Metoprolol Tartrate vs Succinate: Key Differences

Key Takeaways

Both metoprolol tartrate and metoprolol succinate work in similar ways for the treatment of high blood pressure and angina. However, each drug is also approved for different health conditions and cannot be used interchangeably.
Metoprolol succinate can be used to treat chronic heart failure, while metoprolol tartrate can be used to treat unstable angina, certain arrhythmias such as atrial fibrillation and flutter, and acute myocardial infarction (heart attack).
Metoprolol succinate is preferred over tartrate in heart failure because of improved survival, reduced need for hospitalizations, and overall beneficial effects on patient well-being.

Metoprolol tartrate and metoprolol succinate contain the same active ingredient, metoprolol, which is a beta-blocker. But they are different salt forms and are used to treat different conditions, are dosed differently, and cannot be interchanged. Please continue reading to find out the key differences between metoprolol tartrate vs metoprolol succinate.

Which is better: metoprolol tartrate or metoprolol succinate?

Both metoprolol tartrate and metoprolol succinate are FDA-approved prescription medications. One is not better than the other. They have similar mechanisms of action; thus, they work in similar ways, but they are used to treat people with different conditions.

The main difference is that metoprolol tartrate is a film-coated immediate-release tablet, whereas metoprolol succinate is an extended-release formulation that allows once-daily dosing. Only metoprolol succinate is used for people with cardiac failure.

Here are some of the other differences between metoprolol tartrate vs metoprolol succinate.

Mechanism of Action

Metoprolol tartrate and metoprolol succinate belong to a group of drugs called beta blockers, targeting the beta receptors residing in the heart. The two drugs are used to treat high blood pressure and chest pain due to heart disease. They slow down the heart rate, relax the blood vessels, and lower blood pressure.

Generic Forms and Trade Names

The brand name Lopressor contains the generic version of metoprolol tartrate (immediate-release tablet). Toprol XL is the brand name product for the generic name metoprolol succinate (extended-release tablet).

Uses

Both metoprolol tartrate and metoprolol succinate are used to treat high blood pressure and angina pectoris (chest pain due to reduced blood flow in people with coronary heart disease).

In addition, metoprolol tartrate is also used to treat unstable angina, certain arrhythmias such as atrial fibrillation and flutter, and acute myocardial infarction (heart attack). It is also prescribed to prevent future heart attacks in those who have had a heart attack in the past.

In addition to high blood pressure and angina, metoprolol succinate is used to treat chronic heart failure.

Off-label uses of metoprolol include heart arrhythmias such as supraventricular tachycardia and thyroid storm.

Interestingly, while other beta-blockers, such as propranolol, are used off-label to alleviate anxiety symptoms, both metoprolol succinate and metoprolol tartrate are not used for anxiety.

Age Range

Metoprolol tartrate (the immediate-release formulation) is approved for use in adults only. The safety and efficacy of this medication have not been established in pediatric patients.

Metoprolol succinate (the extended-release formulation) has been used in children 6 years of age and older to treat high blood pressure by itself or in combination with other anti-hypertensive medications.

Metoprolol succinate is dosed per body weight for children aged 6 or older and can be adjusted by doctors based on clinical responses.

Dosage Forms, Dosage, and Administration

Metoprolol tartrate tablet is an immediate-release formulation available in strengths of 25 milligrams (mg), 37.5 mg, 50 mg, 75 mg, and 100 mg. Depending on the indication (why you’re taking this medication), you may take metoprolol tartrate once or multiple times a day (typically twice daily).

Your healthcare provider may advise taking metoprolol tartrate immediate-release tablets with a meal or immediately after you eat, and you should do so consistently.

Metoprolol tartrate injection solution is also available for intravenous (into the vein) use. The usual dose of metoprolol tartrate is typically between 100 mg and 450 mg daily.

Metoprolol succinate tablet is an extended-release formulation available in strengths of 25 mg, 50 mg, 100 mg, and 200 mg. Unlike metoprolol tartrate, you need to take metoprolol succinate only once a day.

The extended-release tablet can be taken with or without food. You can cut the metoprolol succinate tablet in two, but you should not chew or crush it.

Metoprolol succinate is also available in a sprinkle capsule form under the brand name Kapspargo Sprinkle. The usual dose of metoprolol succinate ranges between 25 mg and 100 mg daily.

Side Effects

Metoprolol tartrate and metoprolol succinate cause similar side effects. The most common side effects include tiredness, dizziness, shortness of breath, bradycardia (slow heart rate), low blood pressure, depression, diarrhea, and rash.

Additionally, metoprolol tartrate can cause side effects such as blurred vision, headache, ringing in the ears, confusion, and short-term memory loss.

Metoprolol succinate can cause side effects such as dry mouth, constipation, and sexual dysfunction.

Warnings

The risks of taking metoprolol succinate and metoprolol tartrate include:

Increased blood pressure, worsening chest pain, and myocardial infarction (heart attack) if the medication is stopped suddenly
Worsening heart failure
Increased risk during major surgery done using general anesthesia
Slowed heart rate
Worsening bronchospastic disease (asthma, COPD)
Masking of signs (for example, fast heart rate) in people with hypoglycemia (low blood sugar)
Masking of signs of thyrotoxicosis (high thyroid hormone levels)
Increase in blood pressure in people with a rare tumor called pheochromocytoma
Serious allergic reaction, including anaphylaxis (throat closing)
May not be safe for people with lung disease, blood circulation problems, heart conduction defects, pheochromocytoma, diabetes, liver disease, and hyperthyroidism (overactive thyroid)
Contraindicated in people with heart conditions such as cardiogenic shock, decompensated heart failure, second or third-degree heart block, sick sinus syndrome, and acute pulmonary edema

As mentioned, compared to metoprolol succinate, metoprolol tartrate is approved to treat a few more heart-related problems. Therefore, metoprolol tartrate should not be used in the following situations:

Heart attack patients with a heart rate of less than 45 beats per minute or a systolic blood pressure (the top number of blood pressure reading) of less than 100 mmHg (millimeters of mercury);
People with high blood pressure or chest pain who also have severe circulation problems.

Drug Interactions

Both metoprolol succinate and tartrate can interact with other drugs and increase the risk of serious adverse effects. Some of the drug interactions of metoprolol include other blood pressure medications such as other beta blockers and calcium channel blockers, heart medications, and certain antidepressants and antipsychotics.

This is not a complete list of metoprolol interactions. Give your healthcare professional a complete list of your other medications, including prescription drugs, over-the-counter drugs, dietary supplements, and herbal remedies to lower the risk of possible drug interactions.

Cost

In terms of the cost of metoprolol tartrate vs metoprolol succinate, the succinate salt costs more at most pharmacies.

Can I switch from metoprolol tartrate to succinate?

You should not switch from metoprolol tartrate to succinate without talking to your healthcare provider. These two medications are not interchangeable. They are used to treat different conditions and are dosed differently.

However, your doctor can prescribe both metoprolol tartrate and metoprolol succinate to treat high blood pressure and alleviate chest pain (angina). If you are taking metoprolol for either of these conditions and want to change from one form to the other, your doctor will tell you how to make the switch.

Why is metoprolol succinate preferred over tartrate in heart failure?

Metoprolol succinate is preferred over tartrate in heart failure because of certain differences in how the drugs are absorbed. Note that only metoprolol succinate is FDA-approved for the treatment of stable heart failure. Metoprolol tartrate is not FDA-approved for this purpose.

Several randomized, placebo-controlled trials have shown that metoprolol succinate and other beta-blockers, such as bisoprolol and carvedilol, reduce the risk of death in people with heart failure.

The COMET trial directly compared a beta blocker called carvedilol with metoprolol tartrate in people with chronic heart failure. It showed that carvedilol can improve outcomes and lower death rates more than metoprolol tartrate.

The MERIT-HF showed that taking metoprolol succinate (extended-release formulation) leads to improved survival, reduced need for hospitalizations due to worsening heart failure, improved NYHA functional class, and overall beneficial effects on patient well-being.

What is the advantage of metoprolol succinate?

The advantages of metoprolol succinate versus metoprolol tartrate include:

Better tolerated.
Easier to start at a higher dose.
Easier to increase the dose.
More convenient to take (once daily instead of multiple times daily).

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