What is the maximum allowed dose of Metoprolol (Lopressor)?

From the Guidelines

The maximum recommended dose of metoprolol is 200 mg daily for immediate-release metoprolol tartrate and 400 mg once daily for extended-release metoprolol succinate. The maximum allowed dose of Metoprolol (Lopressor) varies by formulation, as indicated in the guidelines 1.

Key Considerations

• For immediate-release metoprolol tartrate, the highest dose is typically 200 mg daily, divided into 2-3 doses.
• For extended-release metoprolol succinate (Toprol XL), the maximum daily dose is 400 mg once daily.
• These maximum doses apply to treatment of hypertension, angina, and heart failure, though heart failure patients usually require gradual titration starting at lower doses.
• Doses should be individualized based on patient response and tolerance.
• Elderly patients and those with hepatic impairment often require lower doses due to decreased drug metabolism.

Mechanism and Adverse Effects

• Metoprolol works by blocking beta-1 adrenergic receptors primarily in the heart, reducing heart rate and contractility, which lowers blood pressure and myocardial oxygen demand.
• Exceeding these maximum doses increases the risk of adverse effects like bradycardia, hypotension, bronchospasm, and fatigue without providing additional therapeutic benefit.
• Dose adjustments should always be made under medical supervision, as recommended in the guidelines 1.

Clinical Guidelines

• The guidelines from the American College of Cardiology/American Heart Association 1 provide recommendations for the use of metoprolol in various clinical settings.
• The guidelines emphasize the importance of individualizing doses and monitoring patients for adverse effects.
• The maximum recommended doses of metoprolol are consistent across the guidelines, with some variations in specific clinical settings.

From the Research

Maximum Allowed Dose of Metoprolol

The maximum allowed dose of Metoprolol (Lopressor) is not explicitly stated in the provided studies. However, the following information can be gathered:

• The study 2 mentions that the target dose should be the maximum tolerated for adequate bradycardia, but does not provide a specific maximum dose.
• The study 3 mentions the use of controlled release metoprolol at a dose of 50 mg/day, but does not provide information on the maximum allowed dose.
• The study 4 used metoprolol at doses of 100 mg/day for two weeks and 200 mg/day for the remaining time, but does not provide information on the maximum allowed dose.
• The study 5 suggests that metoprolol at 50-100 mg per day would probably be sufficient to get the desired effect in Indian patients with acute myocardial infarction.
• The study 6 reports a case of severe toxicity and cardiogenic shock in a patient taking a metoprolol dose of 250 mg split daily, but does not provide information on the maximum allowed dose.

Key Points

• The maximum allowed dose of Metoprolol is not explicitly stated in the provided studies.
• Different studies used different doses of metoprolol, ranging from 50 mg/day to 250 mg split daily.
• The study 2 suggests that the target dose should be the maximum tolerated for adequate bradycardia.
• The study 5 suggests that metoprolol at 50-100 mg per day would probably be sufficient to get the desired effect in Indian patients with acute myocardial infarction.
• The study 6 reports a case of severe toxicity and cardiogenic shock in a patient taking a high dose of metoprolol.