Which is Better Than Metoprolol? A Guide to Alternatives

October 9, 2025 •

3 min read

In 2024, metoprolol (succinate and tartrate combined) accounted for over 53% of all beta-blocker prescriptions in the U.S., making it a cornerstone of cardiovascular therapy. This raises a critical question for many patients: Which is better than metoprolol when side effects arise or effectiveness wanes?

Quick Summary

An overview of metoprolol alternatives such as carvedilol, nebivolol, and bisoprolol. This comparison details differences in drug action, side effects, and primary uses to help inform patient-doctor conversations.

Key Points

The 'better' alternative is patient-specific: The best medication depends on the individual's health conditions, side effect tolerance, and treatment goals.
Carvedilol offers dual alpha- and beta-blockade: This makes it highly effective for lowering blood pressure and is a preferred choice for heart failure.
Nebivolol's vasodilation may cause fewer side effects: Its unique nitric oxide pathway can lead to less fatigue and erectile dysfunction compared to other beta-blockers.
Bisoprolol is a highly cardioselective option: Like metoprolol and carvedilol, it is a guideline-recommended therapy for heart failure with reduced ejection fraction.
Other drug classes are also available: If beta-blockers are not suitable, ACE inhibitors, ARBs, and calcium channel blockers are common alternatives for hypertension.
Switching requires medical guidance: Never stop or change a beta-blocker prescription without consulting a healthcare provider due to risks of serious cardiac events.

Understanding Metoprolol: A Quick Review

Metoprolol is a cardioselective beta-blocker that primarily targets beta-1 receptors in the heart, reducing heart rate, lowering blood pressure, and decreasing the heart's workload. It is available as immediate-release metoprolol tartrate (Lopressor) and extended-release metoprolol succinate (Toprol-XL). Metoprolol tartrate is used for high blood pressure, angina, and post-heart attack risk reduction, while metoprolol succinate is also approved for chronic heart failure.

Why Look for an Alternative to Metoprolol?

Alternatives to metoprolol may be considered due to side effects like fatigue, dizziness, or slow heart rate, lack of sufficient efficacy, existing conditions like asthma, or for more convenient once-daily dosing.

Head-to-Head: Metoprolol vs. Other Beta-Blockers

Determining which medication is "better" is highly individual and depends on the patient's specific health needs and tolerance. Several beta-blockers offer distinct advantages.

Carvedilol (Coreg)

Carvedilol is a non-selective beta-blocker with additional alpha-blocking properties, leading to both slower heart rate and widened blood vessels. This can result in greater blood pressure reduction than metoprolol. It is recommended for heart failure and may benefit individuals with Type 2 diabetes by improving insulin sensitivity.

Nebivolol (Bystolic)

Nebivolol is a highly cardioselective beta-blocker that also promotes nitric oxide release, causing blood vessel dilation. This vasodilating effect may contribute to a better side-effect profile, potentially reducing fatigue and erectile dysfunction compared to other beta-blockers and improving quality of life.

Bisoprolol (Zebeta)

Bisoprolol is a highly selective beta-1 blocker with a long half-life, allowing for once-daily dosing. It is a recommended treatment for heart failure with reduced ejection fraction and may be more effective than metoprolol for some chronic heart failure patients.

Atenolol (Tenormin)

Atenolol is a cardioselective beta-blocker with once-daily dosing, similar to metoprolol. However, it is generally not recommended for heart failure in current guidelines, and some studies suggest metoprolol may offer a greater reduction in cardiovascular mortality.

Comparison Table: Metoprolol vs. Key Alternatives


Feature	Metoprolol Succinate	Carvedilol	Nebivolol	Bisoprolol
Drug Class	Cardioselective β-blocker	Non-selective β- and α-blocker	Cardioselective β-blocker with vasodilating effects	Highly cardioselective β-blocker
Primary Uses	HBP, Angina, Heart Failure	HBP, Heart Failure, Post-MI	HBP	HBP, Angina, Heart Failure
Dosing	Once Daily	Twice Daily (IR), Once Daily (CR)	Once Daily	Once Daily
Key Features	Proven in HF, two formulations	Dual α/β action, good for HBP & HF	Vasodilates via nitric oxide, fewer side effects	Highly cardioselective, proven in HF
Common Side Effects	Fatigue, Dizziness, Bradycardia	Dizziness, Fatigue, Weight Gain	Headache, Dizziness, Fatigue	Fatigue, Dizziness, Bradycardia

Beyond Beta-Blockers: Other Classes of Medications

When beta-blockers are not suitable, other medication classes may be prescribed, including ACE inhibitors (e.g., lisinopril), Angiotensin II Receptor Blockers (ARBs) (e.g., losartan), and Calcium Channel Blockers (e.g., amlodipine). These medications work by different mechanisms to lower blood pressure and manage heart conditions.

Conclusion: The "Better" Choice is Personal

No single medication is universally "better" than metoprolol. The best choice is personalized based on a patient's specific condition, other health issues, side effect tolerance, and costs. Carvedilol may offer greater blood pressure reduction and heart failure benefits, while nebivolol might have a more favorable side effect profile. Discuss alternatives with a healthcare provider, and never stop a beta-blocker without medical supervision due to the risk of serious heart problems.

For more information on managing heart conditions, you can visit the American Heart Association.

Frequently Asked Questions

Metoprolol succinate (Toprol-XL) is an extended-release, once-daily formulation approved for hypertension, angina, and heart failure. Metoprolol tartrate (Lopressor) is an immediate-release version taken multiple times a day and is approved for hypertension, angina, and use after a heart attack.

Yes, but beta-blockers lower your heart rate, which can affect your exercise capacity. Some medications like nebivolol are thought to be less likely to cause exercise intolerance. Always consult your doctor before starting a new exercise regimen.

The most common side effects across many beta-blockers include fatigue, dizziness, slow heart rate (bradycardia), shortness of breath, and sometimes depression or sleep disturbances.

Carvedilol often lowers blood pressure more than metoprolol because it has both alpha- and beta-blocking effects, which helps to widen blood vessels in addition to slowing the heart rate. The 'better' choice depends on the patient's specific condition.

A doctor might choose nebivolol (Bystolic) if a patient is experiencing side effects like fatigue or sexual dysfunction with other beta-blockers. Nebivolol's unique ability to release nitric oxide may lead to fewer of these side effects.

Lifestyle changes like a low-salt diet, regular exercise, and weight loss are crucial for managing hypertension. Supplements like Coenzyme Q10, magnesium, and garlic have been studied for their potential to lower blood pressure, but they are not a replacement for prescribed medication and should be discussed with a doctor first.

It is generally not recommended. Alcohol can enhance the blood-pressure-lowering effect of beta-blockers, leading to an increased risk of dizziness, lightheadedness, and fainting. It's best to consult your healthcare provider about safe alcohol consumption levels for your situation.