Metoprolol succinate versus tartrate
Pro Research Analysisby 
Searched over 200M research papers
Comparison of Metoprolol Succinate and Metoprolol Tartrate
Introduction to Metoprolol Forms
Metoprolol, a beta-blocker, is commonly prescribed in two forms: metoprolol succinate (MS) and metoprolol tartrate (MT). Both are used to treat conditions such as heart failure, hypertension, and angina, but they differ in their pharmacokinetics and clinical applications.
Hemodynamic Effects in Heart Failure
Hemodynamic Benefits and Adverse Effects
Both metoprolol succinate and metoprolol tartrate have been shown to produce significant hemodynamic benefits in patients with congestive heart failure. A study comparing the two forms found no significant difference in their hemodynamic and clinical effects over a three-month period. Both forms led to a decrease in cardiac index and stroke volume index, and an increase in systemic vascular resistance upon readministration during chronic therapy.
Mortality and Hospitalization in Heart Failure
Comparative Mortality Benefits
A meta-analysis comparing carvedilol and metoprolol (both tartrate and succinate) in patients with heart failure with reduced ejection fraction (HFrEF) found that while carvedilol reduced all-cause mortality more effectively than metoprolol tartrate, there was no significant difference in mortality or hospitalization rates between carvedilol and metoprolol succinate. This suggests that metoprolol succinate is as effective as carvedilol in reducing mortality in HFrEF patients.
Cardiac Function and Heart Rate
Impact on Cardiac Function
In patients with chronic congestive heart failure, metoprolol succinate was found to decrease the average heart rate more effectively than metoprolol tartrate, although both forms had similar effects on other cardiac and renal function parameters. Another study on acute myocardial infarction patients showed that while both forms reduced heart rates significantly over 72 hours, there was no significant difference in the degree and trend of heart rate reduction between the two groups.
Clinical Outcomes in Specific Conditions
Vasospastic Angina
In patients with vasospastic angina, metoprolol succinate was more effective in reducing the incidence of clinically significant angina attacks compared to metoprolol tartrate. However, there were no significant differences in the rates of cardiovascular mortality, myocardial infarction, or stroke between the two groups.
Chronic Obstructive Pulmonary Disease (COPD) with Heart Failure
For patients with COPD complicating chronic heart failure, metoprolol succinate showed a higher total effective rate in improving cardiac function compared to metoprolol tartrate, although both forms had similar safety profiles and effects on lung function.
Structural and Pharmacokinetic Differences
Solid-State Behavior
The solid-state structures of metoprolol tartrate and succinate salts exhibit different behaviors upon temperature changes. Metoprolol succinate shows a reversible anisotropic lattice expansion/contraction and quickly recrystallizes after melting, whereas metoprolol tartrate expands/contracts isotropically and forms an amorphous solid upon cooling, taking several days to revert to its crystalline form . These differences can influence their stability and shelf-life.
Conclusion
Both metoprolol succinate and metoprolol tartrate are effective in managing heart failure, reducing heart rates, and improving cardiac function. Metoprolol succinate may offer advantages in terms of heart rate reduction and stability, while both forms show similar safety profiles and efficacy in reducing mortality and hospitalization rates. The choice between the two may depend on specific patient conditions and clinical goals.
Sources and full results
Most relevant research papers on this topic