What's the difference between metoprolol and propranolol?

October 10, 2025 •

2 min read

According to a 2020 estimate, metoprolol was prescribed to over 80 million people in the U.S., making it one of the most common beta-blockers on the market, while its counterpart propranolol was prescribed to approximately 27 million. Despite their shared classification, understanding the specific purpose and functionality behind each medication is key to knowing what's the difference between metoprolol and propranolol. While both reduce heart rate and blood pressure, their distinct mechanisms of action make them suitable for different conditions.

Quick Summary

This article examines the primary differences between metoprolol and propranolol, focusing on their selectivity, therapeutic uses, and side effect profiles. Metoprolol is cardioselective, targeting the heart, while propranolol is nonselective, affecting multiple bodily systems, including the lungs.

Key Points

Selectivity is the core difference: Metoprolol is cardioselective, acting primarily on the heart's beta-1 receptors, while propranolol is nonselective, blocking both beta-1 and beta-2 receptors throughout the body.
Different uses based on action: Metoprolol is mainly for heart conditions, whereas propranolol's broader effect allows it to treat migraines and anxiety as well.
Respiratory risk with propranolol: Due to its nonselective nature, propranolol can affect lung function and is often avoided in patients with asthma or COPD, making metoprolol a safer alternative.
Consult a healthcare provider: Only a doctor can determine the best medication for an individual, weighing factors like the specific condition, health history, and other medications.
Do not stop abruptly: Both medications require a gradual tapering process under medical supervision to avoid potential rebound effects like increased heart rate or blood pressure.
Propranolol can treat anxiety symptoms: By blocking beta-receptors associated with the 'fight or flight' response, propranolol effectively manages the physical symptoms of performance anxiety and tremors.
Formulations vary: Both drugs are available in immediate-release (IR) and extended-release (ER) forms, which affects dosing frequency.

Understanding Beta-Blockers: A Pharmacological Overview

Both metoprolol and propranolol are beta-blockers, working by blocking the effects of adrenaline on beta-receptors. This action reduces heart rate, blood pressure, and strain on the heart. The main difference lies in their selectivity: metoprolol is cardioselective, primarily targeting beta-1 receptors in the heart, while propranolol is nonselective, blocking both beta-1 and beta-2 receptors in various locations, including the heart and lungs. This difference affects their uses, side effects, and suitability for different patients.

The Mechanism of Action: Selective vs. Nonselective

Metoprolol (Cardioselective): This drug primarily blocks beta-1 receptors found mainly in the heart, leading to a more targeted effect on the cardiovascular system. This selectivity can be beneficial for patients with respiratory issues as it has less impact on lung beta-2 receptors, though high doses can reduce this selectivity.
Propranolol (Nonselective): Propranolol blocks both beta-1 and beta-2 receptors, affecting the heart, lungs, and blood vessels. While effective for cardiovascular conditions, its broader action can increase the risk of side effects, especially in individuals with conditions like asthma.

Clinical Applications and Approved Uses

Metoprolol is primarily used for heart conditions like hypertension, angina, and heart failure, and for reducing the risk of death after a heart attack. Propranolol has a wider range of uses, including hypertension, angina, migraine prevention, essential tremor, certain heart rhythm disorders, hypertrophic subaortic stenosis, and anxiety symptoms like performance anxiety.

Consideration of Side Effects and Patient Profiles

Both medications share common side effects such as fatigue, dizziness, and slow heart rate. However, their different mechanisms lead to distinct side effect profiles. Propranolol's effect on beta-2 receptors can cause bronchospasm and is often less suitable for patients with asthma or COPD compared to the more cardioselective metoprolol. For diabetic patients, metoprolol's selectivity may slightly lessen the masking of low blood sugar symptoms. Propranolol can cross the blood-brain barrier more easily, making it effective for tremor and anxiety, but it may also cause more sleep disturbances than metoprolol.

Comparison Table


Feature	Metoprolol	Propranolol
Selectivity	Cardioselective (Beta-1)	Nonselective (Beta-1 and Beta-2)
Primary Target	Heart	Heart, Lungs, Blood Vessels, Brain
Key Uses	Hypertension, Angina, Heart Failure	Hypertension, Angina, Migraine, Anxiety, Tremor
Risk for Asthma/COPD	Lower risk; generally safer	Higher risk; may cause bronchospasm
Anxiety Treatment	Limited use; may help with physical symptoms	Often preferred for physical symptoms, like performance anxiety
Drug Interactions	Primarily metabolized by CYP2D6	Broader range of interactions via multiple pathways

Conclusion

Metoprolol and propranolol, while both effective beta-blockers, differ primarily in their selectivity. Metoprolol is cardioselective, targeting heart issues and being a safer option for patients with certain respiratory conditions. Propranolol's nonselective action allows it to treat conditions like migraines and anxiety but requires caution in those with lung disease. The choice of medication is a personalized decision made by a healthcare provider based on the patient's condition, history, and goals. Abruptly stopping either medication is not advised due to the risk of rebound symptoms.

For more clinical information, consult the National Institutes of Health.

Frequently Asked Questions

While beta-blockers like metoprolol can help manage the physical symptoms of anxiety (such as rapid heart rate), propranolol is generally the preferred beta-blocker for treating anxiety, particularly performance anxiety, due to its broader nonselective effects.

Metoprolol is generally considered a safer choice for patients with respiratory conditions like asthma or COPD. Its cardioselectivity means it is less likely to cause respiratory side effects, unlike propranolol, which can cause bronchospasm.

Both metoprolol and propranolol have been shown to be effective in treating high blood pressure. While metoprolol may have a more targeted effect on the heart, studies have shown that both are comparable in their ability to reduce blood pressure.

Propranolol is FDA-approved for the prevention of migraines due to its nonselective action, which affects receptors in the brain and blood vessels throughout the body, helping to prevent the conditions that lead to migraines.

It is not recommended to take metoprolol and propranolol together. They have similar mechanisms and taking both could result in an excessively slow heart rate (bradycardia), low blood pressure, and fatigue.

Stopping either medication suddenly can cause severe rebound effects, such as worsening chest pain, increased heart rate (tachycardia), and even heart attacks. Dosage should always be tapered off gradually under a healthcare provider's supervision.

Both drugs share common side effects like fatigue, dizziness, and slow heart rate. However, propranolol's nonselective nature means it has a higher risk of respiratory side effects like shortness of breath. Metoprolol may also cause unique side effects like muscle pain.