How frequently can the dose of metoprolol (beta blocker) be increased?

Metoprolol Dose Titration Frequency

Metoprolol can be increased every 1-2 weeks when titrating for optimal therapeutic effect. 1

Standard Titration Protocol

For Hypertension and Chronic Conditions

• Increase the dose gradually every 1-2 weeks if blood pressure control is not achieved 1
• Start with metoprolol tartrate 25-50 mg twice daily or metoprolol succinate 50 mg once daily 1
• Target maximum doses: 200 mg daily for metoprolol tartrate, 400 mg daily for metoprolol succinate 1

For Heart Failure with Reduced Ejection Fraction

• Begin at 12.5-25 mg once daily and titrate at 2-week intervals 1, 2
• Target dose is 200 mg once daily of metoprolol succinate 1, 2
• The MERIT-HF trial demonstrated this approach reduces all-cause mortality by 34% at 12 months 2

Critical Monitoring Parameters During Titration

• Check blood pressure and heart rate at each visit 1
• Target resting heart rate of 50-60 beats per minute unless limiting side effects occur 1
• Monitor for signs of worsening heart failure (increased dyspnea, fatigue, edema, weight gain) 1
• Watch for symptomatic bradycardia or hypotension requiring dose adjustment 1

Important Contraindications Before Each Dose Increase

Do not increase metoprolol if any of the following are present:

• Systolic blood pressure <100 mmHg with symptoms 1
• Heart rate <50 bpm with symptoms 1
• Signs of decompensated heart failure or low output state 1
• Second or third-degree heart block 1
• Active asthma or reactive airway disease 1

Common Pitfalls to Avoid

• Never increase doses more frequently than weekly intervals - this increases risk of symptomatic bradycardia and hypotension 1
• Do not abruptly discontinue metoprolol - this can cause severe exacerbation of angina, myocardial infarction, and ventricular arrhythmias with 50% mortality in one study 1
• If adverse effects occur during titration, reduce the dose by 50% rather than stopping completely 1
• For women, consider that they may achieve optimal outcomes at 50% of guideline-recommended doses due to 50-80% higher drug exposure 1

Special Population Considerations

Elderly Patients

• Use more cautious titration with smaller incremental reductions 1
• Metoprolol exposure is significantly higher in elderly patients due to decreased hepatic metabolism 3
• Start at the lowest possible dose and titrate slowly 3

Hepatic Impairment

• Initiate at low doses with cautious gradual dose titration 3
• Elimination half-life can be prolonged up to 7.2 hours depending on severity 3