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Dec 7, 2022

Blood Pressure


Bystolic vs. Metoprolol: How They Compare

Both Bystolic and Metoprolol are beta-blockers to treat hypertension (HBP: high blood pressure).

Beta-blockers work by blocking adrenaline from binding to beta receptors. Adrenaline (epinephrine) controls your heart rate and blood pressure. When adrenaline is blocked from binding to its receptor, it results in vasodilation (widening of blood vessels) and lowers your blood pressure.

While thiazide diuretics are recommended as the first-line treatment for HBP, beta-blockers are often used in individuals with high-risk diseases including heart failure, heart attack, heart disease, and/or diabetes.


1 in 3 American adults has hypertension. Most cases of hypertension are asymptomatic (have no symptoms), which can prolong detection and decrease drug adherence in those who have received treatment. Finding the right medication for you is essential since uncontrolled hypertension puts you at higher risk for heart disease, stroke, and kidney damage.

Read about What blood pressure is normal?

Bystolic (Nebivolol)

Bystolic (generic name: nebivolol) is a selective beta-1 blocker with nitric oxide-dependent vasodilation (widening of your blood vessels).


Bystolic can be taken with or without food and is available as a tablet in dosages ranging between 5–40 mg taken by mouth daily.

For those with moderate liver impairment or severe renal impairment, the recommended initial starting dose is 2.5 mg taken by mouth daily.

How does Bystolic work?

Bystolic works by altering your body’s reaction to nerve signals. It makes your heart beat more slowly and lowers your blood pressure. The volume of blood and oxygen reaching your heart is enhanced when your blood pressure is reduced.

Bystolic is a first-line treatment option for people with heart failure and heart attacks. It's different from other beta-blockers in that it doesn’t cause asthma flare-ups or headaches. It affects your heart more directly and has less side effects than other beta-blockers.

Click here to learn more on Bystolic (nebivolol) uses, dosages, side-effects and warnings.

Metoprolol (Lopressor, Toprol XL)


Metoprolol is a selective beta-1 blocker that comes in 2 forms:

  • Metoprolol tartrate immediate-release (Lopressor): 100–450 mg daily.
    Taken with food.
  • Metoprolol succinate extended-release (Toprol XL): 25–100 mg daily (initial dosage range), or 100–400 mg daily (maintenance dose range).
    Taken with food.
    First-line treatment option for heart failure

Metoprolol tartrate are only available as an immediate-release tablet, requiring multiple doses per day, while metoprolol succinate is an extended-release tablet, allowing for a single dose per day. They are not thought to be interchangeable because of the variations in their doses and uses.

When administered right after a heart attack, metoprolol tartrate can also lessen your mortality rate or the occurrence of a second heart attack. It can also reduce the risk of a heart attack in individuals with cardiovascular disease.

However, the prevention of heart attacks with metoprolol succinate is not advised.

How does Metoprolol work?

Metoprolol works similar to Bystolic. It lowers blood pressure by altering how your body reacts to nerve signals. It makes your heart beat more slowly, which lowers blood pressure.

Metoprolol is a first-line treatment option for those with chest pain (angina). It reduces the frequency of episodes and enables you to engage in more activity without experiencing chest discomfort or pain.

Click here to learn more on Metoprolol uses, dosages, side-effects and warnings.

The similarities and differences

Bystolic and Metoprolol are both beta-blockers commonly used to treat high blood pressure. Your body's epinephrine hormone (adrenaline) is prevented from functioning as beta-blockers enter your body. As a result, it lowers your blood pressure by reducing your heart rate and widening your veins and arteries.

The primary differentiation between Bystolic and Metoprolol is the variation in dosing requirements because of their various strengths.

It's crucial to remember that dosages vary based on the condition you're trying to manage or treat. For instance, the initial dose for congestive heart failure is often greater than the dose for high blood pressure.

Comparing side effects

Side effects
Bystolic Metoprolol
  • Nausea
  • Diarrhea
  • Decreased heartbeats
  • Swelling that my occur in your legs
  • Headache
  • Tiredness
  • Decreased HDL levels
  • Increased triglycerides levels
  • Decreased heart rate
  • Low blood pressure (hypotension)
  • Fatigue/tiredness
  • Dizziness
  • Depression
  • Decreased sex drive
  • Impotence (inability to have an erection for sexual intercourse)
  • Confusion and/or memory problems

Because of fewer side effects, bystolic is frequently chosen over metoprolol when managing HBP on its own.

Risks associated with Bystolic or Metoprolol

To prevent sudden tachycardia (increased heart rate), hypertension, and/or reduced blood flow (ischemia), metoprolol dosage should not be abruptly stopped; instead, it should be tapered or gradually reduced over a period of 1–2 weeks.

Your cognition or behavior may be affected by Bystolic. If you drive or do anything else that calls for alertness, use caution.

Driving and other risky activities should be avoided until you know how these medications will affect you. Your reflexes can be compromised.

Particular adverse effects of these medications may worsen if you drink alcohol.


In addition to masking some hypoglycemia (low blood sugar) symptoms, such as palpitations, trembling, and anxiety, beta-blockers can also augment the hypoglycemic effects of insulin and sulfonylureas.

They can also result in hyperglycemia (high blood sugar) by reducing insulin secretion. Your blood glucose should be monitored if you have diabetes.

Although it's often not advised, using Bystolic or Metoprolol with any of the following medications may be necessary for specific circumstances. Your physician may adjust the dosage or frequency of usage of one or both medications if they are given simultaneously.

Avoid the following drugs while on Bystolic or Metoprolol
Bystolic Metoprolol
  • Cimetidine
  • Digoxin
  • Another beta-blocker
  • Antidepressants, including duloxetine or sertraline
  • Diltiazem
  • Verapamil
  • Amiodarone
  • Epinephrine (Epi-Pen)
  • Monoamine oxidase (MAO) inhibitors, including Rasagiline
  • Another beta-blocker
  • Calcium channel blockers (CCBs)
  • Hydralazine

Your physician must be aware of any additional medications you are taking because some of them might significantly raise your chance of developing serious muscle

What happens if I miss a dose?

Both Bystolic and Metoprolol should be taken at roughly the same time every day so you don’t forget to take them.

However, if you do forget to take a dose, take it as soon as you remember unless it's almost time for your next dose. In this case, skip the forgotten dose and take the next one at the usual time. Do not take 2 doses together to make up for a missed dose.

Note that your blood pressure may spike abruptly if you stop taking these medications, increasing your risk of developing a heart attack and/or stroke.

What if I’m pregnant or breastfeeding?

There isn't enough research on women to determine the harm to the baby by taking these medications during breastfeeding. Before using these drugs during nursing, weigh the possible advantages against the potential disadvantages, and talk to your healthcare provider.

Which medication is better?

Although Bystolic and Metoprolol are both effective, there is little evidence that indicates the systematic use of one medication over others in this drug class.

Speak With Your Doctor

Talk to your healthcare provider about which medication is best suited for you and send your prescription to Marley Drug. Save up to 95% compared to your local pharmacy by using Marley Drug.

Marley Drug provides free nationwide shipping, allowing you to receive your medication at no additional cost straight to your door.

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