Normal Dosage of Metoprolol for Hypertension
The normal dose of metoprolol for hypertension is typically 100 mg twice daily, which is effective for controlling mild to moderate hypertension in most patients. 1
Dosage Forms and Administration
Metoprolol is available in two main formulations:
Immediate-Release (IR) Tablets
- Initial dose: 50-100 mg twice daily
- Maintenance dose: 100-200 mg twice daily
- Maximum daily dose: 400 mg 2
Extended-Release (CR/ZOK) Tablets
- Initial dose: 100 mg once daily
- Maintenance dose: 100-200 mg once daily
- Maximum daily dose: 400 mg 3
Dosing Algorithm
Start with lower dose:
- 50 mg twice daily (immediate-release) or
- 100 mg once daily (extended-release)
Evaluate response after 1-2 weeks
- If blood pressure remains elevated (>140/90 mmHg), increase dose
Titration:
- Increase to 100 mg twice daily (immediate-release) or
- Increase to 200 mg once daily (extended-release) 3
For resistant hypertension:
- May increase to 300-400 mg total daily dose if needed 4
- Consider adding a thiazide diuretic before reaching maximum dose
Special Considerations
Elderly Patients
- Start with lower doses (25-50 mg twice daily)
- Titrate more slowly due to potential for higher plasma concentrations 2
Hepatic Impairment
- Reduce initial dose by 50%
- Elimination half-life may be prolonged up to 7.2 hours 2
Renal Impairment
- No significant dose adjustment typically required 2
Poor CYP2D6 Metabolizers
- May require lower doses due to higher plasma concentrations
- Approximately 8% of Caucasians and 2% of other populations 2
Monitoring Parameters
- Blood pressure
- Heart rate (target 50-60 beats per minute unless side effects occur)
- Signs of bradycardia or hypotension
- Development of heart failure symptoms 5
Contraindications
- Cardiogenic shock
- Decompensated heart failure
- Severe bradycardia
- Greater than first-degree heart block
- Severe bronchospastic disease 5
Clinical Efficacy
Research shows that metoprolol at doses of 100-200 mg daily effectively controls blood pressure in 85-93% of hypertensive patients within 4 weeks of treatment 3. The sustained-release formulation offers the convenience of once-daily dosing with equivalent efficacy to twice-daily immediate-release tablets 3, 6.
Remember that while beta-blockers were once first-line agents for hypertension, current guidelines often position them after other classes like ACE inhibitors, ARBs, calcium channel blockers, and thiazide diuretics, particularly in uncomplicated hypertension.