Metoprolol Dosage and Treatment Protocol for Hypertension and Heart-Related Conditions
For patients with hypertension or heart-related conditions, metoprolol tartrate should be dosed at 25-50 mg orally every 6-12 hours initially, then transitioned over 2-3 days to twice-daily dosing, with titration to a daily dose of 200 mg as tolerated. 1
Dosing Recommendations by Condition
Hypertension
- Initial dosing:
- Titration: Increase gradually based on blood pressure response, typically at 1-2 week intervals 2
- Maximum dose: 200 mg daily for metoprolol tartrate; 400 mg daily for metoprolol succinate 1
- Once-daily dosing may be effective for hypertension with metoprolol succinate (extended-release) formulation 3, 4
Acute Myocardial Infarction
- Early treatment protocol: 2, 1
- Initial: Three 5 mg IV boluses given at 2-minute intervals
- Monitor blood pressure, heart rate, and ECG during administration
- For patients tolerating full IV dose (15 mg): Begin 50 mg oral metoprolol tartrate every 6 hours, 15 minutes after last IV dose
- Continue for 48 hours, then transition to maintenance dose of 100 mg twice daily
- For patients not tolerating full IV dose: Begin with 25-50 mg orally every 6 hours
Angina Pectoris
- Dosage range: 100-400 mg daily, divided into 2-4 doses 2
- Typical starting dose: 50 mg twice daily, titrated upward based on response 2
Supraventricular Tachycardia
- IV administration: 5 mg over 1-2 minutes, repeated as required every 5 minutes to maximum dose of 15 mg 1
- Titrate: According to heart rate and blood pressure response 1
Special Populations
Elderly Patients (>65 years)
- Start with lower doses due to potential decreased hepatic, renal, or cardiac function 2, 5
- Metoprolol CR/ZOK 50 mg once daily has shown effectiveness in elderly patients with mild to moderate hypertension 5
Hepatic Impairment
- Use lower initial doses with cautious gradual titration 2
- Monitor closely as elimination half-life may be prolonged up to 7.2 hours 2
Renal Impairment
- No dose adjustment required for metoprolol in renal impairment 2
Contraindications and Precautions
Absolute Contraindications 1
- Signs of heart failure
- Low output state
- Increased risk for cardiogenic shock
- PR interval >0.24 seconds
- Second or third-degree heart block
- Active asthma or reactive airways disease
Risk Factors for Cardiogenic Shock 1
- Age >70 years
- Systolic BP <120 mm Hg
- Sinus tachycardia >110 bpm or heart rate <60 bpm
- Increased time since symptom onset
Precautions for Administration 1
- Mild wheezing or history of COPD: Use short-acting cardioselective agent (metoprolol) at reduced dose (12.5 mg)
- Monitor during IV therapy: Frequent checks of heart rate, blood pressure, continuous ECG, and auscultation for rales and bronchospasm
- Avoid abrupt cessation of therapy to prevent rebound hypertension or worsening of angina 1
Combination Therapy
- For hypertension not controlled with metoprolol alone, consider adding:
Monitoring Parameters
- Blood pressure and heart rate at each visit 1
- Target resting heart rate: 50-60 beats per minute unless limiting side effects occur 1
- ECG monitoring during initiation, particularly with IV administration 2
- Signs of worsening heart failure or bronchospasm 1