What is the equivalent dosage of metoprolol (beta blocker) to carvedilol (beta blocker)?

From the Guidelines

The equivalent dosage of metoprolol to carvedilol can be estimated as 25-50 mg of metoprolol tartrate twice daily being comparable to 6.25-25 mg of carvedilol twice daily, based on the dosing recommendations from the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction 1. When converting from metoprolol to carvedilol, it's essential to consider the differences in their pharmacological properties. Carvedilol has additional alpha-blocking effects, which can lead to more pronounced vasodilation and blood pressure lowering compared to metoprolol.

• The recommended dosing for metoprolol tartrate is 25-50 mg every 6-12 hours orally, with a target daily dose of 200 mg as tolerated 1.
• In contrast, carvedilol is typically started at a low dose of 6.25 mg twice daily and titrated up to 25 mg twice daily as tolerated 1.
• A study comparing the effects of carvedilol and metoprolol in patients with heart failure found that carvedilol may have a more favorable effect on mortality reduction, with a 17% greater reduction in mortality compared to metoprolol tartrate 1.
• The choice of beta blocker should be based on individual patient characteristics, including the presence of heart failure, hypertension, and other comorbidities, as well as the potential for drug interactions and side effects.
• It's crucial to monitor patients closely during the transition from metoprolol to carvedilol, with regular assessments of blood pressure, heart rate, and symptoms of dizziness or fatigue.
• The dosing equivalence between metoprolol and carvedilol may vary depending on the specific clinical context and patient population, and should be guided by the most recent and highest-quality evidence available.

From the Research

Equivalent Dosage of Metoprolol and Carvedilol

The equivalent dosage of metoprolol (beta blocker) to carvedilol (beta blocker) can be determined based on the target daily dose used in randomized clinical trials.

• The target daily dose for metoprolol is 200 mg 2
• The target daily dose for carvedilol is 50 mg 2 This suggests that the equivalent dosage of metoprolol to carvedilol is approximately 4:1 (200 mg metoprolol = 50 mg carvedilol).

Initiating Dose and Titration

When initiating beta-blocker therapy, the dose should be very low and increased gradually over weeks.

• The initiating dose for bisoprolol is 1.25 mg, for carvedilol is 3.125 mg, and for metoprolol succinate is 12.5 mg 3
• The dose should be titrated to the maximum tolerated for adequate bradycardia 3

Comparison of Beta-Blocking Effects

The beta-blocking effects of metoprolol and carvedilol have been compared in healthy subjects.

• Metoprolol tended to decrease heart rate during exercise to a greater extent than carvedilol 4
• Carvedilol caused a clinically relevant beta-blockade in humans predominantly during exercise, but its effects on heart rate at rest appeared rather weak 4