol is a beta blocker. While they both treat blood pressure, they have different uses and differences, such as certain side effects and drug interactions.

Is losartan or metoprolol better?

The choice between losartan and metoprolol depends on individual factors such as your specific health conditions, medical history, and other medications you are taking. Losartan is generally used for treating high blood pressure and can also be beneficial for reducing stroke risk and managing diabetic kidney disease. On the other hand, metoprolol is often prescribed for high blood pressure, chest pain, or heart failure, with its immediate-release form also used to improve survival after a heart attack.

There is no one-size-fits-all answer, as the effectiveness of each medication varies based on personal health needs. Consult your healthcare provider for the most appropriate choice tailored to your condition.

Can I use losartan or metoprolol while pregnant?

Losartan should not be used during pregnancy as it can cause serious harm, such as Reduced placental blood flow, placental abruption, premature birth, future cardiovascular disease, or even death of the unborn baby. If you become pregnant while taking losartan, contact your healthcare provider immediately. The safety of metoprolol during pregnancy is less well-studied, so it’s important to consult your healthcare provider for guidance if you are pregnant or planning to become pregnant. 

Can I use losartan or metoprolol with alcohol?

Medical professionals advise caution when consuming alcohol while taking blood pressure-lowering medications. Alcohol can either increase or decrease blood pressure, which may affect the effectiveness of losartan or metoprolol. Drinking alcohol while on losartan or metoprolol may cause dizziness or lightheadedness if your blood pressure drops too low. If you drink alcohol, you can consult your healthcare provider for medical advice. Those who take Kapspargo should completely avoid alcohol, as alcohol increases the speed with which the medicine is released into the body, which can worsen side effects.