Pharm

Metoprolol

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Metoprolol, Lopressor, Metoprolol Succinate, Metoprolol Tartrate, Toprol XL

  • See Also
  1. Beta Blocker
  • Indications
  1. Hypertension
  2. Coronary Artery Disease (including Angina, acute Myocardial Infarction)
  3. Atrial Fibrillation Rate Control
  • Mechanism
  1. Selective Beta Blocker
  • Pharmacokinetics
  1. Intravenous dosing
    1. Onset of action in 5 minutes after intravenous dose
    2. Sustained response for 6-8 hours
  • Precautions
  1. Transitioning from immediate to extended release formulation is NOT a mg for mg substitution
    1. Exercise caution with gradual titration of dose
  • Dosing
  1. Oral: Metoprolol Succinate (Toprol XL, extended release)
    1. Preferred oral formulation for Hypertension
    2. Avoid for acute management of Heart Rate (Atrial Fibrillation Rate Control)
      1. Onset of activity is too slow and difficult to titrate acutely
    3. Typical Hypertension Dose: 50-100 mg orally daily (Maximum 400 mg/day)
    4. 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)
  • Adverse Effects
  1. See Beta Blocker
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation
  • Drug Interactions
  1. Increased Metoprolol levels with strong CYP2D6 Inhibitors (e.g. Bupropion, Cimetidine)
  • Resources
  1. Metoprolol Succinate Extended Release Tablet or Toprol XL (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=209eccb0-29a1-4456-b902-0c99b47f6aa0
  2. Metoprolol Tartrate Immediate Release or Lopressor Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=0283bc9d-6998-493a-824a-d4c85f704111
  3. Metoprolol Tartrate Injection Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=7c1f998a-233d-4feb-6ea2-457702abd0d2
  • References
  1. (2019) Presc Lett, Resource #350503, Comparison of Oral Beta Blockers
  2. Hamilton (2020) Tarascon Pharmacopoeia, Jones and Bartlett, Boston
  3. Morris (2022) Metoprolol, StatPearls, Treasure Island, FL
    1. https://www.ncbi.nlm.nih.gov/books/NBK532923/