Below are the general guidelines for dosing metoprolol. Note that these dosages may be adjusted on a case-by-case basis for individual patients. Always follow your prescribing physician’s instructions for taking metoprolol.
The following information comes from DailyMed, an FDA label information provider.
What if I miss a dose of Metoprolol?
According to Mayo Clinic, if you miss a dose of metoprolol, take it as soon as possible, unless you are closer to your next dose. If the latter is true, skip the missed dose and wait until your next dose. Never double dose.
Please note: dosing may look different for everyone. Talk to your doctor about specific dosing instructions before starting treatment with metoprolol.
What if I overdose on Metoprolol?
Acute Toxicity:
Several cases of overdosage have been reported, some leading to death.
Signs and Symptoms:
Potential signs and symptoms associated with overdosage with metoprolol tartrate are bradycardia, hypotension, bronchospasm, myocardial infarction, cardiac failure and death.
Management:
There is no specific antidote.
In general, patients with acute or recent myocardial infarction may be more hemodynamically unstable than other patients and should be treated accordingly (see WARNINGS, MYOCARDIAL INFARCTION).
On the basis of the pharmacologic actions of metoprolol tartrate, the following general measures should be employed:
Hypotension: Administer a vasopressor, e.g., levarterenol, norepinephrine, or dopamine.
Bronchospasm: Administer a beta2-stimulating agent and/or a theophylline derivative.
Cardiac Failure: Administer digitalis glycoside and diuretic. In shock resulting from inadequate cardiac contractility, consider administration of dobutamine, isoproterenol or glucagon.
Other clinical manifestations of overdose should be managed symptomatically based on modern methods of intensive care.
Dosage and Administration
Hypertension:
Individualize the dosage of metoprolol tartrate tablets. Metoprolol tartrate tablets should be taken with or immediately following meals/food.
The usual initial dosage of metoprolol tartrate tablets is 100 mg daily in single or divided doses, whether used alone or added to a diuretic. Increase the dosage at weekly (or longer) intervals until optimum blood pressure reduction is achieved. In general, the maximum effect of any given dosage level will be apparent after 1 week of therapy. The effective dosage range of metoprolol tartrate tablets is 100-450 mg per day. Dosages above 450 mg per day have not been studied. 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. Beta-1 selectivity diminishes as the dose of metoprolol tartrate is increased.
Angina Pectoris:
The dosage of metoprolol tartrate tablets should be individualized. Metoprolol tartrate tablets should be taken with or immediately following meals.
The usual initial dosage of metoprolol tartrate tablets is 100 mg daily, given in two divided doses. Gradually increase the dosage at weekly intervals until optimum clinical response has been obtained or there is pronounced slowing of the heart rate. The effective dosage range of metoprolol tartrate tablets is 100-400 mg per day. Dosages above 400 mg per day have not been studied. If treatment is to be discontinued, gradually decrease the dosage over a period of 1-2 weeks (see WARNINGS).
Myocardial Infarction:
Early Treatment:
During the early phase of definite or suspected acute myocardial infarction, initiate treatment with metoprolol tartrate as soon as possible after the patient’s arrival in the hospital. Such treatment should be initiated in a coronary care or similar unit immediately after the patient’s hemodynamic condition has stabilized.
Begin treatment in this early phase with the intravenous administration of three bolus injections of 5 mg of metoprolol tartrate each; give the injections at approximately 2-minute intervals. During the intravenous administration of metoprolol tartrate, monitor blood pressure, heart rate, and electrocardiogram.
In patients who tolerate the full intravenous dose (15 mg), initiate metoprolol tartrate tablets, 50 mg every 6 hours, 15 minutes after the last intravenous dose and continue for 48 hours. Thereafter, the maintenance dosage is 100 mg twice daily (see LATE TREATMENT below).
Start patients who appear not to tolerate the full intravenous dose on metoprolol tartrate tablets either 25 mg or 50 mg every 6 hours (depending on the degree of intolerance) 15 minutes after the last intravenous dose or as soon as their clinical condition allows. In patients with severe intolerance, discontinue metoprolol tartrate (see WARNINGS).
Late Treatment:
Start 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 on metoprolol tartrate tablets, 100 mg twice daily, as soon as their clinical condition allows. Continue therapy for at least 3 months. Although the efficacy of metoprolol tartrate beyond 3 months has not been conclusively established, data from studies with other beta blockers suggest that treatment should be continued for 1-3 years.
Special populations:
Pediatric patients: No pediatric studies have been performed. The safety and efficacy of metoprolol tartrate in pediatric patients have not been established.
Renal impairment: No dose adjustment of metoprolol tartrate is required in patients with renal impairment.
Hepatic impairment: Metoprolol tartrate blood levels are likely to increase substantially in patients with hepatic impairment. Therefore, metoprolol tartrate should be initiated at low doses with cautious gradual dose titration according to clinical response.
Geriatric patients (>65 years): In general, use a low initial starting dose in elderly patients given their greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Method of administration:
For oral treatment, the tablets should be swallowed un-chewed with a glass of water. Metoprolol tartrate should always be taken in standardized relation with meals. If the physician asks the patient to take metoprolol tartrate either before breakfast or with breakfast, then the patient should continue taking metoprolol tartrate with the same schedule during the course of therapy.
How is Metoprolol supplied?
Metoprolol tartrate tablets, USP 25 mg are available as white to off-white, round, film-coated tablets, debossed with “RE” above the bisect and “79” below the bisect on one side and plain on the other side.
Bottles of 10 NDC 63304-579-03
Bottles of 100 NDC 63304-579-01
Bottles of 1000 NDC 63304-579-10
Metoprolol tartrate tablets, USP 50 mg are available as pink colored, round, film-coated tablets debossed with “RE” above the bisect and “75” below the bisect on one side and plain on the other side.
Bottles of 10 NDC 63304-580-03
Bottles of 100 NDC 63304-580-01
Bottles of 1000 NDC 63304-580-10
Metoprolol tartrate tablets, USP 100 mg are available as white to off-white, round, film-coated tablets, debossed with “RE” above the bisect and “76” below the bisect on one side and plain on the other side.
Bottles of 10 NDC 63304-581-03
Bottles of 100 NDC 63304-581-01
Bottles of 1000 NDC 63304-581-10
Store at 20 – 25°C (68 – 77°F) [See USP Controlled Room Temperature]. Protect from moisture and heat.
Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.
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