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What Is the Difference between Lisinopril and Metoprolol?

By H. Lo
Updated Jun 04, 2024
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Lisinopril and metoprolol are both medications that treat high blood pressure. The main difference between lisinopril and metoprolol is that lisinopril is an angiotensin-converting enzyme (ACE) inhibitor while metoprolol is a beta blocker. As they are two different types of medications, lisinopril and metoprolol each help control high blood pressure through different means. Other differences between lisinopril and metoprolol include dosage, additional medical conditions they treat, and safety issues for pregnant or breastfeeding women.

High blood pressure is a medical condition in which the heart pumps blood with too much force through the arteries. An ACE inhibitor lowers blood pressure by preventing the body from producing a substance called angiotensin II. Angiotensin II makes the heart work harder and causes high blood pressure because it narrows blood vessels. A beta blocker, on the other hand, lowers blood pressure by blocking the effects that epinephrine has on the body. By blocking epinephrine, or adrenaline, a beta blocker enables the heart to beat at a slower pace, and less forcefully as well.

Lisinopril comes in tablet form and the usual prescription is to take it once a day. In addition to high blood pressure, lisinopril is also helpful in treating heart failure, when combined with other medications. Metoprolol also comes in tablet form, as well as in extended-release tablet form, with a usual prescription for the tablet being once or twice a day, and the extended-release tablet being once a day; the extended-release tablet is designed to allow the medication to release slowly into the body over a period of time, so the medication stays in the system longer. Unlike lisinopril, metoprolol needs to accompany or follow a meal. Other medical conditions that metoprolol helps treat include chest pain, heart failure and irregular heartbeat.

Pregnant or breastfeeding women should not use lisinopril. In pregnant women, lisinopril can cause the baby to have birth defects. It is not known whether lisinopril is found in breast milk, but as pregnant women should not take the medication, it is the usual recommendation that breastfeeding women not take it as well. As for metoprolol, pregnant or breastfeeding women should only take the medication if their doctor recommends it; it will depend on their condition and if it will be beneficial to the mother. This is because it is not known whether metoprolol has a negative effect on unborn babies.

What Are The Side Effects?

Lisinopril and Metoprolol have similar side effects, including dizziness, tiredness, lightheadedness, and nausea. However, some more serious side effects of these medications differ. Lisinopril can cause high potassium levels and fainting. It’s important to have regular blood checks while taking Lisinopril to maintain healthy potassium levels.

On the other hand, Metoprolol can potentially reduce blood flow to your hands and feet, causing them to be cold or turn blue from circulation loss. If you notice this while taking Metoprolol, tell your doctor immediately.

Other serious side effects of both medications can include liver damage, vomiting/diarrhea, weight changes, changes in mood, or swelling in the hands or feet. Tell your doctor if you experience any of these or other symptoms while taking either medication.

This is not a complete list of side effects for either medication. Check with your doctor or pharmacist for more information regarding side effects.

What Other Conditions Do They Treat?

Lisinopril is also commonly used to help patients after they have suffered a heart attack. Heart attacks can sometimes damage the muscles and tissues in and around the heart. Lisinopril can benefit patients as early as 24 hours after a heart attack to help protect those muscles and increase survival rates.

Metoprolol is also commonly prescribed to patients who have recently suffered a heart attack. Metoprolol differs from Lisinopril in that it is used for chest pain more than tissue damage. Metoprolol also treats patients suffering from heart failure.

Metoprolol can also treat migraines, irregular heartbeat, and some movements or tics caused by mental illness.

What Dosage Looks Like

Lisinopril and Metoprolol differ in the amount of medication you may have to take. Each patient is different, so remember to follow your doctor’s instructions on dosage closely. Lisinopril’s first dose will typically be 10mg for high blood pressure treatment and 5mg for heart failure or treatment after a heart attack. Lisinopril’s dosage does not usually exceed 40mg.

Metoprolol’s dosage, however, typically starts at 25-100mg for most of the conditions it treats, depending on the type of tablet/capsule you are prescribed. Metoprolol’s dosage does not usually exceed 400mg. Both medications are usually taken just once per day. 

If you miss a dose of either medication it is best to take the missed dose as soon as you remember. However, if it is close to your next dose, you should just skip the missed dose and take the next dose. As with any medication, you should never double dose.

Other Ways To Help Lower Blood Pressure

Your doctor may talk to you about other changes you can make in your lifestyle to help these medications work best for your condition. For example, your doctor may ask you to change your diet, such as reducing your intake of salt or sodium and certain fats.

If you are taking Lisinopril, you may also need to reduce the amount of potassium in your diet. A great way to do that is to keep a close eye on what ingredients are high in potassium in the foods you eat.

It is best to avoid smoking cigarettes or marijuana and drinking alcohol while taking these medications as these things can prevent the treatment from working correctly. Alcohol can also contribute to liver damage associated with either drug.

What Else You Should Know

Lisinopril and Metoprolol are not incredibly different from each other with what conditions they treat and the side effects involved. However, these medications differ on a larger scale by treating these conditions in different ways. 

The main differences between these drugs are in the things that can affect their usefulness. Many preexisting conditions can affect the way these drugs interact within your body. It is important to tell your doctor about any preexisting conditions you may have such as diabetes, other circulation issues, or liver disease.

Both of these medications can interact with other drugs, be sure to discuss any other medications you are taking with your doctor before starting any new medication. If your doctor has prescribed you either of these medications, it is vital to remember that they believe the benefits outweigh the risks. Always follow your doctor’s instructions closely.

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Discussion Comments
By fBoyle — On Oct 29, 2013

@fify-- I'm not sure how the body responds when these are taken together. But as an athlete, I know that metoprolol prevents my heartbeat from going up too much, but lisinopril doesn't. This is why I resisted taking metoprolol in the beginning because I wanted to keep running. But my high pulse rate is more of a problem than my blood pressure, so metoprolol is the right drug for me.

By SarahGen — On Oct 28, 2013

@fify-- Yes, they can be prescribed together. As you said, they do the same thing, but very differently. Depending on what a patient's blood pressure ratings and pulse are like, a doctor may want to prescribe both.

I take both of these together for high blood pressure. In terms of results, they are both effective although at times, I feel that the lisinopril works better than metoprolol. I don't know if this applies to everyone though or if it is just me.

As far as I know, lisinopril is better for high blood pressure if someone has risk of kidney damage due to diabetes or some other reason. I have type 2 diabetes in addition to high blood pressure, so maybe that's why lisinopril works better for me.

By fify — On Oct 28, 2013

Since lisinopril and metoprolol reduce high blood pressure through different ways, are they ever prescribed together for a high blood pressure patient? Or do they interact negatively with one another because of side effects?

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