Atenolol vs Metoprolol: What You Need to Know

Table of ContentsView AllTable of ContentsAtenolol vs. Metoprolol SimilaritiesDifferencesThe Way They WorkUsesSide Effects and SafetyInteractionsHow to Choose

Table of ContentsView All

View All

Table of Contents

Atenolol vs. Metoprolol Similarities

Differences

The Way They Work

Uses

Side Effects and Safety

Interactions

How to Choose

Atenolol(brand name Tenormin) andmetoprolol(brand names Lopressor and Toprol XL) are beta-blockers commonly prescribed for cardiovascular conditions.

Both atenolol and metoprolol are effective in managing conditions like heart failure, coronary artery disease (CAD), and certain types of heart arrhythmias (abnormal heart rhythms).They are also used to help manage high blood pressure, though they are not the preferred medicines for it.

200 mg tablets of AstraZeneca’s hypertension drug, Toprol-XL.Bloomberg / Contributor / Getty Images

Bloomberg / Contributor / Getty Images

Atenolol and metoprolol have many things in common, including drug class, where they work in the body, and conditions they treat.

They’re bothbeta-blockers, which means they blockbeta-adrenergic receptorsin the body so that other molecules can’t bind to them.

When these receptors are activated,blood pressureandheart rateincrease. Beta-blockers reverse these effects; they lower blood pressure and heart rate.

Beta receptors are located in different parts of the body, including the heart, lungs, and fat tissue.

Atenolol and metoprolol primarily block beta receptors in the heart, so they are known as “cardioselective.“At higher doses, though, they can also block beta receptors in the lungs.

Both atenolol and metoprolol are used to treat the following conditions:

Keep in mind that you shouldn’t abruptly stop takingmetoprolol, atenolol, or any other beta-blocker. This can cause chest pain to worsen and may even cause a heart attack.

Be sure to discuss any plans you have to stop taking your medication with your healthcare provider first for optimal safety.

Atenolol vs. Metoprolol Differences

Though they’re in the same drug class, atenolol and metoprolol have some significant differences in terms of the following:

Read on for more details on these distinctions.

Some nuances between atenolol and metoprolol help guide when to use them.

Some of the differences in how these medicines work include:

These differences often dictate which medicine is prescribed. For instance, atenolol and ER metoprolol are usually taken once a day, which makes it easier to remember and stick to your medication regimen. However, regular metoprolol may need to be taken two to four times a day.

Atenolol vs. Metoprolol Uses

Many of the specific uses and indications for atenolol and metoprolol are the same. But there are some distinctions to keep in mind:

Your healthcare provider will consider your medical history and underlying conditions when recommending metoprolol or atenolol for you.

Side effects and drug interactions associated with atenolol and metoprolol may make one of them better for you than the other.

Side effects associated with atenolol and metoprolol are similar. Both of them are associated with the following:

Metoprolol,butnot atenolol, is also associated with the following side effects in the central nervous system:

As a class, beta-blockers interact with the following medications:

Key TakeawaysIf you are taking a medication that interacts with metoprolol, atenolol will be a safer choice for you.If you have underlying mood disorders or insomnia, atenolol will be a safer choice to minimize troublesome side effects.

Key Takeaways

If you are taking a medication that interacts with metoprolol, atenolol will be a safer choice for you.If you have underlying mood disorders or insomnia, atenolol will be a safer choice to minimize troublesome side effects.

How to Choose Between Atenolol and Metoprolol

There are many factors to consider when selecting between atenolol and metoprolol. Some of them include:

Discuss your treatment options with a healthcare provider to make an informed decision. If you have specific questions about your prescription, your pharmacist is an excellent resource to help.

Summary

Atenolol and metoprolol are beta-blockers that primarily act on beta receptors in the heart. While they are indicated for many of the same conditions, they have several important distinctions.

Metoprolol crosses into the brain and can cause side effects like hallucinations and nightmares. Enzymes in the liver break it down, so it also has more drug interactions than atenolol.

On the other hand, metoprolol is safer than atenolol during pregnancy and lactation. And it is more effective for people who have had heart attacks.

Your healthcare provider will work with you to develop the safest and most effective treatment plan for you. The best choice will likely depend on several factors, such as formulation, potential side effects, and coexisting health conditions.

21 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.do Vale GT, Ceron CS, Gonzaga NA, et al.Three generations of β-blockers: History, class differences and clinical applicability.Curr Hypertens Rev. 2019;15(1):22-31. doi:10.2174/1573402114666180918102735Dézsi CA, Szentes V.The real role of β-blockers in daily cardiovascular therapy.Am J Cardiovasc Drugs. 2017;17(5):361-373. doi:10.1007/s40256-017-0221-8Wiysonge CS, Bradley HA, Volmink J, et al.Beta-blockers for hypertension.Cochrane Database Syst Rev. 2017;1(1):CD002003. Published 2017 Jan 20. doi:10.1002/14651858.CD002003.pub5Skeberdis VA.Structure and function of beta3-adrenergic receptors.Medicina (Kaunas). 2004;40(5):407-413.U.S. Food and Drug Administration.Tenormin (atenolol) tablets prescribing information.U.S. Food and Drug Administration.LOPRESSOR (metoprolol tartrate) tablet prescribing information.Carey RM, Wright JT Jr, Taler SJ, et al.Guideline-driven management of hypertension: An evidence-based update.Circ Res. 2021;128(7):827-846. doi:10.1161/CIRCRESAHA.121.318083Kloner RA, Chaitman B.Angina and its management.J Cardiovasc Pharmacol Ther. 2017;22(3):199-209. doi:10.1177/1074248416679733Celić V, Pencić B, Dekleva M, et al.Metoprolol and atenolol in mild-to-moderate chronic heart failure: comparative study.Srp Arh Celok Lek. 2005;133(5-6):242-247. doi:10.2298/sarh0506242cIshak D, Aktaa S, Lindhagen L, et al.Association of beta-blockers beyond 1 year after myocardial infarction and cardiovascular outcomes.Heart. 2023;109(15):1159-1165. Published 2023 Jul 12. doi:10.1136/heartjnl-2022-322115Joglar JA, Chung MK, Armbruster AL, et al.2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[published correction appears in Circulation. 2024 Jan 2;149(1):e167. doi: 10.1161/CIR.0000000000001207] [published correction appears in Circulation. 2024 Feb 27;149(9):e936. doi: 10.1161/CIR.0000000000001218] [published correction appears in Circulation. 2024 Jun 11;149(24):e1413. doi: 10.1161/CIR.0000000000001263].Circulation. 2024;149(1):e1-e156. doi:10.1161/CIR.0000000000001193Niriayo YL, Asgedom SW, Demoz GT, et al.Treatment optimization of beta-blockers in chronic heart failure therapy.Sci Rep. 2020;10(1):15903. Published 2020 Sep 28. doi:10.1038/s41598-020-72836-4Ray S, Nair T, Sawhney J, et al.Role of β-blockers in the cardiovascular disease continuum: a collaborative Delphi survey-based consensus from Asia-Pacific.Curr Med Res Opin. 2023;39(12):1671-1683. doi:10.1080/03007995.2023.2256218Martinez A, Lakkimsetti M, Maharjan S, et al.Beta-blockers and their current role in maternal and neonatal health: A narrative review of the literature.Cureus. 2023;15(8):e44043. Published 2023 Aug 24. doi:10.7759/cureus.44043Wikstrand J, Andersson B, Kendall MJ, et al.Pharmacokinetic considerations of formulation: extended-release metoprolol succinate in the treatment of heart failure.J Cardiovasc Pharmacol. 2003;41(2):151-157. doi:10.1097/00005344-200302000-00001U.S. Food and Drug Administration.Metoprolol succinate extended-release tablets prescribing information.Parker ED, Margolis KL, Trower NK, et al.Comparative effectiveness of 2 β-blockers in hypertensive patients.Arch Intern Med. 2012;172(18):1406-1412. doi:10.1001/archinternmed.2012.4276Nilsson OR, Atterhög JH, Castenfors J, et al.A comparison of 100 mg atenolol and 100 mg metoprolol once a day at rest and during exercise in hypertensives.Acta Med Scand. 1984;216(3):301-307. doi:10.1111/j.0954-6820.1984.tb03808.xFlack JM, Adekola B.Blood pressure and the new ACC/AHA hypertension guidelines.Trends Cardiovasc Med. 2020;30(3):160-164. doi:10.1016/j.tcm.2019.05.003von Haehling S, Arzt M, Doehner W, et al.Improving exercise capacity and quality of life using non-invasive heart failure treatments: evidence from clinical trials.Eur J Heart Fail. 2021;23(1):92-113. doi:10.1002/ejhf.1838Wee Y, Burns K, Bett N.Medical management of chronic stable angina.Aust Prescr. 2015;38(4):131-136. doi:10.18773/austprescr.2015.042

21 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.do Vale GT, Ceron CS, Gonzaga NA, et al.Three generations of β-blockers: History, class differences and clinical applicability.Curr Hypertens Rev. 2019;15(1):22-31. doi:10.2174/1573402114666180918102735Dézsi CA, Szentes V.The real role of β-blockers in daily cardiovascular therapy.Am J Cardiovasc Drugs. 2017;17(5):361-373. doi:10.1007/s40256-017-0221-8Wiysonge CS, Bradley HA, Volmink J, et al.Beta-blockers for hypertension.Cochrane Database Syst Rev. 2017;1(1):CD002003. Published 2017 Jan 20. doi:10.1002/14651858.CD002003.pub5Skeberdis VA.Structure and function of beta3-adrenergic receptors.Medicina (Kaunas). 2004;40(5):407-413.U.S. Food and Drug Administration.Tenormin (atenolol) tablets prescribing information.U.S. Food and Drug Administration.LOPRESSOR (metoprolol tartrate) tablet prescribing information.Carey RM, Wright JT Jr, Taler SJ, et al.Guideline-driven management of hypertension: An evidence-based update.Circ Res. 2021;128(7):827-846. doi:10.1161/CIRCRESAHA.121.318083Kloner RA, Chaitman B.Angina and its management.J Cardiovasc Pharmacol Ther. 2017;22(3):199-209. doi:10.1177/1074248416679733Celić V, Pencić B, Dekleva M, et al.Metoprolol and atenolol in mild-to-moderate chronic heart failure: comparative study.Srp Arh Celok Lek. 2005;133(5-6):242-247. doi:10.2298/sarh0506242cIshak D, Aktaa S, Lindhagen L, et al.Association of beta-blockers beyond 1 year after myocardial infarction and cardiovascular outcomes.Heart. 2023;109(15):1159-1165. Published 2023 Jul 12. doi:10.1136/heartjnl-2022-322115Joglar JA, Chung MK, Armbruster AL, et al.2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[published correction appears in Circulation. 2024 Jan 2;149(1):e167. doi: 10.1161/CIR.0000000000001207] [published correction appears in Circulation. 2024 Feb 27;149(9):e936. doi: 10.1161/CIR.0000000000001218] [published correction appears in Circulation. 2024 Jun 11;149(24):e1413. doi: 10.1161/CIR.0000000000001263].Circulation. 2024;149(1):e1-e156. doi:10.1161/CIR.0000000000001193Niriayo YL, Asgedom SW, Demoz GT, et al.Treatment optimization of beta-blockers in chronic heart failure therapy.Sci Rep. 2020;10(1):15903. Published 2020 Sep 28. doi:10.1038/s41598-020-72836-4Ray S, Nair T, Sawhney J, et al.Role of β-blockers in the cardiovascular disease continuum: a collaborative Delphi survey-based consensus from Asia-Pacific.Curr Med Res Opin. 2023;39(12):1671-1683. doi:10.1080/03007995.2023.2256218Martinez A, Lakkimsetti M, Maharjan S, et al.Beta-blockers and their current role in maternal and neonatal health: A narrative review of the literature.Cureus. 2023;15(8):e44043. Published 2023 Aug 24. doi:10.7759/cureus.44043Wikstrand J, Andersson B, Kendall MJ, et al.Pharmacokinetic considerations of formulation: extended-release metoprolol succinate in the treatment of heart failure.J Cardiovasc Pharmacol. 2003;41(2):151-157. doi:10.1097/00005344-200302000-00001U.S. Food and Drug Administration.Metoprolol succinate extended-release tablets prescribing information.Parker ED, Margolis KL, Trower NK, et al.Comparative effectiveness of 2 β-blockers in hypertensive patients.Arch Intern Med. 2012;172(18):1406-1412. doi:10.1001/archinternmed.2012.4276Nilsson OR, Atterhög JH, Castenfors J, et al.A comparison of 100 mg atenolol and 100 mg metoprolol once a day at rest and during exercise in hypertensives.Acta Med Scand. 1984;216(3):301-307. doi:10.1111/j.0954-6820.1984.tb03808.xFlack JM, Adekola B.Blood pressure and the new ACC/AHA hypertension guidelines.Trends Cardiovasc Med. 2020;30(3):160-164. doi:10.1016/j.tcm.2019.05.003von Haehling S, Arzt M, Doehner W, et al.Improving exercise capacity and quality of life using non-invasive heart failure treatments: evidence from clinical trials.Eur J Heart Fail. 2021;23(1):92-113. doi:10.1002/ejhf.1838Wee Y, Burns K, Bett N.Medical management of chronic stable angina.Aust Prescr. 2015;38(4):131-136. doi:10.18773/austprescr.2015.042

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

do Vale GT, Ceron CS, Gonzaga NA, et al.Three generations of β-blockers: History, class differences and clinical applicability.Curr Hypertens Rev. 2019;15(1):22-31. doi:10.2174/1573402114666180918102735Dézsi CA, Szentes V.The real role of β-blockers in daily cardiovascular therapy.Am J Cardiovasc Drugs. 2017;17(5):361-373. doi:10.1007/s40256-017-0221-8Wiysonge CS, Bradley HA, Volmink J, et al.Beta-blockers for hypertension.Cochrane Database Syst Rev. 2017;1(1):CD002003. Published 2017 Jan 20. doi:10.1002/14651858.CD002003.pub5Skeberdis VA.Structure and function of beta3-adrenergic receptors.Medicina (Kaunas). 2004;40(5):407-413.U.S. Food and Drug Administration.Tenormin (atenolol) tablets prescribing information.U.S. Food and Drug Administration.LOPRESSOR (metoprolol tartrate) tablet prescribing information.Carey RM, Wright JT Jr, Taler SJ, et al.Guideline-driven management of hypertension: An evidence-based update.Circ Res. 2021;128(7):827-846. doi:10.1161/CIRCRESAHA.121.318083Kloner RA, Chaitman B.Angina and its management.J Cardiovasc Pharmacol Ther. 2017;22(3):199-209. doi:10.1177/1074248416679733Celić V, Pencić B, Dekleva M, et al.Metoprolol and atenolol in mild-to-moderate chronic heart failure: comparative study.Srp Arh Celok Lek. 2005;133(5-6):242-247. doi:10.2298/sarh0506242cIshak D, Aktaa S, Lindhagen L, et al.Association of beta-blockers beyond 1 year after myocardial infarction and cardiovascular outcomes.Heart. 2023;109(15):1159-1165. Published 2023 Jul 12. doi:10.1136/heartjnl-2022-322115Joglar JA, Chung MK, Armbruster AL, et al.2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[published correction appears in Circulation. 2024 Jan 2;149(1):e167. doi: 10.1161/CIR.0000000000001207] [published correction appears in Circulation. 2024 Feb 27;149(9):e936. doi: 10.1161/CIR.0000000000001218] [published correction appears in Circulation. 2024 Jun 11;149(24):e1413. doi: 10.1161/CIR.0000000000001263].Circulation. 2024;149(1):e1-e156. doi:10.1161/CIR.0000000000001193Niriayo YL, Asgedom SW, Demoz GT, et al.Treatment optimization of beta-blockers in chronic heart failure therapy.Sci Rep. 2020;10(1):15903. Published 2020 Sep 28. doi:10.1038/s41598-020-72836-4Ray S, Nair T, Sawhney J, et al.Role of β-blockers in the cardiovascular disease continuum: a collaborative Delphi survey-based consensus from Asia-Pacific.Curr Med Res Opin. 2023;39(12):1671-1683. doi:10.1080/03007995.2023.2256218Martinez A, Lakkimsetti M, Maharjan S, et al.Beta-blockers and their current role in maternal and neonatal health: A narrative review of the literature.Cureus. 2023;15(8):e44043. Published 2023 Aug 24. doi:10.7759/cureus.44043Wikstrand J, Andersson B, Kendall MJ, et al.Pharmacokinetic considerations of formulation: extended-release metoprolol succinate in the treatment of heart failure.J Cardiovasc Pharmacol. 2003;41(2):151-157. doi:10.1097/00005344-200302000-00001U.S. Food and Drug Administration.Metoprolol succinate extended-release tablets prescribing information.Parker ED, Margolis KL, Trower NK, et al.Comparative effectiveness of 2 β-blockers in hypertensive patients.Arch Intern Med. 2012;172(18):1406-1412. doi:10.1001/archinternmed.2012.4276Nilsson OR, Atterhög JH, Castenfors J, et al.A comparison of 100 mg atenolol and 100 mg metoprolol once a day at rest and during exercise in hypertensives.Acta Med Scand. 1984;216(3):301-307. doi:10.1111/j.0954-6820.1984.tb03808.xFlack JM, Adekola B.Blood pressure and the new ACC/AHA hypertension guidelines.Trends Cardiovasc Med. 2020;30(3):160-164. doi:10.1016/j.tcm.2019.05.003von Haehling S, Arzt M, Doehner W, et al.Improving exercise capacity and quality of life using non-invasive heart failure treatments: evidence from clinical trials.Eur J Heart Fail. 2021;23(1):92-113. doi:10.1002/ejhf.1838Wee Y, Burns K, Bett N.Medical management of chronic stable angina.Aust Prescr. 2015;38(4):131-136. doi:10.18773/austprescr.2015.042

do Vale GT, Ceron CS, Gonzaga NA, et al.Three generations of β-blockers: History, class differences and clinical applicability.Curr Hypertens Rev. 2019;15(1):22-31. doi:10.2174/1573402114666180918102735

Dézsi CA, Szentes V.The real role of β-blockers in daily cardiovascular therapy.Am J Cardiovasc Drugs. 2017;17(5):361-373. doi:10.1007/s40256-017-0221-8

Wiysonge CS, Bradley HA, Volmink J, et al.Beta-blockers for hypertension.Cochrane Database Syst Rev. 2017;1(1):CD002003. Published 2017 Jan 20. doi:10.1002/14651858.CD002003.pub5

Skeberdis VA.Structure and function of beta3-adrenergic receptors.Medicina (Kaunas). 2004;40(5):407-413.

U.S. Food and Drug Administration.Tenormin (atenolol) tablets prescribing information.

U.S. Food and Drug Administration.LOPRESSOR (metoprolol tartrate) tablet prescribing information.

Carey RM, Wright JT Jr, Taler SJ, et al.Guideline-driven management of hypertension: An evidence-based update.Circ Res. 2021;128(7):827-846. doi:10.1161/CIRCRESAHA.121.318083

Kloner RA, Chaitman B.Angina and its management.J Cardiovasc Pharmacol Ther. 2017;22(3):199-209. doi:10.1177/1074248416679733

Celić V, Pencić B, Dekleva M, et al.Metoprolol and atenolol in mild-to-moderate chronic heart failure: comparative study.Srp Arh Celok Lek. 2005;133(5-6):242-247. doi:10.2298/sarh0506242c

Ishak D, Aktaa S, Lindhagen L, et al.Association of beta-blockers beyond 1 year after myocardial infarction and cardiovascular outcomes.Heart. 2023;109(15):1159-1165. Published 2023 Jul 12. doi:10.1136/heartjnl-2022-322115

Joglar JA, Chung MK, Armbruster AL, et al.2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[published correction appears in Circulation. 2024 Jan 2;149(1):e167. doi: 10.1161/CIR.0000000000001207] [published correction appears in Circulation. 2024 Feb 27;149(9):e936. doi: 10.1161/CIR.0000000000001218] [published correction appears in Circulation. 2024 Jun 11;149(24):e1413. doi: 10.1161/CIR.0000000000001263].Circulation. 2024;149(1):e1-e156. doi:10.1161/CIR.0000000000001193

Niriayo YL, Asgedom SW, Demoz GT, et al.Treatment optimization of beta-blockers in chronic heart failure therapy.Sci Rep. 2020;10(1):15903. Published 2020 Sep 28. doi:10.1038/s41598-020-72836-4

Ray S, Nair T, Sawhney J, et al.Role of β-blockers in the cardiovascular disease continuum: a collaborative Delphi survey-based consensus from Asia-Pacific.Curr Med Res Opin. 2023;39(12):1671-1683. doi:10.1080/03007995.2023.2256218

Martinez A, Lakkimsetti M, Maharjan S, et al.Beta-blockers and their current role in maternal and neonatal health: A narrative review of the literature.Cureus. 2023;15(8):e44043. Published 2023 Aug 24. doi:10.7759/cureus.44043

Wikstrand J, Andersson B, Kendall MJ, et al.Pharmacokinetic considerations of formulation: extended-release metoprolol succinate in the treatment of heart failure.J Cardiovasc Pharmacol. 2003;41(2):151-157. doi:10.1097/00005344-200302000-00001

U.S. Food and Drug Administration.Metoprolol succinate extended-release tablets prescribing information.

Parker ED, Margolis KL, Trower NK, et al.Comparative effectiveness of 2 β-blockers in hypertensive patients.Arch Intern Med. 2012;172(18):1406-1412. doi:10.1001/archinternmed.2012.4276

Nilsson OR, Atterhög JH, Castenfors J, et al.A comparison of 100 mg atenolol and 100 mg metoprolol once a day at rest and during exercise in hypertensives.Acta Med Scand. 1984;216(3):301-307. doi:10.1111/j.0954-6820.1984.tb03808.x

Flack JM, Adekola B.Blood pressure and the new ACC/AHA hypertension guidelines.Trends Cardiovasc Med. 2020;30(3):160-164. doi:10.1016/j.tcm.2019.05.003

von Haehling S, Arzt M, Doehner W, et al.Improving exercise capacity and quality of life using non-invasive heart failure treatments: evidence from clinical trials.Eur J Heart Fail. 2021;23(1):92-113. doi:10.1002/ejhf.1838

Wee Y, Burns K, Bett N.Medical management of chronic stable angina.Aust Prescr. 2015;38(4):131-136. doi:10.18773/austprescr.2015.042

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