- Selective Beta Blocker
- Intravenous dosing
- Onset of action in 5 minutes after intravenous dose
- Sustained response for 6-8 hours
- Transitioning from immediate to extended release formulation is NOT a mg for mg substitution
- Exercise caution with gradual titration of dose
- 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)
- See Beta Blocker
- Pregnancy Category C
- Unknown safety in Lactation
- Increased Metoprolol levels with strong CYP2D6 Inhibitors (e.g. Bupropion, Cimetidine)
- Metoprolol Succinate Extended Release Tablet or Toprol XL (DailyMed)
- Metoprolol Tartrate Immediate Release or Lopressor Tablet (DailyMed)
- Metoprolol Tartrate Injection Solution (DailyMed)
- (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