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Drug vs. Drug

Propranolol vs. metoprolol: Differences, similarities, and which one is better for you

Since propranolol and metoprolol are in the same drug class, they can cause similar side effects, including fatigue, lightheadedness or dizziness, cold hands or feet, and shortness of breath
Gerardo Sison medical writer headshot
By | Sep. 11, 2024
Two Rx tablets: Propranolol vs. metoprolol

Key takeaways

  • Propranolol and metoprolol are beta blockers used to treat cardiovascular conditions and are available in immediate- and extended-release forms.

  • Propranolol is nonselective, affecting the heart, lungs, and other body parts, while metoprolol is selective, mainly targeting the heart.

  • Propranolol is approved for a wider range of conditions, including migraines and essential tremors, whereas metoprolol is mainly used for heart-related issues like heart failure.

  • Both medications share common side effects, but propranolol has a broader range of drug interactions due to its metabolism involving multiple pathways.

In this article:

If you’ve been diagnosed with high blood pressure or other cardiovascular problems, your doctor may recommend a medication like propranolol or metoprolol. Both medications belong to the same drug class known as beta blockers. They’re available as generic drugs commonly covered by insurance plans, making both drugs accessible.

While propranolol and metoprolol share many similarities, they differ in various ways. For example, they have different uses, costs, and drug interactions. These differences help doctors and healthcare providers decide which beta blocker fits your needs best.

What are the main differences between propranolol and metoprolol?

The first major difference between these drugs is that propranolol is a nonselective beta blocker, affecting both beta-1 and beta-2 receptors. On the other hand, metoprolol is a selective beta blocker, specifically targeting only the beta-1 adrenergic receptors. Beta-1 receptors are mostly in the heart, while beta-2 receptors are found in the lungs and other parts of the body.

In other words, propranolol can affect beta-receptors of various body parts, such as the heart, lungs, and blood vessels. This broader impact may be helpful for conditions like performance anxiety and essential tremors.

Due to its selectiveness, metoprolol is mainly used for heart-related conditions. This selectivity may reduce the risk of side effects related to the lungs, potentially making it a better choice for people with respiratory issues.

Dosing and dosage forms

Propranolol is available in several forms, including immediate-release tablets and extended-release capsules under brand names like Inderal and Inderal LA. Metoprolol is available in immediate-release (metoprolol tartrate) and extended-release (metoprolol succinate) tablets under Lopressor and Toprol XL.

The dosing of these medications varies based on the condition being treated. Immediate-release propranolol usually requires multiple doses throughout the day, while metoprolol tartrate is typically taken twice daily. However, both medications also come in once-daily formats. 

Dosing and dosage forms
Propranolol Metoprolol
Drug class Beta blocker Beta blocker
Brand/generic status Brand and generic versions available Brand and generic versions available
What is the brand name? Inderal (immediate-release. IR)

Inderal LA (extended-release, ER)

 Lopressor (metoprolol tartrate)

Toprol XL (metoprolol succinate)
What form(s) does the drug come in? Oral tablet

Oral solution

Oral capsule

Injectable solution

 Oral tablet
What is the standard dosage? Propranolol (immediate-release): 40 to 320 mg per day in divided doses 

Propranolol (extended-release): 80 to 160 mg once daily

Dosage depends on the condition being treated

 Metoprolol tartrate: 50 to 100 mg twice daily

Metoprolol succinate: 25 to 100 mg once daily

Dosage depends on the condition being treated
How long is the typical treatment? Long-term Long-term
Who typically uses the medication? Adults Adults

Conditions treated by propranolol and metoprolol

The Food and Drug Administration (FDA) has approved propranolol for more conditions than metoprolol. It may treat hypertension (high blood pressure), angina pectoris (chest pain), and essential tremor. 

Propranolol can also help reduce the risk of death after a myocardial infarction (heart attack), prevent migraines, and control heart rhythm in people with atrial fibrillation. In addition, propranolol is approved for conditions like hypertrophic subaortic stenosis, which is a thickening of part of the heart that makes it harder for blood to flow out, and pheochromocytoma, a rare tumor of the adrenal gland that can cause high blood pressure.

Metoprolol, on the other hand, is approved to treat heart failure, high blood pressure, and chest pain. It may also be used to reduce the risk of death after a heart attack. Off-label uses may include treatment of atrial fibrillation, migraine, and essential tremor.

While both medications help manage complications of heart disease, they may also help manage symptoms of anxiety. Beta blockers may help manage the physical symptoms of anxiety by reducing heart rate, trembling, and sweating.

Condition Propranolol Metoprolol
Heart failure No Yes (metoprolol ER)
High blood pressure Yes Yes
Chest pain Yes Yes
Heart attacks Yes (propranolol IR) Yes (metoprolol IR)
Atrial fibrillation Yes (propranolol IR) Off-label
Migraine Yes Off-label
Essential tremor Yes (propranolol IR) Off-label
Hypertrophic subaortic stenosis Yes No
Pheochromocytoma Yes (propranolol IR) No
Anxiety Off-label Off-label

Is propranolol or metoprolol more effective?

The more effective treatment option will depend on the condition being treated. Clinical trials have shown that these medications are more effective than placebo for different health conditions. 

In a study of 52 patients with essential hypertension, participants were given either metoprolol or propranolol for 36 weeks. By the end of the antihypertensive treatment, those on metoprolol saw an average reduction in resting blood pressure of 26/15 mm Hg. In comparison, those on propranolol had a decrease of 16/9 mm Hg. Overall, the reductions in certain diastolic and systolic blood pressure measurements were significantly greater in the metoprolol group than in the propranolol group.

In a study with 20 patients, researchers compared the effectiveness of metoprolol and propranolol for chest pain caused by angina. Both drugs significantly improved the patient’s ability to exercise, with metoprolol increasing exercise tolerance by 36%. There were no harmful effects of metoprolol or propranolol, and the study concluded that metoprolol is just as effective as propranolol in treating angina.

Another study analyzed the medical records of over 200,000 heart attack patients to compare the effectiveness of different beta blockers, including metoprolol, propranolol, and atenolol. The 2-year mortality rates for metoprolol and atenolol were nearly identical at around 14%, while propranolol had a slightly higher rate at almost 16%. Despite these differences, all three drugs significantly improved survival compared to the 24% mortality rate in patients who did not receive beta blockers.

Always consult a healthcare provider for the best treatment option. They can determine treatments based on a person’s overall condition and other medications or supplements they may be taking. 

Coverage and cost comparison of propranolol vs. metoprolol

Both propranolol and metoprolol are generic medications usually covered by most insurance plans, including Medicare Part D. However, prices for these drugs can vary based on insurance coverage, pharmacy, and location. Patients should check with their insurance providers to understand their specific coverage details.

Retail costs for propranolol and metoprolol can differ depending on the quantity purchased and the pharmacy used. The average retail price for a 30-day supply of propranolol 20 mg tablets is around $45, while the average retail cost for a 30-day supply of metoprolol tartrate 25 mg tablets is around $50. 

Patients might save on prescription costs using discount coupons from services like SingleCare. A SingleCare savings card may help reduce the out-of-pocket expenses for these medications.

Propranolol Metoprolol
Typically covered by insurance? Yes Yes
Typically covered by Medicare Part D? Yes Yes
Quantity 60 tablets 30 or 60 tablets
Typical Medicare copay Varies Varies
SingleCare cost $2 $12

Common side effects of propranolol vs. metoprolol

Because they belong to the same drug class, propranolol and metoprolol share some common side effects, such as fatigue, lightheadedness or dizziness, cold hands or feet, and shortness of breath. People might also experience digestive issues such as nausea or diarrhea. 

Each medication may also have its unique side effects. For example, propranolol can cause dry eyes, while metoprolol may cause muscle pain. However, most side effects are mild and temporary or linked to the therapeutic effects of propranolol and metoprolol, such as lower blood pressure and slower heart rate. 

Common side effects
Propranolol Metoprolol
Side Effect Applicable? Applicable?
Lightheadedness Yes Yes
Fatigue Yes Yes
Nausea Yes Yes
Vomiting Yes Yes
Bronchospasm Yes Yes
Dry eyes Yes No
Erectile dysfunction Yes Yes
Cold hands or feet Yes Yes
Rash Yes Yes
Diarrhea Yes Yes
Constipation Yes Yes
Muscle pain No Yes

Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.

Source: DailyMed (Propranolol), DailyMed (Metoprolol)

Drug interactions of propranolol vs. metoprolol

Propranolol and metoprolol may interact with many of the same drugs due to how they’re metabolized in the liver, particularly through the cytochrome P-450 enzyme system. This can lead to a range of interactions, some of which can be serious. 

Both drugs are affected by CYP2D6 inhibitors like quinidine, fluoxetine, and paroxetine, which can increase the levels of beta blockers and cause adverse effects. For example, increased metoprolol levels can decrease cardioselectivity, increasing the risk of side effects such as slow heart rate (bradycardia).

Catecholamine-depleting drugs like monoamine oxidase inhibitors (MAOIs) can have an additive effect with beta blockers. Taking beta blockers with these medications can lead to hypotension (low blood pressure), slow heart rate, and fainting.

Still, propranolol has a broader range of interactions due to its metabolism involving multiple pathways, such as CYP2D6, CYP1A2, and CYP2C19. This variation means propranolol may interact with more drugs than metoprolol.

Drug Drug Class Propranolol Metoprolol
Rythmol (propafenone) 

Quinidex (quinidine)

 Xylocaine (lidocaine)

 Antiarrhythmic drug Yes Yes
Cardene (nicardipine) 

Procardia (nifedipine) 

 Calcium channel blocker Yes Yes
Prozac (fluoxetine)

Paxil (paroxetine)

 Antidepressant Yes Yes
Zomig (zolmitriptan)

Maxalt (rizatriptan)

 Triptan Yes No
Mellaril (thioridazine)

Thorazine (chlorpromazine)

 Antipsychotic Yes Yes
Nardil (phenelzine)

Parnate (tranylcypromine)

 MAOI Yes Yes
Questran (cholestyramine)

Colestid (colestipol)

 Bile acid sequestrant Yes No
Mevacor (lovastatin)

Pravachol (pravastatin)

 Statin Yes No
Coumadin (warfarin) Anticoagulant Yes No
Epinephrine Sympathomimetic Yes Yes
Lanoxin (digoxin) Cardiac glycoside Yes Yes

Consult a healthcare professional for other possible drug interactions

Warnings of propranolol and metoprolol

Both propranolol and metoprolol can cause serious problems if stopped suddenly, such as worsening chest pain, fast heart rate (tachycardia), and even heart attacks. It’s important to taper off these medications gradually under a healthcare provider’s supervision. 

Both drugs may be risky for people with lung conditions like asthma and COPD, but cardioselective ones like metoprolol generally have fewer risks. Beta blockers also mask signs of low blood sugar and hyperthyroidism, which may be a concern for people with diabetes or thyroid problems. 

Propranolol and metoprolol also have unique warnings. Propranolol may increase the risk of severe skin reactions, including rashes and rare conditions like Stevens-Johnson syndrome. Metoprolol may cause severe blood pressure spikes in people with pheochromocytoma if not used with an alpha blocker.

Before taking a beta blocker, consult a healthcare provider for other warnings and precautions. 

Frequently asked questions about propranolol vs. metoprolol

What is propranolol?

Propranolol is a beta blocker used to treat high blood pressure, angina, and heart rhythm disorders. It also helps prevent migraines and reduces the risk of death after a heart attack. It is available in various forms, including immediate-release tablets and extended-release capsules.

What is metoprolol?

Metoprolol is another beta blocker medication that treats high blood pressure, chest pain, and heart failure. It also helps improve survival rates after a heart attack. Metoprolol tartrate is the immediate-release form, while metoprolol succinate is the extended-release form. 

Are propranolol and metoprolol the same?

Propranolol and metoprolol are not the same, though they belong to the same class of drugs. Propranolol is nonselective, affecting the heart and other parts of the body, like the lungs. Metoprolol is selective, mainly targeting the heart. 

Is propranolol or metoprolol better?

Determining whether propranolol or metoprolol is better depends on the condition being treated. Propranolol is often preferred for migraine prevention and performance anxiety, while metoprolol is usually the choice for heart failure and other heart-related conditions.

Can I use propranolol or metoprolol while pregnant?

Using propranolol or metoprolol during pregnancy should be done only if needed and prescribed by a healthcare provider. Both medications may have effects on the fetus, potentially leading to problems such as low birth weight or slow heart rate in the baby. Discuss the risks and benefits with your prescribing doctor if you’re pregnant.

Can I use propranolol or metoprolol with alcohol?

Combining propranolol or metoprolol with alcohol may increase the risk of side effects such as dizziness, lightheadedness, and low blood pressure. It is recommended to limit or avoid alcohol consumption while taking these medications.