From the Research
A typical metoprolol taper regimen involves gradually reducing the dose over 2-3 weeks to avoid rebound hypertension, tachycardia, or angina, as abrupt discontinuation can lead to sympathetic nervous system overactivity and potentially life-threatening consequences, as highlighted in a recent study 1. When tapering metoprolol, it is essential to consider the patient's individual needs and medical history.
- For patients on metoprolol tartrate (immediate-release), reduce the dose by 25-50% every 5-7 days, as demonstrated in a study on metoprolol withdrawal phenomena 2.
- For example, if taking 50 mg twice daily, decrease to 25 mg twice daily for one week, then 25 mg once daily for another week before stopping.
- For metoprolol succinate (extended-release), reduce from the current dose to half-dose for 7-10 days, then to quarter-dose for another 7-10 days before discontinuation. Patients should monitor blood pressure and heart rate during the taper and report symptoms like chest pain, palpitations, severe headache, or significant blood pressure elevation. The importance of gradual tapering is further emphasized by a study on beta-blockers in hypertension, which highlights the potential risks of abrupt discontinuation 3. Additionally, a study on rebound hypertension following abrupt cessation of clonidine and metoprolol suggests that labetalol may be beneficial in managing hyperadrenergic states following abrupt withdrawal of adrenergic blockers 4. However, the most recent and highest quality study on the topic, published in 2020, emphasizes the need for careful consideration of the beta-blocker rebound phenomenon and its prevention strategies 1.