II. Mechanism

  1. Selective Beta Blocker

IV. Pharmacokinetics

  1. Intravenous dosing
    1. Onset of action in 5 minutes after intravenous dose
    2. Sustained response for 6-8 hours

V. Precautions

  1. Transitioning from immediate to extended release formulation is NOT a mg for mg substitution
    1. Exercise caution with gradual titration of dose

VI. Dosing

  1. Oral: Metoprolol Succinate (Toprol XL, extended release)
    1. Preferred oral formulation for Hypertension
    2. Typical Hypertension Dose: 50-100 mg orally daily (Maximum 400 mg/day)
    3. Congestive Heart Failure: Start at 12.5 to 25 mg orally twice daily
  2. Oral: Metoprolol Tartrate (Lopressor, immediate release)
    1. Preferred for rapid activity onset (e.g. Atrial Fibrillation with Rapid Ventricular Response) and for dose titration (e.g. elderly, CHF)
    2. Typical Hypertension Dose: 50 mg orally twice daily (Maximum 450 mg/day)
    3. SVT Rate Control or Myocardial Infarction: 25 to 50 mg every 6 hours
    4. Congestive Heart Failure: Start at 6.25 mg orally twice daily
    5. Elderly: Start at 12.5 to 25 mg orally twice daily
  3. Intravenous Metoprolol (Lopressor)
    1. Load: 2.5 to 5 mg IV over 2 to 5 minutes
    2. Repeated up to 3 doses (15 mg maximum)

VII. Adverse Effects

  1. See Beta Blocker
  2. Pregnancy Category C

VIII. Drug Interactions

  1. Increased Metoprolol levels with strong CYP2D6 Inhibitors (e.g. Bupropion, Cimetidine)

IX. References

  1. Hamilton (2020) Tarascon Pharmacopoeia, Jones and Bartlett, Boston
  2. Morris (2022) Metoprolol, StatPearls, Treasure Island, FL
    1. https://www.ncbi.nlm.nih.gov/books/NBK532923/

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Related Studies

Cost: Medications

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