Switching from metoprolol tartrate to succinate
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Switching from Metoprolol Tartrate to Metoprolol Succinate: Clinical Insights
Introduction to Metoprolol Tartrate and Succinate
Metoprolol is a beta-blocker commonly used to treat various cardiovascular conditions, including heart failure, hypertension, and angina. It is available in two formulations: metoprolol tartrate (MT) and metoprolol succinate (MS). While both forms are effective, they differ in their pharmacokinetic properties and dosing schedules. This article synthesizes research findings on the clinical implications of switching from metoprolol tartrate to metoprolol succinate.
Hemodynamic and Clinical Effects in Heart Failure
Hemodynamic Comparisons
Studies have shown that both metoprolol tartrate and metoprolol succinate produce similar hemodynamic effects in patients with heart failure. For instance, a study comparing the two formulations found no significant differences in cardiac index, systemic vascular resistance, or stroke volume index after three months of therapy2. Both formulations resulted in parallel adverse hemodynamic effects when readministered during chronic therapy2.
Clinical Outcomes
In terms of clinical outcomes, metoprolol succinate has been shown to offer some advantages over metoprolol tartrate. For example, a study on patients with vasospastic angina found that metoprolol succinate was more effective in reducing the incidence of clinically significant angina attacks compared to metoprolol tartrate3. However, there were no significant differences in primary endpoints such as cardiovascular death, myocardial infarction, or stroke between the two groups3.
Impact on Heart Rate and Cardiac Function
Heart Rate Reduction
Research comparing the effects of metoprolol succinate and metoprolol tartrate on heart rates in patients with acute myocardial infarction found no significant differences in the degree and trend of heart rate reduction between the two groups over a 72-hour period4. Another study on chronic congestive heart failure patients reported that metoprolol succinate was more effective in reducing average heart rate compared to metoprolol tartrate8.
Cardiac Function Improvement
In patients with chronic obstructive pulmonary disease (COPD) complicating chronic heart failure, metoprolol succinate was found to be more effective in improving cardiac function compared to metoprolol tartrate5. Both formulations, however, showed similar safety profiles and no significant differences in lung function or quality of life scores5.
Pharmacokinetic and Pharmacodynamic Properties
Metoprolol succinate is designed as a controlled-release/extended-release formulation, providing relatively constant plasma concentrations and beta-1 blockade with the convenience of once-daily administration7. This formulation disintegrates into individual pellets that release the drug at a constant rate over approximately 20 hours, which may offer advantages in terms of patient compliance and consistent therapeutic effects7.
Conclusion
Switching from metoprolol tartrate to metoprolol succinate can offer several clinical benefits, including more effective heart rate reduction and improved cardiac function in certain patient populations. Both formulations have similar hemodynamic effects and safety profiles, but the extended-release nature of metoprolol succinate provides a more convenient dosing schedule and potentially better patient adherence. Clinicians should consider these factors when deciding on the most appropriate formulation for their patients.
Sources and full results
Most relevant research papers on this topic
Endothelial function is unaffected by changing between carvedilol and metoprolol in patients with heart failure-a randomized study
Endothelial function remains unchanged when switching from carvedilol to metoprolol tartrate or metoprolol succinate, and blood pressure and heart rate remain unchanged in patients with mild heart failure.
RCT
Rigorous JournalHemodynamic comparison of twice daily metoprolol tartrate with once daily metoprolol succinate in congestive heart failure.
Metoprolol tartrate and metoprolol succinate both produce similar hemodynamic and clinical effects in congestive heart failure patients, with once daily metoprolol succinate offering a faster initiation and potentially better treatment outcomes.
RCTComparative evaluation of the effectiveness of metoprolol succinate and metoprolol tartrate in patients with vasospastic angina
Metoprolol succinate has a significant advantage in reducing clinically significant angina attacks, but no significant difference in cardiovascular events or death between the two drugs.
Comparison of effects of metoprolol succinate sustained-release tablets and metoprolol tartrate tablets on heart rates of patients with acute myocardial infarction
Metoprolol succinate sustained-release tablets and metoprolol tartrate tablets both decrease heart rate in acute myocardial infarction patients, but their effects differ in the first 72 hours.
RCTClinical Observation of Two Dosage Forms of Metoprolol in the Treatment of Chronic Obstructive Pulmonary Disease Complicating with Chronic Heart Failure
Metoprolol succinate sustained-release tablet is more effective than Metoprolol tartrate tablet in improving cardiac function in COPD patients with chronic heart failure, but both have similar safety.
RCTMeta-analysis of the effects of carvedilol versus metoprolol on all-cause mortality and hospitalizations in patients with heart failure.
Carvedilol and metoprolol succinate have similar effects in reducing all-cause mortality in patients with heart failure with reduced ejection fraction.
Meta-AnalysisMetoprolol Succinate Combination in the Treatment of Hypertension
Metoprolol succinate combined with diuretics effectively reduces cardiovascular events and mortality in hypertension patients.
Literature ReviewASSA14-07-02 Comparision of metoprolol succinate sustained-release tablets and metoprolol tartrate tablets on cardiac function in patients with chronic congestive heart failure
Metoprolol succinate sustained-release tablets decreased average heart rate in chronic congestive heart failure patients compared to Metoprolol Tartrate tablets, with equal effects on cardiac and renal function.
Observational StudyRigorous Journal