From the Guidelines
The maximum dose of metoprolol is 400 mg daily for immediate-release metoprolol tartrate and 400 mg daily for extended-release metoprolol succinate. The dosage of metoprolol varies depending on the formulation and indication. For immediate-release metoprolol tartrate, the maximum daily dose is typically 400 mg, usually divided into 2-4 doses 1. For extended-release metoprolol succinate (Toprol XL), the maximum daily dose is generally 400 mg taken once daily 1.
Key Considerations
- For hypertension, doses typically range from 100-400 mg daily.
- For heart failure, the target dose is usually 200 mg daily of the extended-release formulation, titrated gradually from lower doses 1.
- For acute myocardial infarction, up to 15 mg IV can be given in divided doses, followed by oral therapy.
- For angina, doses typically range from 100-400 mg daily.
Important Safety Information
- Metoprolol should be titrated gradually to avoid hypotension, bradycardia, or worsening heart failure.
- Patients with hepatic impairment may require lower maximum doses due to decreased drug metabolism.
- Metoprolol works by blocking beta-1 adrenergic receptors, primarily affecting the heart by reducing heart rate, contractility, and blood pressure, which explains its effectiveness in cardiovascular conditions.
- The most recent and highest quality study 1 provides the maximum dose of metoprolol as 400 mg daily for both immediate-release and extended-release formulations.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Maximum Dose of Metoprolol
The maximum dose of metoprolol varies depending on the specific formulation and the condition being treated.
- For metoprolol tartrate, the maximum dose is typically 200-450 mg per day, divided into 2-3 doses 2.
- For metoprolol succinate, the maximum dose is typically 400 mg per day, taken as a single dose 3. Some key points to consider when determining the maximum dose of metoprolol include:
- The patient's individual response to the medication
- The severity of the condition being treated
- The presence of any underlying medical conditions, such as kidney or liver disease
- The potential for interactions with other medications
Dosing Considerations
When initiating metoprolol therapy, it is generally recommended to start with a low dose and gradually increase as needed and tolerated.
- For example, in patients with heart failure, metoprolol CR/XL may be initiated at a dose of 12.5-25 mg once daily, with gradual increases to a target dose of 200 mg once daily 3.
- In patients with hypertension, metoprolol tartrate may be initiated at a dose of 100-200 mg per day, divided into 2-3 doses, with gradual increases as needed to achieve blood pressure control 2.
Special Considerations
In certain patient populations, such as those with severe heart failure or those taking other medications that interact with metoprolol, the maximum dose may need to be adjusted.
- For example, in patients with severe heart failure, the dose of metoprolol CR/XL may need to be reduced to 25-50 mg once daily 3.
- In patients taking other medications that interact with metoprolol, such as beta blockers or calcium channel blockers, the dose of metoprolol may need to be adjusted to avoid adverse interactions 2, 4.