Equivalent Dose of Metoprolol Succinate for 80 mg Carvedilol CR
80 mg of Carvedilol CR (controlled release) is equivalent to 200 mg of metoprolol succinate. 1
Dosing Equivalence Based on Guidelines
The 2022 AHA/ACC/HFSA guideline for heart failure management provides clear dosing equivalence information for beta-blockers in heart failure with reduced ejection fraction (HFrEF):
- Carvedilol CR 80 mg once daily is listed as the maximum/target dose 1
- Metoprolol succinate extended release 200 mg once daily is listed as the maximum/target dose 1
- These doses are considered therapeutically equivalent in the management of heart failure 1
Dose Conversion Rationale
The equivalence is based on several factors:
- Both medications are evidence-based beta-blockers proven to reduce mortality in HFrEF 1
- Clinical trials achieved mean doses of 159 mg daily for metoprolol succinate and equivalent efficacy with carvedilol CR 80 mg daily 1
- The 2017 ACC/AHA/HFSA focused update confirms these target doses 1
Clinical Considerations When Switching Between Beta-Blockers
When converting between these medications, consider:
- Carvedilol is a non-selective beta-blocker with additional alpha-blocking properties, while metoprolol succinate is relatively beta-1 selective at lower doses 2
- At higher doses (such as 200 mg), metoprolol succinate begins to lose its beta-1 selectivity 2
- A 100 mg metoprolol controlled/extended-release tablet contains 95 mg of metoprolol succinate and is considered equivalent to 100 mg metoprolol tartrate 3
Dosing in Clinical Practice
The European Society of Cardiology guidelines also support this equivalence, listing:
- Carvedilol CR 80 mg once daily as the target dose 1
- Metoprolol succinate extended release 200 mg once daily as the target dose 1
Important Caveats
- Beta-blocker dosing should be initiated at low doses and gradually titrated up to target doses as tolerated 1
- When switching between beta-blockers, close monitoring is required due to differences in pharmacological properties 4
- Some studies suggest that at equivalent doses, metoprolol succinate may provide more complete beta-1 blockade than carvedilol 4
- The COMET trial showed differences between carvedilol and metoprolol tartrate (not succinate), so those results should not be directly applied to metoprolol succinate 5
Clinical Implications
- Beta-blockers reduce mortality by approximately 34% in HFrEF patients when titrated to target doses 1
- The number needed to treat (NNT) to prevent one death over 12 months with beta-blockers is 28 patients 1
- Achieving target doses is important as studies have shown a dose-response relationship with clinical outcomes 1
In summary, when converting from carvedilol CR 80 mg to metoprolol succinate, the equivalent dose is 200 mg once daily based on current heart failure guidelines 1.