What is the maximum dose of metoprolol (beta blocker)?

Maximum Dose of Metoprolol

The maximum daily dose of metoprolol is 200 mg for metoprolol succinate (extended-release) taken once daily, and 400 mg for metoprolol tartrate taken as 200 mg twice daily. 1

Dosing Guidelines by Formulation

Metoprolol Tartrate (Immediate Release)

• Maximum daily dose: 400 mg (typically given as 200 mg twice daily) 1
• Usual dose range: 100-200 mg daily in divided doses 1
• Requires twice-daily dosing for optimal blood pressure control 1
• Onset of action begins within 1-2 hours after administration, with significant hemodynamic effects observed within 2-4 hours 2

Metoprolol Succinate (Extended Release)

• Maximum daily dose: 200 mg once daily 1, 3
• Designed to deliver metoprolol at a near-constant rate for approximately 20 hours 4
• Produces even plasma concentrations over a 24-hour period without marked peaks and troughs 4
• Maintains consistent beta1-blockade over 24 hours while preserving cardioselectivity at doses up to 200 mg daily 4

Dosing Considerations for Specific Conditions

Hypertension

• Initial dose typically starts lower (25-100 mg) and is titrated upward based on blood pressure response 1
• Maximum dose of 400 mg daily (tartrate) or 200 mg daily (succinate) should not be exceeded 1
• In studies comparing metoprolol to other antihypertensives, the average effective dose was 308 mg daily 5

Heart Failure

• For chronic heart failure, metoprolol CR/XL (succinate) is initiated at a low dose of 12.5-25 mg once daily 3
• Dose is gradually increased at 2-week intervals until reaching the target dose of 200 mg once daily or maximum tolerated dose 3
• The MERIT-HF trial demonstrated significant mortality reduction with metoprolol CR/XL at target dose of 200 mg daily 3

Perioperative Use

• When used perioperatively, doses typically range from 25-100 mg 1
• For perioperative beta blockade, careful monitoring of heart rate and blood pressure is required 2

Special Populations

Elderly Patients

• No specific dose adjustments are required based on age alone, though clinical experience suggests some elderly individuals may have increased sensitivity 6
• It is recommended to proceed with caution when dosing in elderly populations 6

Patients with Hepatic Impairment

• Patients with hepatic impairment may experience prolonged half-life and potentially more pronounced side effects 2
• Consider lower maximum doses in these patients

Important Precautions

• Avoid abrupt cessation of metoprolol as this may precipitate withdrawal symptoms or exacerbate underlying conditions 1
• If a patient is treated with clonidine and metoprolol concurrently, and clonidine treatment is to be discontinued, stop metoprolol several days before clonidine is withdrawn to prevent rebound hypertension 6
• Monitor heart rate and blood pressure during dose titration 2
• Lower doses (50-100 mg daily) may be sufficient in some populations to achieve desired effects 7

Remember that while these are the maximum recommended doses, the optimal dose should aim for the lowest effective dose that achieves therapeutic goals while minimizing side effects.