Metoprolol succinate (Toprol XL) alternatives: What can I take instead of metoprolol succinate?

Compare metoprolol succinate alternatives | Bisoprolol | Carvedilol | Lisinopril | Entresto | Valsartan | Natural alternatives | How to switch meds

Metoprolol succinate is a generic prescription medication that belongs to a group of drugs called beta blockers and is available under the brand-name Toprol XL. Beta blockers can be used to treat a variety of conditions, including high blood pressure (hypertension), heart failure, angina (chest pain often associated with coronary artery disease), and post-myocardial infarction (heart attack). 

Additionally, there are many off-label uses, including migraine prevention, treatment of arrhythmias (irregular heartbeats), tremor reduction, and the symptomatic treatment of anxiety disorders. These medications work by slowing down the heart, which results in lower blood pressure and improves blood flow in the body. More specifically, metoprolol succinate is selective for beta-1 receptors (a cardioselective beta blocker), which mostly affects the heart.

In contrast, non-selective beta blockers can also affect other areas such as the lungs, blood vessels, and the gastrointestinal (GI) tract. For that reason, metoprolol succinate is preferred for heart disease therapy. An advantage of metoprolol succinate is that it is an extended-release tablet dosed once daily.

While an effective treatment for some people, metoprolol succinate may not be the best and safest treatment for everyone. People with asthma or chronic lung disease (such as COPD) should not use some types of beta blockers, as the medications could worsen breathing problems. Additionally, there are potentially unwanted side effects of metoprolol, including fatigue, dizziness, trouble sleeping, shortness of breath, a slow heart rate (bradycardia), and insomnia. For people with diabetes, metoprolol succinate can potentially increase blood sugar and may hide some of the warning signs of hypoglycemia (low blood sugar).

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What can I take in place of metoprolol succinate?

There are other options available to treat hypertension, heart failure, or chest pain that does not improve with metoprolol succinate. These alternative medications include other beta blockers, angiotensin-converting enzyme inhibitors, (ACE inhibitors), angiotensin II receptor blockers (ARBs), aldosterone antagonists, vasodilators, diuretics, and medications that control the heart rate or heart rhythm. These options may be more suitable for certain individuals due to their different uses, side effect profiles, and dosages.

Other alternatives to metoprolol succinate

For people seeking other alternatives to metoprolol succinate, there are a variety of medications in several drug classes that can be used depending on the condition being treated.

Angiotensin-Converting Enzyme (ACE) Inhibitors

• Captopril (Capoten)
• Enalapril (Vasotec)
• Fosinopril (Monopril)
• Perindopril (Aceon)
• Quinapril (Accupril)
• Ramipril (Altace)
• Trandolapril (Mavik)

Angiotensin II Receptor Blockers (ARBs)

• Candesartan (Atacand)
• Losartan (Cozaar)

Aldosterone Antagonists

• Spironolactone (Aldactone)
• Eplerenone (Inspra)

Beta Blockers

• Labetalol (Trandate, Normodyne)
• Nadolol (Corgard)
• Pindolol (Visken)
• Propranolol (Inderal)
• Sotalol (Betapace)

Calcium Channel Blockers

• Amlodipine (Norvasc)
• Diltiazem (Cardizem)
• Felodipine
• Nifedipine (Procardia XL)
• Verapamil (Verelan)

Diuretics

• Furosemide (Lasix)
• Bumetanide (Bumex)
• Torsemide (Demadex)
• Chlorothiazide (Diuril)
• Amiloride (Midamor Chlorthalidone (Hygroton)
• Hydrochlorothiazide or HCTZ (Esidrix, Hydrodiuril)
• Indapamide (Lozol)
• Metolazone (Zaroxolyn)
• Triamterene (Dyrenium)

RELATED: What’s the best beta blocker for heart failure?

Top 5 metoprolol succinate alternatives

The following are some of the most common alternatives to metoprolol succinate.

1. Bisoprolol

Bisoprolol is a beta-1 selective blocker that is currently only available as a generic medication. Like metoprolol succinate, bisoprolol is recommended by the American Heart Association (AHA) as a beta-blocker for the treatment of heart failure. Bisoprolol has been shown to be effective in reducing the risk of death in patients with heart failure with reduced ejection fraction (HFrEF). Bisoprolol is also an effective option for controlling high blood pressure. This alternative may be best suited for people treating both heart failure and high blood pressure. Bisoprolol is available as a tablet and is taken once a day.

2. Carvedilol

Carvedilol is a beta blocker with additional alpha-blocking activity that is available under the brand-name Coreg. Along with working on beta receptors, carvedilol also works on alpha receptors, which help widen blood vessels, leading to lowered blood pressure. This unique feature makes carvedilol effective in treating heart failure and other cardiovascular diseases. Along with metoprolol succinate and bisoprolol, the AHA recommends carvedilol as the preferred beta blocker treatment of heart failure. This alternative may be well-suited for people with type 2 diabetes as carvedilol usually has a lower impact on fasting blood glucose compared to other beta blockers. Carvedilol is available as an immediate-release tablet dosed twice a day and an extended-release capsule (Coreg CR) dosed once a day.

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

3. Lisinopril

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that is available under the brand-names Prinivil and Zestril. Lisinopril works differently than beta blockers but is also used to treat hypertension and heart failure and improve survival after a heart attack. ACE inhibitors work by preventing an enzyme in the body from producing angiotensin II, which is responsible for narrowing blood vessels. Lisinopril is recommended as a first-line medication for treating hypertension, according to the AHA hypertension guidelines. Sometimes lisinopril may be prescribed alongside a beta blocker, like metoprolol succinate, for treating heart failure. The most common adverse effects include dizziness, coughing, and headaches. Lisinopril is available as a tablet and is dosed 10 to 40 mg by mouth once daily.

RELATED: Lisinopril side effects, warnings, and interactions

4. Entresto

Entresto is a brand-name drug made up of two medications, sacubitril and valsartan. Entresto is currently the only drug in a unique medication class called angiotensin receptor neprilysin inhibitors (ARNIs). Based on clinical trials, Entresto is now positioned as a first-line therapy for people with heart failure, particularly those with a reduced ejection fraction. In addition, Entresto is effective in lowering blood pressure in people with hypertension. Common side effects include dizziness, coughing, and increased potassium. Entresto is available as a tablet and is usually dosed twice a day.

5. Valsartan

Valsartan is an angiotensin II receptor blocker (ARB) that is available as a brand called Diovan. Valsartan works differently than beta blockers but is also used to treat hypertension, heart failure, and improve survival after a heart attack. ARBs work by blocking the action of angiotensin II, which leads to the widening of the blood vessels. According to the AHA hypertension guidelines, ARBs like valsartan are first-line treatment options. In the Valsartan Heart Failure Trial (Val-HeFT), valsartan significantly reduced hospitalizations for heart failure. This alternative may be best suited for people managing hypertension and heart failure. Common side effects include dizziness, diarrhea, and fatigue. Valsartan is either dosed as an 80 to 320 mg tablet by mouth once daily for hypertension or as a 160 mg tablet by mouth twice daily for heart failure or post-myocardial infarction (heart attack).

Natural alternatives to metoprolol succinate

Depending on the condition being treated, alternative remedies for metoprolol succinate include certain supplements, lifestyle changes, and diet modifications to either help keep blood pressure in a healthy range or improve heart function.

Lifestyle modifications include diet changes, regular physical exercise, and weight loss. According to the American College of Cardiology, being overweight, especially in the belly, is associated with increased blood pressure. A heart-healthy diet, like the DASH (Dietary Approaches to Stop Hypertension) diet, is recommended for people with hypertension. The DASH diet centers on eating fruits, vegetables, low fat milk, whole grains, fish, poultry, beans, and nuts. This diet also aims to decrease sodium, foods and beverages with added sugars, and red meat.

The Journal of the American College of Cardiology notes that natural alternatives are not included in the standard treatment for heart failure. However, some natural remedies can be used along with standard treatment for heart failure. It’s important that people with heart failure consult with their healthcare provider or cardiologist before starting any natural remedies as some may interact with prescription heart failure medications.

Carnitine (also called L-carnitine) is naturally made in the body and is part of fatty acid metabolism that leads to energy production in the body. Some evidence shows that L-carnitine given as a supplement helps with relief of heart failure including improvement of energy metabolism in cardiomyocytes (heart muscle cells), which could contribute to the improvement of clinical symptoms and cardiac function. 

Magnesium is a mineral that is consumed through the diet, but some people may benefit from magnesium supplements. Due to the nature of the condition, people with congestive heart failure may be deficient in magnesium. Some evidence shows that magnesium likely improves outcomes in people with congestive heart failure by preventing ventricular arrhythmias (a type of abnormal heart rhythm). 

Coenzyme q10 (also called CoQ10) is an antioxidant naturally made in the body and can be taken as a supplement. In the Q-SYMBIO study, supplementation with CoQ10 in addition to standard therapy for people with moderate to severe heart failure was studied. The study concluded that CoQ10 supplementation is safe and well tolerated, and is associated with lowering symptoms and major adverse cardiovascular events.

RELATED: How exercise affects your blood pressure

How to switch to a metoprolol succinate alternative

1. Discuss all health conditions with a healthcare provider

Before switching from metoprolol succinate to an alternative, it’s important the prescribing doctor has reviewed all health conditions. Alternatives may have serious side effects, precautions, or drug interactions that need to be avoided. It’s best to seek medical advice prior to changing medication therapy.

2. Do not suddenly stop taking metoprolol succinate

Before stopping metoprolol succinate, make a care plan with the prescribing doctor    to avoid sudden increases in blood pressure and further risk for cardiovascular    events such as heart attack or stroke. In general, beta blockers should be slowly    tapered down (gradual lowering of the dose) over the course of one to two weeks to    avoid unwanted side effects. Once a plan has been established, metoprolol succinate    can be safely discontinued and replaced with the new treatment.

3. Discuss all prescription and over-the-counter medications with a healthcare provider

Before switching from metoprolol succinate to an alternative, it’s important that the prescribing doctor has reviewed a patient’s medication list including prescription drugs, over-the-counter medications, and supplements. Some alternatives have dangerous drug interactions that must be avoided.

4. Continue to monitor blood pressure readings

For those managing hypertension, it’s important to check blood pressure with an at home monitor. Keeping a blood pressure journal can help healthcare providers determine if the blood pressure medication plan is working or not. Continue to be aware of the signs of low blood pressure (hypotension) including weakness, confusion, lightheadedness, blurred vision, and fainting