From the Guidelines
The equivalent dose of carvedilol for metoprolol tartrate 50 mg daily, given as 25 mg twice daily, is approximately 12.5-25 mg twice daily. When converting between these beta-blockers, it's essential to consider the potency and pharmacological differences. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, carvedilol is preferred in patients with heart failure with reduced ejection fraction (HFrEF) and has a usual dose range of 12.5-50 mg/day, given twice daily. The dose conversion ratio between carvedilol and metoprolol can be approximated as 1:2 (carvedilol:metoprolol), considering the differences in their pharmacological profiles. Key points to consider when switching between these medications include:
- Monitoring blood pressure and heart rate closely during the transition period
- Informing patients about potential differences in side effects due to the distinct pharmacological properties of carvedilol, including its alpha-blocking effects, which may lead to more vasodilation and orthostatic hypotension. It is crucial to tailor the dose conversion to the individual patient's response and clinical condition, ensuring the best possible outcome in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
Carvedilol Tablet was studied in 2 placebo-controlled trials that utilized twice-daily dosing, at total daily doses of 12.5 to 50 mg. At 50 mg/day, Carvedilol Tablet reduced sitting trough (12-hour) blood pressure by about 9/5.5 mm Hg; at 25 mg/day the effect was about 7.5/3. 5 mm Hg.
The equivalent dose of carvedilol for metoprolol tartrate 50 mg daily, given as 25 mg twice daily (bid), cannot be directly determined from the provided information.
- The carvedilol dosing information is provided, but there is no direct comparison to metoprolol tartrate dosing in the text.
- The studies described do not provide a direct conversion between carvedilol and metoprolol tartrate doses 2.
From the Research
Equivalent Dose of Carvedilol for Metoprolol Tartrate
The equivalent dose of carvedilol for metoprolol tartrate 50 mg daily, given as 25 mg twice daily (bid), can be determined based on the provided studies.
- The study 3 compared the long-term clinical efficacy of metoprolol tartrate to carvedilol in chronic heart failure patients using the same dosing regimen as in COMET. The results showed that metoprolol tartrate 50 mg bid and carvedilol 25 mg bid had similar effects on 24-h heart rate.
- Another study 4 compared the effects of metoprolol tartrate and carvedilol on cause-specific mortality and morbidity in patients with chronic heart failure. The target doses used in this study were 25 mg of carvedilol twice daily or 50 mg of metoprolol tartrate twice daily.
- Based on these studies, it can be inferred that the equivalent dose of carvedilol for metoprolol tartrate 50 mg daily (25 mg bid) is 25 mg bid of carvedilol 3, 4.
Key Findings
- Metoprolol tartrate 50 mg bid and carvedilol 25 mg bid have similar effects on 24-h heart rate 3.
- The target doses used in the COMET study were 25 mg of carvedilol twice daily or 50 mg of metoprolol tartrate twice daily 4.
- Carvedilol reduced cardiovascular mortality, sudden death, death caused by circulatory failure, death caused by stroke, as well as fatal and nonfatal myocardial infarctions compared to metoprolol tartrate 4.