What can I take instead of metoprolol for Afib?

October 7, 2025 •

5 min read

Atrial fibrillation (Afib) affects millions of people, and while metoprolol is a common first-line treatment for rate control, it's not suitable or effective for everyone. In such cases, patients and their doctors must explore other pharmacological and procedural options for managing the irregular heartbeat associated with Afib.

Quick Summary

Alternatives to metoprolol for atrial fibrillation exist for patients who experience side effects, have contraindications, or don't achieve sufficient rate or rhythm control. Treatment options include other beta-blockers, calcium channel blockers, digoxin, antiarrhythmic drugs, or procedural interventions like catheter ablation.

Key Points

Rate Control Alternatives: Calcium channel blockers like diltiazem and verapamil are primary alternatives for slowing the heart rate when metoprolol is not suitable, especially in patients without heart failure with reduced ejection fraction (HFrEF).
Rhythm Control Medications: For patients who need to restore or maintain a normal heart rhythm, antiarrhythmic drugs such as amiodarone, flecainide, and propafenone may be used, though they carry a higher risk of side effects and require careful monitoring.
Surgical/Procedural Alternatives: Catheter ablation and the newer pulsed field ablation technique offer a procedural option for managing Afib, particularly for those with recurrent symptoms or who cannot tolerate medications.
Other Beta-Blockers: If the issue is intolerance to metoprolol itself rather than the entire drug class, other beta-blockers like bisoprolol or carvedilol may be effective alternatives.
Lifestyle Management: Lifestyle changes, including maintaining a healthy diet and weight, regular exercise, and stress reduction, are critical complementary strategies for managing Afib regardless of the chosen medication.
Consult a Professional: Any medication changes must be supervised by a healthcare professional due to the complexity of Afib and the potential for serious complications or adverse effects.

Why Are Alternatives to Metoprolol Necessary for Afib?

Metoprolol is a beta-blocker that works by slowing the heart rate, a key strategy for managing atrial fibrillation (Afib). However, some patients may not tolerate metoprolol due to side effects, such as fatigue, dizziness, gastrointestinal issues, or mood changes. Other individuals have underlying medical conditions that make metoprolol unsuitable. For example, it is generally avoided in patients with decompensated heart failure and certain types of heart block. The choice of alternative medication is highly individualized and depends on the patient's specific health profile, therapeutic goals, and response to treatment.

Rate Control Alternatives to Metoprolol

For patients requiring rate control (slowing the heart rate), there are several effective alternatives to metoprolol, each with a different mechanism of action and side effect profile.

Calcium Channel Blockers

Non-dihydropyridine calcium channel blockers are often a primary alternative to beta-blockers for controlling a rapid heart rate in Afib. They work by preventing calcium from entering the cells of the heart and blood vessels, which slows the heart rate and relaxes the blood vessels.

Diltiazem (Cardizem, Tiazac): This is a widely used alternative that slows the heart rate and is effective for controlling a rapid ventricular response. It does not tend to cause the same level of fatigue as some beta-blockers. Common side effects can include dizziness, headache, and swelling in the ankles.
Verapamil (Calan, Verelan): Similar to diltiazem, verapamil is another effective rate-control agent. A common side effect is constipation, and it can also cause dizziness. Both diltiazem and verapamil are generally avoided in patients with heart failure with reduced ejection fraction, as they can further weaken the heart's pumping ability.

Other Beta-Blockers

If the issue is a specific intolerance to metoprolol rather than the entire beta-blocker class, another beta-blocker might be a suitable replacement.

Bisoprolol (Zebeta): A cardioselective beta-blocker similar to metoprolol, often recommended for heart failure patients. It is generally well-tolerated and can be taken once daily.
Carvedilol (Coreg): This non-selective beta-blocker also has alpha-blocking activity, which helps to relax blood vessels and lower blood pressure. It may be better suited for patients with type 2 diabetes due to its metabolic profile.

Digoxin (Lanoxin)

This older medication works on the heart's electrical system to slow the heart rate and can improve heart muscle contractions. Digoxin is particularly useful for older, sedentary patients with heart failure and may be combined with other rate-control agents. Its slower onset and limited effectiveness during exercise make it less ideal for physically active individuals.

Rhythm Control Alternatives

In some cases, the goal of treatment is not just to control the heart rate but to restore and maintain a normal heart rhythm. Antiarrhythmic drugs are used for this purpose and are selected based on the patient's heart condition and risk factors.

Amiodarone (Pacerone, Cordarone): This is a highly effective antiarrhythmic drug for Afib, but it has a long half-life and a wide range of potential side effects, including pulmonary, thyroid, and liver toxicity. It is often reserved for severe cases or when other options have failed.
Flecainide (Tambocor) and Propafenone (Rythmol): These are Class IC antiarrhythmic agents, used to prevent and treat Afib. They are generally reserved for patients with no underlying structural heart disease. They can be used as a "pill-in-the-pocket" strategy for some patients with intermittent Afib episodes.
Dofetilide (Tikosyn) and Sotalol (Betapace): These are Class III antiarrhythmic drugs that are started in a monitored hospital setting due to the risk of serious arrhythmia side effects.

Non-Pharmacological Alternatives (Ablation)

For many patients, especially those with symptomatic or drug-refractory Afib, a procedure called catheter ablation is a highly effective alternative to long-term medication.

Catheter Ablation: This minimally invasive procedure involves threading catheters into the heart to deliver energy (heat or cold) to destroy small areas of heart tissue that are causing the irregular electrical signals. The procedure has high success rates, particularly for paroxysmal (intermittent) Afib.
Pulsed Field Ablation (PFA): A newer, non-thermal ablation technique that delivers electrical pulses to the problematic cells, potentially reducing the risk of damage to surrounding structures like the esophagus.

Lifestyle Modifications and Natural Approaches

Complementary to medical treatments, certain lifestyle changes can help manage Afib symptoms and risk factors.

Diet: Adopting a heart-healthy diet, such as the Mediterranean diet, can reduce inflammation and improve cardiovascular function. Limiting caffeine and alcohol can help reduce triggers for some individuals.
Exercise: Regular, moderate exercise is linked to a lower risk of developing Afib and can improve overall heart health. A doctor should be consulted before starting a new routine.
Stress Management: Chronic stress can disrupt heart rhythm. Techniques like mindfulness meditation, yoga, and deep breathing can help.
Weight Management: Obesity is a significant risk factor for Afib. Losing even a small percentage of body weight can significantly reduce episodes.

Comparison of Metoprolol Alternatives


Drug Class	Examples	Main Action	Best For	Considerations
Beta-Blockers	Bisoprolol, Carvedilol	Rate control	Patients tolerating beta-blockers but not metoprolol	Fatigue, dizziness, not for severe heart failure
Calcium Channel Blockers	Diltiazem, Verapamil	Rate control	Patients with no HFrEF, potential asthma/COPD	Not for HFrEF, can cause dizziness/constipation
Cardiac Glycoside	Digoxin	Rate control	Older, sedentary patients, heart failure with Afib	Slower onset, less effective with exercise
Antiarrhythmics	Amiodarone, Flecainide	Rhythm control	Preventing and treating arrhythmia episodes	Significant side effects, require careful monitoring
Ablation	Catheter, Pulsed Field	Rhythm control	Patients with uncontrolled symptoms or medication intolerance	Invasive procedure with risks, highly effective

Conclusion

While metoprolol is a standard treatment for Afib, it is not the only option. The best course of action for a patient depends on the reason for needing an alternative, whether due to side effects, ineffectiveness, or a medical contraindication. Alternatives range from other medications, like calcium channel blockers and antiarrhythmics, to procedural interventions such as catheter ablation. Additionally, lifestyle modifications can provide crucial complementary support. Any change in treatment, including seeking alternatives to metoprolol, should be done under the strict guidance of a healthcare professional to ensure safety and effectiveness. A collaborative discussion with a cardiologist is key to tailoring a management plan that best fits an individual's unique needs and health profile.

For more information on the various treatment strategies for Afib, the Cleveland Clinic offers extensive resources on heart health.

Frequently Asked Questions

Metoprolol is a beta-blocker that slows the heart rate by blocking the effects of adrenaline. Calcium channel blockers, like diltiazem and verapamil, slow the heart rate by preventing calcium from entering heart muscle cells. The choice depends on a patient's overall health, including whether they have heart failure, as calcium channel blockers are often avoided in HFrEF.

No. You should never stop taking metoprolol suddenly or switch medications without consulting your doctor. Abruptly stopping metoprolol can increase the risk of serious side effects, such as chest pain or a heart attack. All medication adjustments should be made under medical supervision.

Yes. Catheter ablation, a procedure that uses energy to create tiny scars in the heart to block irregular electrical signals, is a common and highly effective non-medication option. Lifestyle changes, such as diet, exercise, and weight management, also play a significant role in managing Afib.

Digoxin is an alternative, especially for elderly, sedentary patients with heart failure. However, it is less effective during periods of exercise or high stress compared to beta-blockers or calcium channel blockers. It is typically not used as a sole agent for Afib.

Antiarrhythmic drugs can have significant side effects on organs like the lungs, thyroid, and liver, especially with long-term use (e.g., amiodarone). These risks are generally higher than those associated with metoprolol, which is why antiarrhythmics are often reserved for more severe or complex cases of Afib.

Both beta-blockers (like metoprolol) and calcium channel blockers (like diltiazem) are considered first-line agents for controlling heart rate in Afib. The choice between them depends on the patient's specific health conditions and tolerance to side effects.

Yes. For patients with asthma or COPD, cardioselective beta-blockers like metoprolol are often preferred over non-selective ones, but a cardiologist might recommend a non-dihydropyridine calcium channel blocker like diltiazem or verapamil, as they do not affect lung function in the same way.