What is the equivalent dose of metoprolol tartrate (beta-blocker) when converting from metoprolol succinate (beta-blocker)?

From the Guidelines

When converting from metoprolol succinate to metoprolol tartrate, the equivalent daily dose is the same, but metoprolol tartrate must be divided and given twice daily instead of once daily. For example, if a patient is taking 100 mg of metoprolol succinate (extended-release) once daily, they should be switched to 50 mg of metoprolol tartrate twice daily for a total daily dose of 100 mg. This conversion maintains the same total daily dose while accounting for the different formulations. Metoprolol succinate is an extended-release formulation designed for once-daily dosing, while metoprolol tartrate is immediate-release and requires twice-daily dosing to maintain consistent blood levels throughout the day. Both medications contain the same active beta-blocking component, but their different salt forms and release mechanisms affect how they're administered. When making this switch, it's essential to monitor the patient for any changes in blood pressure or heart rate control, as individual responses may vary slightly despite equivalent dosing 1.

Some key points to consider when making this conversion include:

• The dosage of metoprolol tartrate should be adjusted based on the patient's response and tolerance, with a typical range of 25-200 mg per day, divided into two doses 1.
• Metoprolol tartrate can be administered orally, with or without food, and should be taken at the same time each day to maintain consistent blood levels 1.
• Patients with certain medical conditions, such as heart failure or bronchospastic disease, may require closer monitoring and adjustment of their metoprolol tartrate dosage 1.
• The conversion from metoprolol succinate to metoprolol tartrate should be done under the guidance of a healthcare professional, who can assess the patient's individual needs and adjust the dosage accordingly 1.

Overall, the conversion from metoprolol succinate to metoprolol tartrate requires careful consideration of the patient's individual needs and medical history, as well as close monitoring of their response to the new medication. By following these guidelines and adjusting the dosage as needed, healthcare professionals can help ensure a safe and effective transition for their patients 1.

From the Research

Equivalent Dose of Metoprolol Tartrate

To determine the equivalent dose of metoprolol tartrate when converting from metoprolol succinate, we need to consider the pharmacokinetic and pharmacodynamic properties of both formulations.

• Metoprolol succinate is a controlled-release formulation, whereas metoprolol tartrate is an immediate-release formulation.
• The study 2 compared the hemodynamic effects of twice daily metoprolol tartrate with once daily metoprolol succinate in congestive heart failure patients.
• The study found that metoprolol tartrate and metoprolol succinate produce similar hemodynamic and clinical effects acutely and chronically, despite the fourfold greater starting dose of metoprolol succinate used in the study.
• The equivalent dose of metoprolol tartrate can be estimated based on the dose ratio used in the study, which was 50 mg twice a day of metoprolol tartrate and 100 mg once a day of metoprolol succinate.
• This suggests that the equivalent dose of metoprolol tartrate is approximately half the dose of metoprolol succinate, given twice daily.

Clinical Implications

• The choice of metoprolol formulation depends on individual patient factors, such as compliance and tolerance.
• Metoprolol succinate may be preferred for its convenience and once-daily dosing regimen.
• Metoprolol tartrate may be preferred for its flexibility in dosing and potential for better control of symptoms.
• The study 3 reviewed the pharmacodynamic and pharmacokinetic properties of metoprolol and its therapeutic efficacy in hypertension, ischemic heart disease, and related cardiovascular disorders.
• The study 4 compared the long-term clinical advantages of a vasodilating beta blocker (celiprolol) with metoprolol in patients with chronic heart failure.
• The study 5 systematically reviewed the data from head-to-head studies directly comparing metoprolol succinate with other beta blockers in the treatment of heart failure or atrial fibrillation.
• The study 6 discussed the pharmacological properties, trial results, comorbidity prescribing, and neural pathophysiology of beta blockers, suggesting that European hypertension guideline downgrading of beta blockers is not justified.

Key Points

• Metoprolol succinate and metoprolol tartrate have similar hemodynamic and clinical effects in congestive heart failure patients.
• The equivalent dose of metoprolol tartrate is approximately half the dose of metoprolol succinate, given twice daily.
• The choice of metoprolol formulation depends on individual patient factors.
• Beta blockers, including metoprolol, have solid documentation in preventing cardiovascular complications in the treatment of hypertension.