What is the recommended dose and frequency for metoprolol (beta blocker)?

From the Guidelines

Metoprolol should be initiated at a dose of 25 to 50 mg every 6 to 12 hours orally, then transitioned over the next 2 to 3 days to twice-daily dosing of metoprolol tartrate or to daily metoprolol succinate, with a target daily dose of 200 mg as tolerated. The dosing frequency and administration of metoprolol are crucial in managing various cardiovascular conditions, including hypertension, angina, and heart failure, as well as post-myocardial infarction care 1.

Key Considerations

• The initial dose can be adjusted based on individual patient response and tolerance, with careful monitoring of heart rate and blood pressure.
• Metoprolol tartrate is typically administered orally every 6 to 12 hours, while metoprolol succinate can be taken once daily due to its extended-release formulation.
• It is essential to individualize the dose, considering factors such as the presence of heart failure, low output state, or increased risk of cardiogenic shock, which may require cautious dose titration 1.

Administration and Monitoring

• Metoprolol should be taken with or immediately after meals to enhance absorption and reduce the risk of orthostatic hypotension.
• Patients should be closely monitored for signs of heart failure, low output state, or increased risk of cardiogenic shock, and the dose should be adjusted accordingly.
• The medication should never be stopped abruptly due to the risk of rebound hypertension or angina, and dose adjustments may be necessary for elderly patients or those with liver impairment 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION Myocardial Infarction Early Treatment During the early phase of definite or suspected acute myocardial infarction, initiate treatment with metoprolol tartrate as soon as possible after the patient’s arrival in the hospital. Such treatment should be initiated in a coronary care or similar unit immediately after the patient’s hemodynamic condition has stabilized Begin treatment in this early phase with the intravenous administration of three bolus injections of 5 mg of metoprolol tartrate injection each; give the injections at approximately 2-minute intervals. During the intravenous administration of metoprolol tartrate injection, monitor blood pressure, heart rate, and electrocardiogram In patients who tolerate the full intravenous dose (15 mg), initiate metoprolol tartrate tablets, 50 mg every 6 hours, 15 minutes after the last intravenous dose and continued for 48 hours. Thereafter, the maintenance dosage is 100 mg orally twice daily Start patients who appear not to tolerate the full intravenous on metoprolol tartrate tablets either 25 mg or 50 mg every 6 hours (depending on the degree of intolerance) 15 minutes after the last intravenous dose or as soon as their clinical condition allows. The dose and frequency for metoprolol are as follows:

• Initial dose: 3 bolus injections of 5 mg of metoprolol tartrate injection each, given at approximately 2-minute intervals
• Oral dose after intravenous administration:
  • 50 mg every 6 hours for 48 hours, then 100 mg orally twice daily in patients who tolerate the full intravenous dose
  • 25 mg or 50 mg every 6 hours in patients who do not tolerate the full intravenous dose, depending on the degree of intolerance 2

From the Research

Dose and Frequency of Metoprolol

• The optimal dose and frequency of metoprolol vary depending on the condition being treated and the patient's response to the medication 3.
• For hypertension and angina pectoris, metoprolol can be administered in a twice-daily regimen, but satisfactory control can also be maintained with single daily doses of conventional or slow-release formulations 3, 4.
• The starting dose of metoprolol for hypertension is typically 100 mg twice daily, with increases in dosage at fortnightly intervals until satisfactory blood pressure control is achieved or a total of 400 mg metoprolol is reached 4.
• For heart failure, the initiating dose of metoprolol should be very low (12.5 mg metoprolol succinate) and increased gradually over weeks, with the target dose being the maximum tolerated for adequate bradycardia 5.
• The frequency of metoprolol administration can be once daily or twice daily, depending on the specific formulation and the patient's response to the medication 3, 4.

Specific Formulations and Dosages

• Metoprolol succinate is a slow-release formulation that can be administered once daily, with a starting dose of 12.5 mg and a target dose of 200 mg daily 5, 6.
• Metoprolol tartrate is a short-acting formulation that is typically administered twice daily, with a starting dose of 25-50 mg and a target dose of 100-200 mg daily 5, 7.
• The dosage and frequency of metoprolol may need to be adjusted in patients with certain comorbidities, such as asthma or diabetes, due to the potential for adverse effects 3.