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- Metoprolol vs. atenolol: What's the difference?
- What are metoprolol and atenolol?
- What are the side effects of metoprolol and atenolol?
- What is the dosage of metoprolol vs. atenolol?
- What drugs interact with metoprolol and atenolol?
- Are metoprolol and atenolol safe to use while pregnant or breastfeeding?
Metoprolol vs. atenolol: What's the difference?
- Metoprolol and atenolol are beta-blockers used to treat high blood pressure (hypertension), heart pain (angina), congestive heart failure, hyperthyroidism, abnormal heart rhythms, and some neurologic conditions.
- Metoprolol is also used to prevent migraine headaches.
- Brand names for metoprolol include Lopressor and Toprol XL.
- A brand name for atenolol is Tenormin.
- Side effects of metoprolol and atenolol that are similar include abdominal cramps, diarrhea, constipation, fatigue, insomnia, nausea, depression, dreaming, memory loss, fever, impotence, lightheadedness, low blood pressure, cold extremities, and sore throat.
- Side effects of metoprolol that are different from atenolol include indigestion, decreased exercise tolerance, increased triglycerides, bronchospasm, shortness of breath, or wheezing.
- Side effects of atenolol that are different from metoprolol include slow heart rate, abnormal heart rhythm, numbness, and tingling.
What are metoprolol and atenolol?
Metoprolol is a beta-blocker (beta-adrenergic blocking agent), which blocks the action of the sympathetic nervous system (a portion of the involuntary nervous system) and is used to treat high blood pressure (hypertension), heart pain (angina), congestive heart failure, hyperthyroidism, abnormal heart rhythms, and some neurologic conditions. Metoprolol is also used to prevent migraine headaches.
Atenolol is a beta-blocker that blocks the effects of adrenergic chemicals such as adrenaline or epinephrine, which are released by nerves of the sympathetic nervous system. The beta-adrenergic nerves stimulate the heart muscle to beat more rapidly. By blocking the stimulation by these nerves, atenolol reduces the heart rate and is used to treat abnormally rapid heart rhythms. Atenolol also reduces the force of contraction of heart muscle and lowers blood pressure. By reducing the heart rate, the force of muscle contraction, and the blood pressure against which the heart must pump, atenolol reduces the work of heart muscle and the need of the muscle for oxygen, which helps in treating angina.
What are the side effects of metoprolol and atenolol?
Metoprolol is generally well tolerated. Side effects include:
- Abdominal cramps
- Memory loss
- Low blood pressure
- Decreased exercise tolerance
- Increased triglycerides
- Cold extremities
- Sore throat
- Shortness of breath or wheezing
Possible serious adverse effects include
- In patients with existing slow heart rates (bradycardias) and heart blocks (defects in the electrical conduction of the heart), metoprolol can cause dangerously slow heart rates, and even shock. Metoprolol reduces the force of heart muscle contraction and can aggravate symptoms of heart failure. In patients with coronary artery disease, abruptly stopping metoprolol can suddenly worsen angina, and occasionally precipitate heart attacks. If it is necessary to discontinue metoprolol, its dosage should be reduced gradually over several weeks.
- Initiation of high-dose extended release metoprolol in patients undergoing non-cardiac surgery is associated with bradycardia (slow heart rate), hypotension, stroke, and death. However, long-term therapy with metoprolol should not be routinely withdrawn prior to major surgery. Impaired ability of the heart to respond to reflex adrenergic stimuli may increase the risks of general anesthesia and surgery.
Atenolol is generally well tolerated, and side effects are mild and transient. Its side effects include:
- Abdominal cramps
- Memory loss
- Slow heart rate
- Abnormal heart rhythm
- Low blood pressure
- Cold extremities
- Sore throat
Atenolol can cause breathing difficulties in patients with asthma, chronic bronchitis, or emphysema. In patients with existing slow heart rates (bradycardias) and heart blocks (defects in the electrical conduction of the heart), atenolol can cause dangerously slow heart rates and even shock. Atenolol reduces the force of heart muscle contraction and can aggravate symptoms of heart failure.
In patients with coronary artery disease, abruptly stopping atenolol can suddenly worsen angina, and occasionally precipitate heart attacks. If it is necessary to discontinue atenolol, its dosage can be reduced gradually over several weeks.
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What is the dosage of metoprolol vs. atenolol?
- Metoprolol should be taken before meals or at bedtime.
- The dose for treating hypertension is 100 to 450 mg daily in single or divided doses.
- Angina is treated with 100 to 400 mg daily in two divided doses.
- Heart attack (acute myocardial infarction) is treated with three 5 mg injections administered 2 minutes apart followed by treatment with 50 mg oral metoprolol every 6 hours for 48 hours. After 48 hours, patients should receive 100 mg orally twice daily for at least 3 months.
- The dose for congestive heart failure is 25 mg/daily initially. Then the dose is increased every 2 weeks to reach a target dose of 200 mg/daily orally.
- Hyperthyroidism is treated with 25 to 30 mg by mouth every 6 hours.
- The dose for treating high blood pressure or angina is 25 to 100 mg once daily.
- Acute myocardial infarction (heart attack) is treated with two 5 mg injections administered 10 minutes apart. Ten minutes after the last injection, give 50 mg every 12 hours followed by 100 mg oral atenolol daily for 6 to 9 days. If atenolol injections are not appropriate, patients may be treated with 100 mg daily of oral atenolol for 7 days.
What drugs interact with metoprolol and atenolol?
- Calcium channel blockers and digoxin (Lanoxin) can lower blood pressure and heart rate to dangerous levels when administered together with metoprolol.
- Metoprolol can mask the early warning symptoms of low blood sugar (hypoglycemia) and should be used with caution in patients receiving treatment for diabetes.
- Fluoxetine (Prozac) can increase blood levels of metoprolol by reducing breakdown of metoprolol, and increase the side effects from metoprolol.
- Calcium channel blockers (CCBs) and digoxin (Lanoxin) can cause lowering of blood pressure and heart rate to dangerous levels when administered together with atenolol.
- Atenolol can mask the early warning symptoms of low blood sugar (hypoglycemia), and should be used with caution in patients receiving treatment for diabetes.
Are metoprolol and atenolol safe to use while pregnant or breastfeeding?
- Safe use of metoprolol during pregnancy has not been established.
- Small quantities of metoprolol are excreted in breast milk and may potentially cause adverse effects in the infant.
Metoprolol and atenolol are beta-blockers used to treat high blood pressure (hypertension), heart pain (angina), congestive heart failure, hyperthyroidism, abnormal heart rhythms, and some neurologic conditions. Metoprolol is also used to prevent migraine headaches.
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Related Disease Conditions
High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms. Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure. The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater. If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
Portal hypertension is most commonly caused by cirrhosis, a disease that results from scarring of the liver. Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from the liver to the heart, and a parasitic infection called schistosomiasis. Symptoms of portal hypertension include varices (enlarged veins), vomiting blood, blood in the stool, black and tarry stool, ascites (abnormal fluid collection within the peritoneum, the sac that contains the intestines within the abdominal cavity), confusion and lethargy, splenomegaly or enlargement of the spleen, and decreased white blood cell counts.
Pulmonary hypertension is elevated pressure in the pulmonary arteries that carry blood from the lungs to the heart. The most common symptoms are fatigue and difficulty breathing. If the condition goes undiagnosed, more severe symptoms may occur. As pulmonary hypertension worsens, some people with the condition have difficulty performing any activities that require physical exertion. While there is no cure for pulmonary hypertension, it can be managed and treated with medications and supplemental oxygen to increase blood oxygen levels.
Hypertension-Related Kidney Disease
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Hypertensive Kidney Disease
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)
Pseudotumor Cerebri (intracranial hypertension) is a condition where there is an increase in pressure of fluid surrounding the brain and spinal cord (cerebrospinal fluid or CSF) mimicing a brain tumor. The cause is unknown. The most common symptom is headache but also include eye-pain, vision loss and double vision. Pseudotumor cerebri is diagnosed with MRI or CAT scans and treated by discontinuing offending medications (if applicable), weight loss and diuretic medications. The condition can also be helped by repeated drainage of spinal fluid using the lumbar puncture.
Preeclampsia (Pregnancy Induced Hypertension)
Preeclampsia is related to increased blood pressure and protein in the mother's urine. Preeclampsia typically begins after the 20th week of pregnancy. When preeclampsia causes seizures, it is termed "eclampsia" and is the second leading cause of maternal death of in the US. Preeclampsia is the leading cause of fetal complications. Risk factors for preeclampsia include high blood pressure, obesity, multiple births, and women with preexisting medical conditions such as diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma. Pregnancy planning and lifestyle changes may reduce the risk of preeclampsia during pregnancy.
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