Adult Dosing
Hypertension
Immediate release (IR)
- Start with 100 mg/day PO in single or divided doses; may be used alone or as an adjunct to a diuretic; titrate the dose at weekly (or longer) intervals until optimum blood pressure reduction is achieved
- Effective dose range: 100-450 mg/day
- Max: 450 mg/day
Extended release (ER)
- Start with 25-100 mg PO qd, titrate the dose at weekly (or longer) intervals until optimum blood pressure reduction is achieved
- Max: 400 mg/day
- Note: Tablets may be cut in half; do not crush/chew the whole or half tablet
Angina pectoris
IR
- Start with 50 mg PO bid; gradually increase the dose at weekly intervals until desired effect has been achieved or there is pronounced slowing of heart rate
- Usual dose range: 100-400 mg/day
- Max: 400 mg/day
- Note: Gradually decrease the dose over a period of 1-2 wks if treatment is to be discontinued
ER
- Start with 100 mg PO qd; gradually increase the dose at weekly intervals until desired effect has been achieved or there is pronounced slowing of heart rate
- Max: 400 mg/day
Note:
- Gradually decrease the dose over a period of 1-2 wks, if treatment is to be discontinued
- Tablets may be cut in half; do not crush/chew the whole or half tablet
Myocardial infarction
IR
Early phase of definite or suspected acute MI
- Give 5 mg IV bolus at 2-minute intervals up to 15 mg, carefully monitoring heart rate, BP and ECG during administration
- If 15 mg IV dose is well tolerated, give 50 mg PO qid x 2 days (initiate 15 min after the last IV dose)
- Maintenance dose: 100 mg PO bid
- If 15 mg IV dose is not tolerated, give 25-50 mg PO qid (depending on the degree of intolerance) 15 min after the last IV dose or as soon as their clinical condition allows
- In patients with severe intolerance, discontinue therapy
Late phase
- When contraindicated in early phase of therapy or when the physician wishes to delay therapy for any other reason: Give 100 mg PO bid x 3 months (as soon as their clinical condition allows)
CHF
ER
- Start with 25 mg PO qd x 2 wks in NYHA Class II heart failure patients and 12.5 mg PO qd in severe heart failure patients
- Double the dose q2 wks to the highest dose tolerated by the patient or up to 200 mg/day
- Max: 200 mg/day
- Note: Tablets may be cut in half; do not crush/chew the whole or half tablet
Thyrotoxicosis [Non-FDA Approved]
- 50 mg PO bid, may increase as needed [Max 200 mg bid]
Acute Coronary Syndromes [Non-FDA Approved]
- 25-50mg PO qid for 48 hrs
- Maintenance dose at discharge between 50 – 100 mg bid, (note: aiming for HR between 50-60 bpm)
Pediatric Dosing
IR tablets
- Safety and effectiveness in pediatric patients have not been established
ER tablets
Hypertension
- Safety and effectiveness in pediatric patients <6 yrs of age have not been established
- 6-16 yrs: Start with 1 mg/kg (max: 50 mg/day) PO qd; titrate the dose according to blood pressure response
- Max: 2 mg/kg or 200 mg once daily
17-18 yrs
- Start 25-100 mg PO qd; titrate the dose at weekly (or longer) intervals until optimum blood pressure reduction is achieved
- Max: 400 mg/day
- Note: ER tablets may be cut in half; do not crush/chew the whole or half tablet
Thyrotoxicosis [Non-FDA Approved]
- 1-2 mg/kg/day PO divided bid; Max dose: 6 mg/kg/day [Max 200 mg bid]
[Outline]
See Supplemental Patient Information
- Metoprolol has the potential for further depressing myocardial contractility and precipitating more severe failure in congestive heart failure patients. Administer with caution in hypertensive and angina patients with CHF, which is controlled by digitalis and diuretics
- In patients without a history of heart failure, continued depression of the myocardium with beta-blockers over a period of time may, in certain cases, lead to cardiac failure. Fully digitalize the patients and/or administer a diuretic at the first sign or symptom of impending cardiac failure; closely observe the response. Withdraw therapy if cardiac failure continues, despite adequate digitalization and diuretic therapy
- Abrupt discontinuation of therapy with some beta-blocking agents may lead to exacerbations of angina and myocardial infarction in certain cases
- Gradually reduce the dose over a period of 1-2 weeks, while discontinuing treatment in patients chronically treated with metoprolol, especially in patients with ischemic heart disease. If angina markedly worsens or acute coronary insufficiency develops, promptly reinstate metoprolol therapy, at least temporarily. Avoid treatment interruption or discontinuation without medical advice [US Black box Warning]
- Avoid beta-blockers in patients with bronchospastic disease. Use cautiously in patients with bronchospastic disease failing to respond or tolerate other antihypertensive treatment. Concomitantly administer a beta2-stimulating agent and use the lowest possible dose of metoprolol. Initially administer metoprolol in smaller doses tid, instead of larger doses bid, to avoid higher plasma levels associated with the longer dosing interval
- Metoprolol should be used with caution in diabetic patients if a beta-blocking agent is required, as it may mask tachycardia occurring with hypoglycemia
- If metoprolol is used in patients with pheochromocytoma, administer in combination with an alpha blocker, and only after the alpha blocker has been initiated
- Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of beta blockade, which might precipitate a thyroid storm
- Metoprolol causes a decrease in sinus heart rate in most patients; sometimes MI itself causes a significant lowering of the sinus rate. If sinus rate decreases to <40 beats/min, administer atropine (0.25-0.5 mg) IV; if no therapeutic response is achieved, discontinue metoprolol and cautiously administer isoproterenol or install a cardiac pacemaker
- Metoprolol slows AV conduction and may produce significant heart block. Acute MI also produces heart block. If heart block occurs, discontinue metoprolol and administer atropine intravenously. If atropine treatment is not successful, cautious administration of isopreterenol or installation of a cardiac pacemaker should be considered
- If systolic blood pressure decreases to 90 mmHg or less, discontinue metoprolol and initiate appropriate therapy
Cautions: Use cautiously in
- Hepatic impairment
- Anesthesia and major surgery
- Concomitant use of calcium channel blockers
- History of peripheral vascular disease (contraindicated if severe disease)
- Elderly patients
- History of anaphylactic reactions
- Wolff-Parkinson-White syndrome
- Myasthenia gravis
- Pregnancy 2nd or 3rd trimester
- Lactation
Supplemental Patient Information
- Advise patients to avoid performing hazardous activities such as driving or operating machinery until the patient's response to therapy has been determined
- Instruct patients to seek medical advice if they experience any difficulty in breathing
- Advise heart failure patients to promptly contact their physician if they experience signs or symptoms of worsening heart failure such as increasing shortness of breath or weight gain
Pregnancy Category:C
Breastfeeding: As low levels of metoprolol are excreted in breastmilk, amounts ingested by the infant are small and are not expected to cause any adverse effects in breastfed infants. Studies involving use of metoprolol during breastfeeding have found no adverse reactions in breastfed infants. This information is (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 18 April 2011). Manufacturer advises caution.
US Trade Name(s)
US Availability
metoprolol (generic)
- TABS: 25, 50, 100 mg
- ETABS: 25, 50, 100, 200 mg
Lopressor
Toprol-XL
- ETABS: 25, 50, 100, 200 mg
Canadian Trade Name(s)
Canadian Availability
metoprolol (generic)
- TABS: 25, 50, 100 mg
- ETABS: 100, 200 mg
Lopresor
- TABS: 50, 100 mg
- ETABS: 100, 200 mg
NU-Metop
UK Trade Name(s)
UK Availability
metoprolol (generic)
Lopresor
- TABS: 50, 100 mg
- ETABS: 200 mg
Australian Trade Name(s)
- Betaloc
- Lopresor
- Metohexal
- Metrol
- Minax
- Toprol-XL
Australian Availability
metoprolol (generic)
Betaloc, Lopresor, Metohexal, Metrol, Minax
Toprol-XL
- ETABS: 23.75, 47.5, 95, 190 mg
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Lopressor 100 MG TABS [Bottle] (NOVARTIS)
60 mg = $165.98
180 mg = $497.95 - Lopressor 50 MG TABS [Bottle] (NOVARTIS)
60 mg = $118.99
180 mg = $334.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
0.24 sec) (MI use)