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

From the Guidelines

The recommended dose of metoprolol is 100-200 mg daily of immediate-release metoprolol tartrate divided into two doses, or 50-200 mg once daily of extended-release metoprolol succinate, with a daily frequency of 1-2 times, as indicated in the 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.

Key Considerations

• The dose and frequency of metoprolol may vary based on the formulation and condition being treated, such as hypertension, angina, heart failure, or post-heart attack (myocardial infarction) 1.
• Metoprolol works by blocking beta-1 adrenergic receptors, primarily in the heart, reducing heart rate and blood pressure.
• Doses should be taken consistently, with or without food, and should never be stopped abruptly as this can cause rebound effects.
• Dose adjustments may be needed for elderly patients or those with liver impairment.
• Common side effects include fatigue, dizziness, and bradycardia (slow heart rate).

Specific Conditions

• For hypertension, the typical starting dose is 25-100 mg daily of immediate-release metoprolol tartrate divided into two doses, or 50-100 mg once daily of extended-release metoprolol succinate (Toprol XL) 1.
• For angina, 50-100 mg twice daily of immediate-release or 100-400 mg once daily of extended-release is common 1.
• For heart failure, patients usually start at 12.5-25 mg once daily of extended-release, gradually increasing to a target of 200 mg daily as tolerated 1.
• For post-heart attack (myocardial infarction), 25-50 mg twice daily of immediate-release is typical 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 recommended 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 for maintenance
• Alternative oral dose for patients who do not tolerate the full intravenous dose: 25 mg or 50 mg every 6 hours, depending on the degree of intolerance 2

From the Research

Dose and Frequency for Metoprolol

The recommended dose and frequency for metoprolol can vary depending on the condition being treated.

• For hypertension, metoprolol can be administered twice daily 3.
• Some evidence suggests that once daily administration may be possible in treating hypertension 3.
• In patients with chronic heart failure, metoprolol controlled-release/extended-release (CR/XL) can be initiated at a low dosage of 12.5 to 25 mg once daily and gradually increased at 2-weekly intervals until the target dosage (200 mg once daily) or maximal tolerated dosage is attained 4.
• For angina pectoris, metoprolol can be administered at a dosage of 150 and 300 mg/day, with significant reductions in angina frequency/nitroglycerin consumption and increases in total work performed on a bicycle ergometer 5.
• A comparative trial of ordinary metoprolol tablets and metoprolol sustained-release tablets in hypertensive patients found that heart rate was greatly reduced both at rest and on exercise at all times studied with both treatments 6.
• In a long-term comparison of metoprolol and methyldopa in the treatment of hypertension, the maximum dose of metoprolol was 200 mg twice daily (average 308 mg) 7.

Key Findings

• Metoprolol is a beta1-selective adrenoceptor blocking drug that is suitable for twice daily administration in hypertension 3.
• Metoprolol CR/XL is effective in reducing mortality and improving clinical status in patients with stable mild to moderate chronic heart failure 4.
• Metoprolol is as effective as propranolol in reducing angina attacks and improving exercise tolerance in patients with uncomplicated angina pectoris 5.
• Metoprolol has a lower incidence of side effects compared to methyldopa in the treatment of hypertension 7.