Metoprolol Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Angina Pectoris Prophylaxis

Initial dose: 100 mg orally in 1 or 2 divided doses.
Maintenance dose: 100 to 450 mg/day.
Extended release may be used at the same total daily dose given once a day.

Usual Adult Dose for Hypertension

Initial dose: 100 mg orally in 1 or 2 divided doses.
Maintenance dose: 100 to 450 mg/day.
Extended release may be used at the same total daily dose given once a day.

Usual Adult Dose for Supraventricular Tachycardia

Initial dose: 100 mg orally in 1 or 2 divided doses.
Maintenance dose: 100 to 450 mg/day.
Extended release may be used at the same total daily dose given once a day.

Usual Adult Dose for Angina Pectoris

Initial dose: 100 mg orally in 1 or 2 divided doses.
Maintenance dose: 100 to 400 mg/day.
Extended release may be used at the same total daily dose given once a day.

Usual Adult Dose for Myocardial Infarction

Early treatment:
IV: 3 bolus injections of 5 mg of metoprolol given at 2 minute intervals.
Oral: In patients who tolerate the full IV dose (15 mg), metoprolol tablets, 50 mg every 6 hours, should be initiated 15 minutes after the last IV dose and continued for 48 hours. Maintenance dose: 100 mg orally twice a day.
Patients who appear not to tolerate the full IV dose should be started on metoprolol tablets at 25 mg or 50 mg every 6 hours 15 minutes after the last intravenous dose or as soon as their clinical condition allows.

Late treatment:
Oral: 100 mg orally twice a day.
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 metoprolol tablets as soon as their clinical condition allows.

Usual Adult Dose for Congestive Heart Failure

Initial dose: 25 mg once daily (of the XL formulation) for two weeks in patients with NYHA class II heart failure and 12.5 mg once daily (of the XL formulation) in patients with more severe heart failure.
Maintenance dose: This dosage should then be doubled every two weeks to the highest dosage level tolerated or up to 200 mg.

If transient worsening of heart failure occurs, it may be treated with increased doses of diuretics, and it may also be necessary to lower the dose or temporarily discontinue treatment. The dose should not be increased until symptoms of worsening heart failure stabilize.

Initial difficulty with titration should not preclude later attempts to institute therapy. If heart failure patients experience symptomatic bradycardia, the dose of metoprolol should be reduced.

Usual Pediatric Dose for Hypertension

Immediate release:
1 to 17 years:
Initial dose: 1 to 2 mg/kg/day, administered in 2 divided doses. Dosage should be adjusted based on patient response.
Maximum dose: 6 mg/kg/day (less than or equal to 200 mg/day)

Extended release:
6 to 16 years:
Initial dose: 1 mg/kg orally once daily (not to exceed 50 mg once daily). The minimum available dose is one half of the 25 mg tablet.
Maintenance dose: Dosage should be adjusted according to blood pressure response. Doses above 2 mg/kg (or in excess of 200 mg) once daily have not been studied.

Renal Dose Adjustments

No adjustment is usually recommended in patients with chronic renal failure.

Liver Dose Adjustments

Metoprolol should be used with caution in patients with hepatic disease.

Dose Adjustments

The dosage may be increased at weekly (or longer) intervals until optimum blood pressure reduction is achieved or there is pronounced slowing of the heart rate. In general, the maximum effect of any given dosage level will be apparent after 1 week of therapy.

While once daily dosing is effective and can maintain a reduction in blood pressure throughout the day, lower doses (especially 100 mg) may not maintain a full effect at the end of the 24-hour period, and larger or more frequent daily doses may be required. This can be evaluated by measuring blood pressure near the end of the dosing interval to determine whether satisfactory control is being maintained throughout the day.

In general, a lower initial starting dose should be used in elderly patients given their greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Because metoprolol is metabolized by the liver, metoprolol blood levels are likely to increase substantially with poor hepatic function. Therefore, therapy should be initiated at doses lower than those recommended for a given indication; and doses should be increased gradually in patients with impaired hepatic function.

Precautions

Safety and effectiveness of metoprolol immediate release has not been established in pediatric patients less than 2 years of age. Safety and effectiveness of metoprolol controlled release has not been established in pediatric patients less than 6 years of age.

Dialysis

A supplemental dose should be administered after hemodialysis. No supplemental dose is needed with peritoneal dialysis.

Other Comments

Metoprolol should be taken with or immediately following meals.
Doses above 450 mg per day have not been studied for hypertension.
Myocardial Infarction therapy should be continued for at least 3 months. Although the efficacy of metoprolol beyond 3 months has not been conclusively established, data from studies with other beta blockers suggest that treatment should be continued for 1 to 3 years.

Doses above 400 mg per day have not been studied for angina pectoris.

Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with beta-blockers; however, the reduced response is largely eliminated if combination therapy that includes an adequate dose of a diuretic is instituted.

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