Usual Adult Dose for Hypertension

METOPROLOL TARTRATE IMMEDIATE RELEASE TABLETS:
Initial dose: 100 mg orally per day in single or divided doses

Maintenance dose: 100 to 450 mg orally per day

Comments:

• May increase dose at weekly, or longer, intervals.
• Doses above 450 mg per day have not been studied.
• Lower once-daily doses may not maintain full effect at the end of the 24-hour period; larger or more frequent daily doses may be required. Beta-1 selectivity diminishes as the dose is increased.

METOPROLOL SUCCINATE EXTENDED RELEASE TABLETS:
Initial dose: 25 to 100 mg orally once a day

Maintenance dose: 100 to 400 mg orally once a day

Comments:

• May increase dose at weekly, or longer, intervals.
• Doses above 400 mg per day have not been studied.

Usual Adult Dose for Angina Pectoris

Initial dose:

• Metoprolol tartrate immediate release tablets: 50 mg orally twice a day
• Metoprolol succinate extended release tablets: 100 mg orally once a day

Maintenance dose: 100 to 400 mg per day

Comments:

• Increase dose at weekly intervals until optimum clinical response has been obtained or pronounced slowing of heart rate occurs.
• Doses above 400 mg per day have not been studied.

Usual Adult Dose for Myocardial Infarction

METOPROLOL TARTRATE:
Early Treatment:
Initial dose: 5 mg IV every 2 minutes as tolerated for 3 doses

• Patients tolerant of full IV dose (15 mg): 50 mg orally every 6 hours starting 15 minutes after the last IV dose and continued for 48 hours
• Patients intolerant of full IV dose (15 mg): 25 or 50 mg orally every 6 hours depending on the degree of intolerance starting 15 minutes after the last IV dose or as soon as their clinical condition allows

Late Treatment:
Maintenance dose: 100 mg orally twice a day

Comments:

• Patients with contraindications to treatment during the early phase of suspected or definite myocardial infarction, patients who appear not to tolerate the full early treatment, and patients in whom the physician wishes to delay therapy for any other reason should be started on 100 mg orally twice a day as soon as their clinical condition allows.
• Continue therapy for at least 3 months; efficacy beyond 3 months has not been conclusively established; data from studies with other beta blockers suggest a treatment duration of 1 to 3 years.

Use: Treatment of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality. Treatment with the IV formulation can be initiated as soon as the patient's clinical condition allows. Alternatively, treatment can begin within 3 to 10 days of the acute event.

Usual Adult Dose for Congestive Heart Failure

METOPROLOL SUCCINATE EXTENDED RELEASE TABLETS:
25 mg orally once a day (12.5 mg orally once a day in patients with more severe heart failure); double dose every 2 weeks to highest tolerated dose or up to 200 mg orally once a day

Comments: Initial titration difficulty should not preclude later attempts to introduce this drug.

Use: Treatment of stable, symptomatic New York Heart Association (NYHA) Class II or III heart failure of ischemic, hypertensive, or cardiomyopathic origin.

Usual Pediatric Dose for Hypertension

METOPROLOL SUCCINATE EXTENDED RELEASE TABLETS:
6 Years or Older:
Initial dose: 1 mg/kg orally once a day (not to exceed 50 mg orally once a day)

Maximum dose: 2 mg/kg (or 200 mg) orally once a day

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

Initiate at low doses and titrate gradually according to clinical response.

Dose Adjustments

For treatment of hypertension and angina, when switching from immediate release to extended release, use the same total daily dose.

Precautions

US BOXED WARNING:

• ISCHEMIC HEART DISEASE: Following abrupt discontinuation of therapy with beta adrenergic blockers, exacerbations of angina pectoris and myocardial infarction have occurred. When discontinuing chronically administered metoprolol, particularly in patients with ischemic heart disease, gradually reduce the dose over a period of 1 to 2 weeks and monitor the patient. If angina markedly worsens or acute coronary insufficiency develops, promptly resume therapy, at least temporarily, and take other measures appropriate for the management of unstable angina. Warn patients against interruption or discontinuation of therapy without the physician's advice. Because coronary artery disease is common and may be unrecognized, avoid abrupt discontinuation of metoprolol therapy even in patients treated only for hypertension.

Metoprolol tartrate safety and efficacy have not been established in patients younger than 18 years.
Metoprolol succinate safety and efficacy have not been established in patients younger than 6 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• If a dose is missed, the patient should take only the next scheduled dose without doubling it.
• Administer immediate release tablets with or immediately after meals.
• Extended release tablets are scored and can be divided; however, do not crush or chew the whole or half tablet.

Monitoring:

• Monitor heart rate and rhythm.
• When discontinuing a chronically administered beta blocker, reduce dose over 1 to 2 weeks and monitor carefully, especially in patients with coronary artery disease.

Patient advice:

• Warn patients not to interrupt or discontinue therapy without a physician's advice.
• Avoid operating automobiles and machinery or engaging in other tasks requiring alertness until the patient's response to therapy has been determined.
• Contact the physician if difficulty in breathing occurs.
• Inform the physician or dentist of use of this drug before any type of surgery.
• Advise heart failure patients to consult their physician if signs or symptoms of worsening heart failure occur such as weight gain or increasing shortness of breath.

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