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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by mike99 on April 17, 2006, at 21:23:23
I have a few questions regarding differences between the two if anyone would care to answer.
Here is what I understand the differences between atenolol and metoprolol to be (please correct me if I'm wrong):
While both are cardioselective, atenolol tends to lose this selectivity much more easily than metoprolol at increased doses.
Metoprolol is more liphophilic--so it penetrates the brain more easily and therefore may be more likely to cause sedation/depression/cognitive problems than atenolol.
Metoprolol: the only beta blocker proven for treatment of angina, high blood pressure and heart failure. I also found an article called "Time to Reconsider Atenolol?" suggesting atenolol may not have many other cardioprotective benefits which metoprolol possesses.
Atenolol: Not metabolized by liver, longer acting
Metoprolol: Metabolized by liver, shorter actingAre there any other significant differences I should know about (perhaps in terms of ED, lipid effects, insulin resistance, exercise tolerance...others)? Is tolerance or dose escalation more likely with one than the other?
It seems atenolol may have the upper hand in terms of CNS effects but metoprolol may be better on the whole for the heart???
OK I will stop with the million questions. Just wondering if there are any important differences of which I should be aware. I'd greatly appreciate any feedback. Peace out.
Posted by SLS on April 18, 2006, at 6:54:42
In reply to atenolol vs metoprolol, posted by mike99 on April 17, 2006, at 21:23:23
I really can't compare and contrast the two drugs, but was wondering if you had looked at Coreg (carvedilol). It is good for both hypertension and heart failure. I'm not sure about angina.
- Scott
> I have a few questions regarding differences between the two if anyone would care to answer.
>
> Here is what I understand the differences between atenolol and metoprolol to be (please correct me if I'm wrong):
>
> While both are cardioselective, atenolol tends to lose this selectivity much more easily than metoprolol at increased doses.
>
> Metoprolol is more liphophilic--so it penetrates the brain more easily and therefore may be more likely to cause sedation/depression/cognitive problems than atenolol.
>
> Metoprolol: the only beta blocker proven for treatment of angina, high blood pressure and heart failure. I also found an article called "Time to Reconsider Atenolol?" suggesting atenolol may not have many other cardioprotective benefits which metoprolol possesses.
>
> Atenolol: Not metabolized by liver, longer acting
> Metoprolol: Metabolized by liver, shorter acting
>
> Are there any other significant differences I should know about (perhaps in terms of ED, lipid effects, insulin resistance, exercise tolerance...others)? Is tolerance or dose escalation more likely with one than the other?
>
> It seems atenolol may have the upper hand in terms of CNS effects but metoprolol may be better on the whole for the heart???
>
> OK I will stop with the million questions. Just wondering if there are any important differences of which I should be aware. I'd greatly appreciate any feedback. Peace out.
>
Posted by ed_uk on April 18, 2006, at 15:30:49
In reply to Re: atenolol vs metoprolol, posted by SLS on April 18, 2006, at 6:54:42
I personally like bisoprolol. It's very similar to metoprolol in its properties except it has a longer duration of action - somewhat longer than atenolol in fact, providing better 24 hour coverage when given as a single daily dose.
Bisoprolol is very popular in the UK, certainly more popular than metoprolol. Bisoprolol is used for heart failure, hypertension and angina. It is very well established in heart failure: it is cardioprotective and prolongs life.
I hear bisoprolol is rarely used in the US. I guess it was badly marketed. It's currently available as an inexpensive generic in the UK, I don't know whether it's generic in the US though.
Regards
Ed
Posted by saturn on April 18, 2006, at 17:08:41
In reply to Re: atenolol vs metoprolol, posted by SLS on April 18, 2006, at 6:54:42
> I really can't compare and contrast the two drugs, but was wondering if you had looked at Coreg (carvedilol). It is good for both hypertension and heart failure. I'm not sure about angina.
>
>
> - Scott
>Hi Scott,
Yeah, I've checked into Coreg as you've mentioned, but I prefer not to take it due to it's non-beta selectivity. I really appreciate the suggestion, however.
(BTW...I've just changed my posting name from mike99 to saturn).
> > I have a few questions regarding differences between the two if anyone would care to answer.
> >
> > Here is what I understand the differences between atenolol and metoprolol to be (please correct me if I'm wrong):
> >
> > While both are cardioselective, atenolol tends to lose this selectivity much more easily than metoprolol at increased doses.
> >
> > Metoprolol is more liphophilic--so it penetrates the brain more easily and therefore may be more likely to cause sedation/depression/cognitive problems than atenolol.
> >
> > Metoprolol: the only beta blocker proven for treatment of angina, high blood pressure and heart failure. I also found an article called "Time to Reconsider Atenolol?" suggesting atenolol may not have many other cardioprotective benefits which metoprolol possesses.
> >
> > Atenolol: Not metabolized by liver, longer acting
> > Metoprolol: Metabolized by liver, shorter acting
> >
> > Are there any other significant differences I should know about (perhaps in terms of ED, lipid effects, insulin resistance, exercise tolerance...others)? Is tolerance or dose escalation more likely with one than the other?
> >
> > It seems atenolol may have the upper hand in terms of CNS effects but metoprolol may be better on the whole for the heart???
> >
> > OK I will stop with the million questions. Just wondering if there are any important differences of which I should be aware. I'd greatly appreciate any feedback. Peace out.
> >
>
>
Posted by sdb on April 18, 2006, at 17:27:51
In reply to atenolol vs metoprolol, posted by mike99 on April 17, 2006, at 21:23:23
>metoprolol may be better on the whole for the >heart
These are a lot of questions.
Choosing a betablocker depends what you want to treat (...vs...)
You cannot generaly say one is the better than the other. Concerning sideeffects I would rate atenolol definately better. If you have a heart failure metoprolol, bisoprolol or carvedilol could be a treatment. But that should be monitored by a cardiologist (!). Metoprolol is more selective for beta1-receptors, both of them cause upregulation by time. Atenolol is longer acting but there is a sustained version of metoprolol you can take once a day. Important is to titrate those betablockers slowly up or if you want to stop titrate slowly down. There are some betablockers which do not cause upregulation. If you want to stop an adrenaline rush there are better options (measured mostly by isoprenaline).
It's very complicated. It depends what metabolizer you are and what variation in your beta1-receptor is.
In the β1 Adrenergic receptor gen are several polymorphisms
– SR: Ser49Arg389
– GR Gly49Arg389
– SG: Ser49Gly389~sdb
Posted by sdb on April 18, 2006, at 17:37:11
In reply to Re: atenolol vs metoprolol, posted by sdb on April 18, 2006, at 17:27:51
bisoprolol is a very smooth drug. It's the most beta1-selective behind nebivolol. But if you want to stop adrenergic stimuli from the adrenal gland bisoprolol is nonsense. Bisoprolol does diminish exercise tachycardia mediated mainly through noradrenaline and the connecting nerves to the cardiac tissue. A positive aspect of bisoprolol is, that it is very unlikely you will have bad sideeffects or more severe problems with asthma or a vasoconstriction.
~sdb
Posted by saturn on April 18, 2006, at 19:02:10
In reply to Re: atenolol vs metoprolol, posted by sdb on April 18, 2006, at 17:27:51
> Choosing a betablocker depends what you want to treat (...vs...)Stressful situations (ie giving a speech, interviews...) and med-induced tachycardia. Possibly med-induced angina (stimulants--which I no longer take-- cause me tachycardia and angina. I'm considering a trial of Provigil. I don't know if it would induce these same effects, but I'm willing to bet it would likely at least cause tachy).
And if I'm taking a beta blocker I'd just as well prefer to also receive any general cardioprotective effects possible at the same time.
> You cannot generaly say one is the better than the other. Concerning sideeffects I would rate atenolol definately better.
Are you referring to CNS effects? Others?
>>There are some betablockers which do not cause upregulation.May I ask which ones? Would it not be easier to withdraw from these then?
>>If you want to stop an adrenaline rush there are better options (measured mostly by isoprenaline).May I ask which ones and what you mean "measured mostly by isoprenaline"?
Sorry to pile on more questions. I really appreciate your input. Thanks.
Posted by SLS on April 19, 2006, at 6:02:21
In reply to Re: atenolol vs metoprolol » SLS, posted by saturn on April 18, 2006, at 17:08:41
> Yeah, I've checked into Coreg as you've mentioned, but I prefer not to take it due to it's non-beta selectivity. I really appreciate the suggestion, however.
Is there a pulmonary thing going on?
Are you worried about the possibility of angina or do you currently experience it? Stable or unstable?
If neither of the above two conditions exist, but you are suffering from heart failure, I think carvedilol is the better drug. It is the only one that also acts as a NE alpha-1 antagonist. This acts as an afterload reducer and helps prevent the progression of hypertrophy. It will treat angina effectively once you reach dosages of 100mg (50mg b.i.d.).
- Scott
Posted by sdb on April 19, 2006, at 6:32:19
In reply to atenolol vs metoprolol, posted by mike99 on April 17, 2006, at 21:23:23
Did you ever have an asthma attack?
How much is your blood pressure (diastolic/systolic)..you should measure that several times a day during some days?
What type of angina do you have, a stable angina (pain increase the more you do/the more you are active)? Or do you have an instable angina (sudden pain in the chest happening accidentially)? Do you have a normal ECG?
You do not have an arrythmia, irregularity in you hearbeat (then the treatment is a lot more difficult and could be dangerous)?kind regards
sdb
Posted by sdb on April 19, 2006, at 6:34:52
In reply to Re: atenolol vs metoprolol saturn, posted by sdb on April 19, 2006, at 6:32:19
how old are you? BMI? Weight? I suppose male?
Posted by saturn on April 19, 2006, at 11:10:06
In reply to Re: atenolol vs metoprolol » saturn, posted by SLS on April 19, 2006, at 6:02:21
>
> Is there a pulmonary thing going on?Not that I'm aware of. I did smoke 5 years, but quit about 3 years ago. My exercise tolerance is excellent, but I am going to ask my doc to do a pulmonary function test.
>
> Are you worried about the possibility of angina or do you currently experience it? Stable or unstable?I have only experienced angina when I've taken stimulants--ritalin (the most), adderall, dex. Needless to stay I no longer take them.
> If neither of the above two conditions exist, but you are suffering from heart failure, I think carvedilol is the better drug. It is the only one that also acts as a NE alpha-1 antagonist. This acts as an afterload reducer and helps prevent the progression of hypertrophy. It will treat angina effectively once you reach dosages of 100mg (50mg b.i.d.).
Thanks Scott, fortunately I've been told many times my heart is working just fine. Many many echos, stress test, even cardiac mri. I think I may have a minor arrythmia though that my docs never mentioned, because I was able to glance at one of the EKG's when I unfortunately had to go the the ED. It said sinus arrythmia and tachycardia, but the doc said the arrythmia is probably due to my thin habitus and the tachy was (surely) due to Dexedrine.
I've always wondered if something weren't going on that makes me so sensitive to stimulants. I've been considering a trial of provigil, but not sure this is wise--first I'm going to see a cardiologist about this and get checked out.
Posted by saturn on April 19, 2006, at 11:16:45
In reply to Re: atenolol vs metoprolol saturn, posted by sdb on April 19, 2006, at 6:32:19
> Did you ever have an asthma attack?
No.
> How much is your blood pressure (diastolic/systolic)..you should measure that several times a day during some days?Usually 115-125/65-80.
> What type of angina do you have, a stable angina (pain increase the more you do/the more you are active)? Or do you have an instable angina (sudden pain in the chest happening accidentially)?
I've only experienced angina when taking stimulants, which I no longer do. I can run several miles without chest pain...though my heart feels it could jump out of my chest at this point and I get a bit winded--but I suspect this is normal.
>>Do you have a normal ECG?This I need to find out. I have seen several cardiologists. One said it was "within normal limits". However I once got a glance at one which was not, but the doc said this may be a normal variant and is unlikely dangerous. I'm going to have another and ask for a more detailed explanation.
Thanks.
Posted by saturn on April 19, 2006, at 11:18:44
In reply to Re: atenolol vs metoprolol }} saturn, posted by sdb on April 19, 2006, at 6:34:52
> how old are you? BMI? Weight? I suppose male?
28 y/o male. BMI=18.9 (5'9'', 128 lbs).
Posted by sdb on April 19, 2006, at 12:20:40
In reply to Re: atenolol vs metoprolol }} saturn, posted by saturn on April 19, 2006, at 11:18:44
>This I need to find out. I have seen several >cardiologists. One said it was "within normal >limits". However I once got a glance at one >which was not, but the doc said this may be a >normal variant and is unlikely dangerous. I'm >going to have another and ask for a more >detailed explanation.
Docs often say different things thus it's a good strategy to ask not one but at least two.
If you dont have any arrythmias and you can run several miles with a little bit strong and fast heart beating its absolutely normal if you're exercising regularely. 28 years is young so you're of course having fatty streaks in the arterias but not dangerous one's.
If you dont have asthma and you want only stop the adrenaline rush from your adrenal gland I would recommend:
Corgard (nadolol) approx. 40mg a day works 24h
It does not cause b1/2 upregulation according two at least two studies. One positive thing is that it is not cardiodepressant. That means you're jogging at least the miles too with this betablocker (in contrast to propranolol which is very cardiodepressant, lipophil, upregulation by time)
Oxprenolol retard (has ISA following b1/b2 downregulation)Propranolol
Both are unselective but proven effective against catecholamines.
Isoprenaline is a beta1/beta2 agonist (works similar like adrenaline). It's used in the laboratory because adrenaline's half-life is too short.
If you want I can e-mail you some different studies about the efficacy of betablockers against catecholamines and measurements of many other parameters.
kind regards
sdb
Posted by sdb on April 19, 2006, at 12:29:45
In reply to Re: atenolol vs metoprolol }} saturn, posted by sdb on April 19, 2006, at 12:20:40
sorry my mistakes in the syntax I seem to be hurry all the time. But that's nothing :-)
Hopefully you're understanding the semantics.~sdb
Posted by saturn on April 19, 2006, at 14:53:46
In reply to Re: atenolol vs metoprolol }} saturn, posted by sdb on April 19, 2006, at 12:20:40
> If you want I can e-mail you some different studies about the efficacy of betablockers against catecholamines and measurements of many other parameters.That would be great. If you'd like to babblemail them, or I can babblemail my e-mail address to you.
Posted by sdb on April 20, 2006, at 3:56:16
In reply to Re: atenolol vs metoprolol }} saturn, posted by saturn on April 19, 2006, at 14:53:46
>>I can babblemail my e-mail address to you.
ok
Posted by sdb on April 20, 2006, at 14:35:33
In reply to Re: atenolol vs metoprolol }} saturn, posted by sdb on April 20, 2006, at 3:56:16
I sent the studies in pdf files to you (approx. 1mb) I hope it came through. I selected the ones that you might be at most in your interest.
kind regards
sdb
Posted by saturn on April 20, 2006, at 18:21:19
In reply to Re: atenolol vs metoprolol, sent studies }} saturn, posted by sdb on April 20, 2006, at 14:35:33
Thanks for sending the articles. I really appreciate it.
You metioned that atenolol probably has less side effects than metoprolol. Are you referring to CNS effects (depression, sedation)?
Do you know how nadolol compares in this regard (CNS penetration)?
I am also curious how it is not a cardiodepressant. How is it that beta-1 blockade would not result in some cardiodepression. I assume atenolol and metoprolol *are* cardiodepressants? If so I would think nadolol would be best in terms of effects on my running.
Thanks again. I know my questions never end! I am going to carefully read all the files you sent over the weekend.
Peace.
Posted by sdb on April 21, 2006, at 15:38:07
In reply to got em', thanks!, posted by saturn on April 20, 2006, at 18:21:19
> You metioned that atenolol probably has less >side effects than metoprolol. Are you >referring to CNS effects (depression, sedation)?Yes for example. You will probably better on the atenolol. It's the "easier" drug pharmacologically.
> Do you know how nadolol compares in this regard (CNS penetration)?
Nadolol is not metabolized, is almost not found in the liquor cerebrospinalis (brain fluid), so there is only very minor penetration through brain-blood barrier.
> I am also curious how it is not a cardiodepressant. How is it that beta-1 blockade would not result in some cardiodepression. I assume atenolol and metoprolol *are* cardiodepressants? If so I would think nadolol would be best in terms of effects on my running.
There are some things that are too difficult to explain. But for running nadolol is probably the best one. Interestingly betablockers can even increase your endurance (slow, long distance running) but they will all decrease the maximum power due to less oxygen max. in the pathway. Note: Nadolol is hydrophil, does not penetrate blood-brain barrier, works 24h.
If you have performance anxiety and you consider to take a betablocker only in special situations you could also take a short actin oxprenolol, propranolol. For the longer term nadolol would be definately better. Nadolol resembles propranolol chemically, it has some other substituents which "likes" more the whater.
The metabolism is much easier than metoprolol for example.It's a pleasure to answer these question. But I think I need some holidays from the p-babble :-)
kind regards
sdb
Posted by saturn on April 21, 2006, at 17:29:51
In reply to Re: got em', thanks! }} answers, posted by sdb on April 21, 2006, at 15:38:07
> It's a pleasure to answer these question. But I think I need some holidays from the p-babble :-
I know what you mean. Thanks for all the great info.
Posted by dodgedthebullet on April 21, 2009, at 14:03:41
In reply to Re: atenolol vs metoprolol }} saturn, posted by saturn on April 19, 2006, at 11:18:44
For saturn (now 3 years later):
I'm facing a very similar situation as you did in 2006. I too am a runner. Can you give me a update on your condition?
This is the end of the thread.
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