II. Indications
III. Mechanism
- Selective Beta Blocker
IV. Pharmacokinetics
- Intravenous dosing
- Onset of action in 5 minutes after intravenous dose
- Sustained response for 6-8 hours
V. Precautions
- Transitioning from immediate to extended release formulation is NOT a mg for mg substitution
- Exercise caution with gradual titration of dose
VI. Dosing
- Oral: Metoprolol Succinate (Toprol XL, extended release)
- Preferred oral formulation for Hypertension
- Avoid for acute management of Heart Rate (Atrial Fibrillation Rate Control)
- Onset of activity is too slow and difficult to titrate acutely
- Typical Hypertension Dose: 50-100 mg orally daily (Maximum 400 mg/day)
- Congestive Heart Failure: Start at 12.5 to 25 mg orally twice daily
- Oral: Metoprolol Tartrate (Lopressor, immediate release)
- Preferred for rapid activity onset (e.g. Atrial Fibrillation with Rapid Ventricular Response) and for dose titration (e.g. elderly, CHF)
- Typical Hypertension Dose: 50 mg orally twice daily (Maximum 450 mg/day)
- SVT Rate Control or Myocardial Infarction: 25 to 50 mg every 6 hours
- Congestive Heart Failure: Start at 6.25 mg orally twice daily
- Elderly: Start at 12.5 to 25 mg orally twice daily
- Intravenous Metoprolol (Lopressor)
- Load: 2.5 to 5 mg IV over 2 to 5 minutes
- Repeated up to 3 doses (15 mg maximum)
VII. Adverse Effects
- See Beta Blocker
VIII. Safety
- Pregnancy Category C
- Unknown safety in Lactation
IX. Drug Interactions
- Increased Metoprolol levels with strong CYP2D6 Inhibitors (e.g. Bupropion, Cimetidine)
X. Resources
- Metoprolol Succinate Extended Release Tablet or Toprol XL (DailyMed)
- Metoprolol Tartrate Immediate Release or Lopressor Tablet (DailyMed)
- Metoprolol Tartrate Injection Solution (DailyMed)
XI. References
- (2019) Presc Lett, Resource #350503, Comparison of Oral Beta Blockers
- Hamilton (2020) Tarascon Pharmacopoeia, Jones and Bartlett, Boston
- Morris (2022) Metoprolol, StatPearls, Treasure Island, FL
Images: Related links to external sites (from Bing)
Related Studies
| metoprolol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| METOPROLOL SUCC ER 100 MG TAB | Generic | $0.13 each |
| METOPROLOL SUCC ER 200 MG TAB | Generic | $0.20 each |
| METOPROLOL SUCC ER 25 MG TAB | Generic | $0.08 each |
| METOPROLOL SUCC ER 50 MG TAB | Generic | $0.08 each |
| METOPROLOL TARTRATE 100 MG TAB | Generic | $0.03 each |
| METOPROLOL TARTRATE 25 MG TAB | Generic | $0.02 each |
| METOPROLOL TARTRATE 50 MG TAB | Generic | $0.02 each |
| METOPROLOL TARTRATE 75 MG TAB | Generic | $0.16 each |
| METOPROLOL-HYDROCHLOROTHIAZIDE 100-25 MG TAB | Generic | $1.56 each |
| METOPROLOL-HYDROCHLOROTHIAZIDE 50-25 MG TAB | Generic | $1.11 each |
| toprol xl (on 9/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| TOPROL XL 100 MG TABLET | Generic | $0.13 each |
| TOPROL XL 25 MG TABLET | Generic | $0.08 each |
| TOPROL XL 50 MG TABLET | Generic | $0.08 each |