ICU Primary PrepCast Epi 97 - ICU Primary Snippet 40 - Metoprolol Vs Verapamil
Apr 22, 2025
Explore the pharmacological showdown between Metoprolol and Verapamil. Discover how Metoprolol, a beta-1 blocker, differs from Verapamil, a calcium channel blocker. They dive into their uses in hypertension, SVT, and other cardiac issues. Learn about their mechanisms and unique hemodynamic effects, including risks of bronchospasm and hypotension. The hosts break down the electrophysiologic impacts and potential adverse events, offering insights into the intricacies of these two important medications.
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Different Classes, Same Downstream Effect
- Metoprolol is a selective beta-1 blocker while verapamil is a non-dihydropyridine L-type calcium channel blocker.
- Both ultimately reduce cardiac calcium entry but via distinct receptor/channel targets and signalling pathways.
Choose Drug By Arrhythmia Type
- Use metoprolol for ventricular tachycardia and for long-term post-MI and heart-failure prophylaxis when stable.
- Reserve verapamil for supraventricular tachycardias and angina, not for VT.
Pitfall: Starting Beta-Blocker Too Early
- A colleague cautioned against starting metoprolol too early in cardiogenic shock as a common clinical mistake.
- This reflects real-world concern about initiating beta-blockers in acute unstable patients.