A friend left a message to Huazi, asking in the lore drug, metoprolol is very common, but there is a drug called bisoprolol, what is the difference between the two, what is the difference in use, which is better?
Huazi said that metoprolol and bisoprolol are both lore drugs, and the mechanism of action of the two is the same, but there are slight differences in the nature of the drug, metabolic pathways and adverse reactions. However, for drugs, there is no better, only more suitable, depending on the difference in the condition, and the sensitivity of the drug to choose.
First, the role of lore drugs
Lore drugs are first-line antihypertensive agents, formally known as β receptor blockers. There are 3 kinds of β receptors in the human body, which are located in the heart, trachea, adipose tissue, etc., and the heart is mainly β1 receptors.
Both metoprolol and bisoprolol are selective beta-1 blockers that are highly selective for the heart and can inhibit the excitability of the heart, reduce myocardial contractility, slow heart rate, reduce cardiac output, reduce cardiac oxygen consumption, and lower blood pressure.
Lore drugs are mainly used for the treatment of hypertension with a rapid heart rate (resting heart rate of more than 80 beats per minute), and are also suitable for the treatment of heart diseases such as coronary heart disease and heart failure.
Second, the difference between two lore drugs
1. Differences in receptor selectivity: Lore drugs play a pharmacological role by blocking β1 receptors, but they may also affect β2 receptors and β3 receptors. For example, blocking the beta2 receptor will cause tracheal contractions, which may induce asthma. Therefore, the higher the selectivity of the β1 receptor, the lower the adverse reactions.
In contrast, bisoprolol is more selective to beta1 receptors than metoprolol and has less effect on respiration. For people with asthma, COPD, and other lung diseases, the choice is more appropriate than soolol.
Lore drugs have an effect on very few male functions, although the conclusions have been different in different trials. If a male friend has a problem taking one of them, you can try changing to another.
2. Different drug characteristics: metoprolol is fat soluble, bisoprolol is hydrolytic bispolytic. Fat-soluble drugs are more likely to pass through the blood-brain barrier and are prone to central adverse reactions such as dizziness, anxiety, and depression, so there are fewer adverse reactions than sorolol. However, studies have found that fat-soluble metoprolol has a more definitive cardiovascular protective effect.
In terms of the effect of drug interactions and gene polymorphisms, bisoprolol is superior to metoprolol. However, because metoprolol was developed earlier, there were more related clinical studies, and more evidence of cardiovascular protection was found, so it was more commonly used in the clinic.
3. Different metabolic pathways: 95% of metoprolol is metabolized by the liver, so for renal insufficiency, it is more suitable to choose metoprolol, and it is not necessary to adjust the dose. The metabolism of bisoprolol requires the simultaneous participation of the liver and kidneys, so patients with renal insufficiency need to adjust the dose.
4. The half-life of the blood drug concentration is different: the half-life of metoprolol is 3 to 5 hours, in order to maintain the stability of the blood drug concentration, it is necessary to administer the drug multiple times a day, or choose the extended-release dosage form. The half-life of bisoprolol is 11 hours, and taking it once a day can stabilize blood pressure and heart rate.
When it is necessary to quickly lower blood pressure and control heart rate, it is appropriate to use ordinary tablets of metoprolol instead of metoprolol extended-release tablets or bisoprolol.
To sum up, metoprolol and bisoprolol are both lore drugs, the pharmacological mechanism of the two is the same, but in the metabolic pathway, organ protection, adverse reactions, time of action and other aspects of differences. We need to understand that there is no "best" drug, only "most suitable", and doctors need to choose the most suitable drug according to the different situations of each patient. If you have any questions about medication, consult your doctor or pharmacist. I am a pharmacist Huazi, welcome to follow me and share more health knowledge.