Bystolic vs. Metoprolol

[warlock]

Hey guys!

Can anyone name the main differences between these two BP meds? I know most say Bystolic is much better.

How do you convince your doctor that you prefer to be on Bystolic over Metoprolol?

 

[bg65]

Metoprolol can cause erectile dysfunction while bystolic is not known to do that because it increases nitric oxide. Metoprolol is generally better for heart rate control though.
Bystolic should have more affect on BP via that nitric oxide pathway while metoprolol can only reduce BP by reducing cardiac output, it does not affect systemic vascular resistance.
Why is your doc looking to start you on a beta blocker?

 

[warlock]

Metoprolol can cause erectile dysfunction while bystolic is not known to do that because it increases nitric oxide. Metoprolol is generally better for heart rate control though.
Bystolic should have more affect on BP via that nitric oxide pathway while metoprolol can only reduce BP by reducing cardiac output, it does not affect systemic vascular resistance.
Why is your doc looking to start you on a beta blocker?

Nice info! Thanks

I was on bystolic for a long time which had zero sides on me, and I know it's a great beta blocker. However, after a recent surgery, they switched me to metoprolol. My heart rate has been high. However, I want to go back to bystolic and was going to mention it to my doctor.

Maybe I'll mention that I'm noticing some ED issues. I heard metoprolol can also make you tired and sluggish so I may mention that too.

 

[01dragonslayer]

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[Lumpi]

Metoprolol is anything but cardioselective. Nebivolol is very cardioselective.

Depending on what your problem is, metoprolol can be the better option. But it does have a ton of downsides that modern betablockers like nebivolol dont have (no lipid worsening, no blood glucose and insulin resistance worsening, no limiting of cardiovascular training capacity, and so on).

 

[warlock]

Metoprolol is anything but cardioselective. Nebivolol is very cardioselective.

Depending on what your problem is, metoprolol can be the better option. But it does have a ton of downsides that modern betablockers like nebivolol dont have (no lipid worsening, no blood glucose and insulin resistance worsening, no limiting of cardiovascular training capacity, and so on).

Metoprolol can worsen lipids and glucose levels?

 

[OuchThatHurts]

Metoprolol can worsen lipids and glucose levels?

Yes but the overall reduction in all heart events is 10 times the miniscule ding in lipids and insulin sensitivity (Am J Cardiol. 1990 Jun 1;65(20):1287-91).

This is really splitting hairs at this point. And that goes for pretty much all beta blockers. Nebivilol isn't without its sides as well. But along with a proven ARB like valsarten or telmisarten (or similar). I mean, do you have bad lipids? What is your glucose tolerance like? Do you experience erectile disfunction? If you're fine in all those areas, go enjoy your life. Just my 2¢

 

[Lumpi]

Metoprolol can worsen lipids and glucose levels?

Yes, there's a ton of studies comparing nebivolol with metoprolol. Nebivolol has a very favorable effect profile compared with other betablockers. It does have a side effect profile that was comparable to the placebo group.

Just one of many studies:

The tolerability of nebivolol has been shown to be superior to that of atenolol and metoprolol. In controlled clinical trials, nebivolol has a side effect profile that is similar to placebo, in particular as it relates to fatigue and sexual dysfunction.

Nebivolol: A Novel Beta-Blocker with Nitric Oxide-Induced Vasodilatation

Nebivolol is a novel beta[1] -blocker with a greater degree of selectivity for beta[1] -adrenergic receptors than other agents in this class and a nitric oxide (NO)-potentiating, vasodilatory effect that is unique among beta-blockers currently available ...

www.ncbi.nlm.nih.gov

 

[bg65]

Metoprolol is anything but cardioselective. Nebivolol is very cardioselective.

Depending on what your problem is, metoprolol can be the better option. But it does have a ton of downsides that modern betablockers like nebivolol dont have (no lipid worsening, no blood glucose and insulin resistance worsening, no limiting of cardiovascular training capacity, and so on).

You may have anecdotal experience that metoprolol might seem non-selective but it is in fact beta-1 selective at common doses. My understanding is that as doses increase the beta-1 selective beta blockers can spill over into antagonism of the peripheral beta receptors, even nebivolol will do this as doses increase. The side effects you listed regarding lipids and insulin resistance are generally associated with the non-selective beta blockers more so than the beta-1 selective drugs.
Carvedilol is another newer beta blocker (around same "age" as nebivolol) and is non-selective. Just pointing that out in reference to you referring to nebivolol as being "modern". (Not that you said this but i don't want people to think that the medical community has been trying to move away from non-selective beta blockers altogether as depending on the application a non-selective drug may be superior to a selective one)

 

[Lumpi]

My understanding is that as doses increase the beta-1 selective beta blockers can spill over into antagonism of the peripheral beta receptors, even nebivolol will do this as doses increase. The side effects you listed regarding lipids and insulin resistance are generally associated with the non-selective beta blockers more so than the beta-1 selective drugs.

This is correct, yet nebivolol even at higher doses at up to 40mg a day showed no significant metabolic or hematologic side effect. Metoprolol at higher dosed did show these side effects. The difference is the nitric oxide mediated and pleiotropic effects that have a strong influence on cholesterol and blood glucose levels. You are correct about them all being cardioselective, I should have been more specific.

 

[bg65]

I think that the nitric oxide pathway itself is worth pursuing. I'd have to look them up to share them here but I've read studies on the beneficial effect of nitric oxide on blood vessel endothelia. I had posted on a pde-5 inhibitor thread that i started daily low dose cialis because of that

 

[bg65]

The role of nitric oxide on endothelial function - PubMed

The vascular endothelium is a monolayer of cells between the vessel lumen and the vascular smooth muscle cells. Nitric oxide (NO) is a soluble gas continuously synthesized from the amino acid L-arginine in endothelial cells by the constitutive calcium-calmodulin-dependent enzyme nitric oxide...

pubmed.ncbi.nlm.nih.gov

This was just a quick google search, lots of info on it

 

[warlock]

The role of nitric oxide on endothelial function - PubMed

The vascular endothelium is a monolayer of cells between the vessel lumen and the vascular smooth muscle cells. Nitric oxide (NO) is a soluble gas continuously synthesized from the amino acid L-arginine in endothelial cells by the constitutive calcium-calmodulin-dependent enzyme nitric oxide...

pubmed.ncbi.nlm.nih.gov

This was just a quick google search, lots of info on it

I sent you a PM if you have time to check. Thanks

 

[warlock]

Does anyone know the equivalent bystolic dose of 100mg metoprolol? I tried to google it but not sure if it's correct. Does 100mg metoprolol equal 10mg bystolic?

 

[fitnessmuscle]

Not to hijack thread lol ,but does anyone have any experience with propranolol? is it useful in anyway?

 

[Lumpi]

Does anyone know the equivalent bystolic dose of 100mg metoprolol? I tried to google it but not sure if it's correct. Does 100mg metoprolol equal 10mg bystolic?

According to my German equivalent dose paper it is 5mg nebivolol.
10mg is equivalent to 200mg metoprolol. You can see it here:

Edit: I deleted the link to PDF file and instead made a screenshot.

 

[warlock]

According to my German equivalent dose paper it is 5mg nebivolol.
10mg is equivalent to 200mg metoprolol. You can see it here:

Edit: I deleted the link to PDF file and instead made a screenshot.

View attachment 175560

Thank you. That's very helpful!

 

[OuchThatHurts]

Not to hijack thread lol ,but does anyone have any experience with propranolol? is it useful in anyway?

Take it every day. Mornings on non-training days, and after training on training days. Adrenaline is vital for workout intensity. This would essentially block those receptors - not exactly good for pushing limits. Although pushing those limits has led to a lot of injuries. It has reduced my GH-induced tachycardia and keeps my heart from pounding before a tense meeting or confrontation - neither of which are physically healthy. Are there better beta cell blockers out there? I guess it all comes down to the specific ailments you're treating in that individual patient. Some sexual related sides but whether 5 times a week is that worse for either of us than 7, who knows?

 

[nothuman]

Metoprolol has the potential to negatively affect your endurance and give sexual problems. Nebivolol will not do those things and will boost NO.

Go with Nebivolol.

 

[muscle96ss]

One thing of note, Metropolol IS FDA approved to treat heart failure whereas Bystolic was declined approval for heart failure. However, I don't know the details to know whether this was due to politics or if there is actually any non-confounded real science behind this.