Carvedilol is better than Metoprolol for HF and DM patients

Some experts think that carvedilol's alpha-1 effects might decrease ischemia and help improve outcomes. Carvedilol may be better than metoprolol...
Maha Khalifa, BS Pharm, PharmD, BCPS, MSc

As a clinical pharmacy specialist, cardiologists will ask you for your recommendations on which beta-blockers are better, carvedilol or metoprolol in patients with heart failure and diabetes. There is tantalizing evidence that carvedilol MIGHT be better. But the truth is not so clear.

The first head-to-head comparison suggests that carvedilol improves survival MORE than metoprolol. Carvedilol (Dilatrend, Dilatrol, carvid, etc) and metoprolol (Lopresor, Seloken Zoc, Logimax, etc) are both beta-blockers, but carvedilol also blocks alpha-1 receptors. Some experts think that carvedilol's alpha-1 effects might decrease ischemia and help improve outcomes. Carvedilol may be better than metoprolol for diabetes patients. This is NOT because carvedilol lowers blood pressure better, but because it doesn't INCREASE blood glucose. Other beta-blockers may increase blood glucose or affect lipids.

Carvedilol can also decrease protein in the urine. These benefits may be due to carvedilol's alpha-blocking effects. The doses of carvedilol compared to that of metoprolol appear to be very low, and generic carvedilol costs a little more than metoprolol. Finally, suggest carvedilol for HF or diabetes patients if needed because other beta-blockers may worsen glycemic control or dyslipidemia.

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