Carvedilol vs. Metoprolol for Heart Disease - GoodRx (2024)

Beta blockers are a class of medications that treat a variety of heart conditions. These include high blood pressure, coronary artery disease, congestive heart failure, and heart rhythm problems like atrial fibrillation.

When it comes to heart failure, carvedilol has been the mainstay of treatment. But metoprolol can be useful for heart failure, too. And even though the two medications are similar, they have some key differences.

Often the choice comes down to which medication can offer the most benefits for your particular condition, with the least likely side effects. In this article we’ll describe the differences between carvedilol and metoprolol, and what might make carvedilol or metoprolol a better choice for you.

What is a beta blocker?

Beta blockers are medications that block beta receptors in the body. Beta receptors are found in the heart and blood vessels. And when they’re blocked, it changes the way these areas in the body function. More specifically, they tend to slow down the heart and relax blood vessels. This leads to a lower heart rate and lower blood pressure.

Your healthcare professional may recommend a beta blocker for a variety of reasons:

• Beta blockers protect the heart after a heart attack.

• If you have congestive heart failure, they may reduce your risk of death or complications.

• If you have irregular heartbeats (arrhythmia), beta blockers can help keep your heart rate normal.

• They can treat high blood pressure (hypertension). But they’re not usually the first-choice treatment for this condition.

What is carvedilol?

Carvedilol is a beta blocker. But it also affects another type of receptor — the alpha-1 receptors. These receptors react to chemicals in the body like adrenaline. This means that carvedilol has more power to block the stress response that can increase your heart rate and blood pressure.

This is particularly helpful for heart failure because it can cause the sympathetic nervous system to go into overdrive. And this naturally raises your pulse rate and blood pressure. Heart failure can also cause the blood vessels in your body to tighten. That can put even more stress on the heart. So it can lead to a vicious cycle.

But carvedilol can help by preventing the start of this cycle. It has less of a direct effect on your blood pressure. One review of multiple studies found that on average, carvedilol lowered the systolic blood pressure (the top number) by four points, and the diastolic blood pressure (lower number) by three points.

But everyone is different. For some people, carvedilol will have no impact on blood pressure. And for others, carvedilol will have a stronger effect. So it’s important to monitor your blood pressure when you start this medication.

Carvedilol is particularly helpful if you have heart failure caused by a weak heart muscle. This is also known as heart failure with reduced ejection fraction (HFrEF).

What is metoprolol?

Metoprolol is a pure beta blocker. It doesn’t affect alpha receptors like carvedilol does. It’s often used for palpitations or other heart rhythm problems, like atrial fibrillation (Afib).

Beta receptors are in many different organs beyond the heart like the lungs. But metoprolol is unique in that it acts mainly on beta receptors in the heart. This means it’s less likely to cause any breathing side effects, like wheezing or shortness of breath.

What are the differences between carvedilol and metoprolol?

Although they’re similar, carvedilol and metoprolol have some important differences:

• Metoprolol slows the heart rate with exercise more than carvedilol. This might make it a better choice if you have Afib or other fast heart rhythms.

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• Carvedilol lowers blood pressure more than metoprolol.

• Metoprolol may increase triglycerides. Carvedilol doesn’t usually have this effect.

• Metoprolol can also raise blood sugar levels if you have diabetes. This is not true for carvedilol.

• Carvedilol might have anti-inflammatory and antioxidant benefits.

• Carvedilol is more likely to cause wheezing if you have asthma.

There are also some differences in the way these medications work for people with heart failure. The next section will dive deeper into that topic.

Side effects of carvedilol vs. metoprolol

Although side effects aren’t common, both medications can cause:

• Erectile dysfunction

• Excessively slow heart rate

• Excessively low blood pressure

People can feel fatigued when their blood pressure and heart rate get too low. In some cases, it can cause someone to feel dizzy or even pass out. Some people also believe that beta blockers can cause or worsen depression. But recent research reports no connection.

Is carvedilol or metoprolol better for heart failure?

In 1996, a landmark study looked at adding carvedilol to the usual treatment for heart failure. The verdict was clear: Adding carvedilol reduced the risk of dying by 65%. This is when beta blockers became a standard part of heart failure treatment.

Carvedilol was the preferred beta blocker for heart failure for many years. But this was also because, at the time, the short-acting form of metoprolol was the only one available. And when researchers compared carvedilol to short-acting metoprolol, carvedilol was better.

But we now have longer-acting metoprolol succinate. And when carvedilol is compared to metoprolol succinate, most people with heart failure do equally well.

Your other health conditions may mean that one option is better than the other. Your healthcare professional will take these into account when helping you choose the beta blocker that’s best for you.

Is carvedilol or metoprolol better after a heart attack?

Beta blockers are a standard part of treatment after a heart attack. When comparing carvedilol and metoprolol in this scenario:

• Both medications reduce the risk of another heart attack.

• Both help to strengthen the heart.

• Both can reduce the likelihood of dangerous heart rhythm problems like ventricular tachycardia.

There are no major differences between the two medications for heart attack treatment. But if your heart muscle is weakened by the heart attack, then carvedilol may be best.

Is carvedilol or metoprolol better for atrial fibrillation?

Atrial fibrillation (Afib) is a condition that leads to an erratic heart rhythm. And this often causes a slightly faster heart rate. Beta blockers can slow the heart rate and even help to prevent the heart from going into an Afib.

Both carvedilol or metoprolol are an option. But if you’ve had recent heart bypass surgery, carvedilol might be a better choice.

It’s important to note that some people with Afib have a slow — rather than a fast — heart rate. If you’re prone to a slow heart rate, then a beta blocker may not be a good choice for you.

How are carvedilol and metoprolol dosed and given?

In most cases, carvedilol and metoprolol are started at a low dose and then slowly increased as needed. It may take 1 to 2 weeks to see the full effect of the medication.

Your healthcare professional may suggest that you track your heart rate and blood pressure to see how the medication is affecting you. You can do this at home with a home blood pressure cuff.

People usually take carvedilol twice daily because it’s short-acting, but there’s a long-acting form that you take once daily. Some people prefer the long-acting form because it’s easier to remember.

Metoprolol comes in two forms: succinate and tartrate. Metoprolol succinate is the long-acting version, and is taken once daily. Metoprolol tartrate is short-acting, and is usually dosed twice daily.

Can you use metoprolol and carvedilol together?

Metoprolol and carvedilol are not usually taken together. The combination could lead to a very low heart rate or low blood pressure. If you’re taking both medications, check with your healthcare professional. You may be getting prescriptions from more than one healthcare professional or pharmacy. And this can be dangerous because it can lead to unexpected side effects or medication interactions.