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 1. The dosing frequency of metoprolol depends on the specific formulation used, with metoprolol tartrate typically requiring twice-daily dosing and metoprolol succinate dosed once daily.
- Key considerations for metoprolol dosing include:
- Initial dose: 25 to 50 mg every 6 to 12 hours orally
- Transition to maintenance dose: over 2 to 3 days
- Target daily dose: 200 mg as tolerated
- Formulation: metoprolol tartrate (twice daily) or metoprolol succinate (once daily) According to the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, metoprolol tartrate can be administered intravenously at a dose of 5 mg every 5 minutes as tolerated, up to a total of 3 doses, with subsequent transition to oral dosing 1. In patients with unstable angina or non-ST-elevation myocardial infarction, beta blockers like metoprolol are recommended to be initiated orally within the first 24 hours, in the absence of contraindications, with a usual dose of 50 to 200 mg twice daily 2.
- Contraindications to metoprolol include:
- Signs of heart failure
- Low output state
- Increased risk of cardiogenic shock
- Prolonged first-degree or high-grade AV block
- Reactive airways disease It is essential to individualize the dose of metoprolol based on patient response and tolerance, with monitoring of heart rate, blood pressure, and other clinical parameters to guide adjustments in therapy 1, 2.
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 recommended metoprolol dose and frequency are as follows:
- Initial dose: 3 bolus injections of 5 mg of metoprolol tartrate injection each, given at approximately 2-minute intervals
- Post-intravenous dose: + 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 3
From the Research
Metoprolol Dose and Frequency
- The dose and frequency of metoprolol can vary depending on the specific condition being treated and the individual patient's response to the medication 4, 5.
- Studies have shown that metoprolol can be effective in controlling blood pressure and heart rate when taken once daily, with doses ranging from 100 mg to 200 mg 4, 5.
- A study comparing metoprolol to atenolol found that metoprolol had some limitations in controlling systolic blood pressure and heart rate, but was still effective in reducing blood pressure over a 24-hour period 4.
- Another study found that metoprolol 100 mg and 200 mg once daily effectively lowered blood pressure over a 24-hour period, and 200 mg slow-release tablets (Durules) once daily gave beta-receptor blockade for 24 hours 5.
- In the treatment of heart failure, metoprolol succinate has been shown to be associated with significant mortality and morbidity benefits, and is considered a cornerstone therapy in heart diseases such as heart failure and atrial fibrillation 6, 7.
- The combination of beta-blockers, including metoprolol, with ACE inhibitors has been shown to be effective in controlling blood pressure and improving cardiovascular outcomes, and is often used in the treatment of hypertension and heart failure 6, 8.
Specific Dosing Recommendations
- For hypertension, metoprolol can be taken once daily, with doses ranging from 100 mg to 200 mg 4, 5.
- For heart failure, metoprolol succinate is often used, with doses ranging from 100 mg to 200 mg once daily 6, 7.
- The specific dose and frequency of metoprolol should be determined by a healthcare provider based on the individual patient's needs and response to the medication 4, 6, 5, 8, 7.