Maximum Dose of Metoprolol Tartrate
The maximum recommended dose of metoprolol tartrate is 450 mg per day for hypertension, 400 mg per day for angina pectoris, and 200 mg per day (100 mg twice daily) for post-myocardial infarction maintenance therapy. 1
Dosing by Indication
Hypertension
- Effective dosage range: 100-450 mg per day
- Maximum studied dose: 450 mg per day
- Dosages above 450 mg per day have not been studied 1
- Note that beta-1 selectivity diminishes as the dose increases
Angina Pectoris
- Effective dosage range: 100-400 mg per day
- Maximum studied dose: 400 mg per day
- Dosages above 400 mg per day have not been studied 1
Post-Myocardial Infarction
- Acute phase (IV): Maximum 15 mg total (5 mg every 5 minutes × 3 doses) 2, 1
- Maintenance therapy: 200 mg per day (100 mg twice daily) 3, 1
- The 2013 ACC/AHA STEMI guidelines specifically recommend titrating to a daily dose of 200 mg as tolerated 3
Supraventricular Tachycardia
- Oral maintenance: Up to 400 mg daily in divided or single doses with long-acting formulations 4
Important Clinical Considerations
Dosing frequency matters for efficacy: While once-daily dosing can be effective for hypertension, lower doses (especially 100 mg) may not maintain full effect over 24 hours, requiring larger or more frequent daily doses 1. This should be evaluated by measuring blood pressure near the end of the dosing interval.
Special populations requiring dose modification:
- Hepatic impairment: Metoprolol blood levels increase substantially; initiate at low doses with cautious gradual titration 1
- Elderly patients (>65 years): Use low initial starting doses given greater frequency of decreased hepatic, renal, or cardiac function 1
- Renal impairment: No dose adjustment required 1
Common Pitfall
The most critical error is confusing metoprolol tartrate with metoprolol succinate (extended-release). Metoprolol succinate has different maximum dosing: up to 400 mg once daily for maintenance therapy 4. Always verify which formulation is being prescribed, as the dosing schedules and maximum doses differ between the two formulations.