Among the olol drugs, what is the difference between bisoprolol and metoprolol?

A friend left a message to Huazi, asking, among the lol drugs, metoprolol is very common, but there is also a drug called bisoprolol. What are the differences between the two? Are there any differences in their use? Which one is better?

Hua Zi said that both metoprolol and bisoprolol are olol drugs with the same mechanism of action, but they are slightly different in terms of drug properties, metabolic pathways and adverse reactions. However, for drugs, there is no better, only more suitable, and the choice should be based on the differences in the condition and the sensitivity to the drug.

1. The role of Lolamine drugs

Lolamine is a first-line antihypertensive drug, and its official name is beta-blocker. There are three types of beta receptors in the human body, located in the heart, trachea, adipose tissue, etc. The main one in the heart is beta1 receptor.

Metoprolol and bisoprolol are both selective β1 receptor blockers with high selectivity for the heart. They can inhibit cardiac excitability, reduce myocardial contractility, slow down heart rate, reduce cardiac output, reduce cardiac oxygen consumption, and lower blood pressure.

Lolamine drugs are mainly used to treat hypertension with a fast heart rate (resting heart rate over 80 beats per minute), and are also suitable for the treatment of heart diseases such as coronary heart disease and heart failure.

2. The difference between the two lore drugs

1. Differences in receptor selectivity: Lolamine drugs exert their pharmacological effects by blocking β1 receptors, but they may also affect β2 receptors and β3 receptors. For example, blocking β2 receptors will cause tracheal constriction and may induce asthma. Therefore, the higher the selectivity for β1 receptors, the lower the adverse reactions.

In comparison, bisoprolol is more selective for β1 receptors than metoprolol and has less effect on breathing. For people with asthma, chronic obstructive pulmonary disease (COPD) and other lung diseases, bisoprolol is a more suitable choice.

Lolamine drugs can affect a very small number of male sexual functions, but different trials have drawn different conclusions. If a male friend has a problem taking one of them, he can try another one.

2. Differences in drug properties: Metoprolol is fat-soluble, while bisoprolol is water- and fat-soluble. Fat-soluble drugs are more likely to pass through the blood-brain barrier and are more likely to cause central nervous system adverse reactions such as dizziness, anxiety, and depression, so bisoprolol has fewer adverse reactions. However, studies have found that fat-soluble metoprolol has a more clear protective effect on cardiovascular disease.

In terms of drug interactions and the effects of gene polymorphism, bisoprolol is superior to metoprolol. However, because metoprolol was developed earlier, there are more related clinical studies and more evidence of cardiovascular protection, so it is more commonly used in clinical practice.

3. Different metabolic pathways: 95% of metoprolol is metabolized by the liver, so for patients with renal insufficiency, metoprolol is more suitable and there is no need to adjust the dose. The metabolism of bisoprolol requires the participation of both the liver and kidney, so patients with renal insufficiency need to adjust the dose.

4. Different half-lives of blood drug concentration: The half-life of metoprolol is 3 to 5 hours. In order to maintain stable blood drug concentration, it is necessary to take the drug multiple times a day or choose a sustained-release formulation. The half-life of bisoprolol is 11 hours. Taking it once a day can stably control blood pressure and heart rate.

When blood pressure needs to be lowered quickly or heart rate needs to be controlled, it is appropriate to use regular metoprolol tablets instead of metoprolol sustained-release tablets or bisoprolol.

To sum up, metoprolol and bisoprolol are both olol drugs. They have the same pharmacological mechanism, but they differ in metabolic pathways, organ protection, adverse reactions, duration of action, etc. Everyone needs to understand that there is no "best" drug, only "most suitable", and doctors need to choose the most suitable drug according to the different conditions of each patient. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.