Metoprolol succinate dosage

Metoprolol succinate is the extended-release formulation of metoprolol and is a commonly prescribed treatment for high blood pressure, chest pain, or heart failure. It’s available as a generic drug or as brand-name Toprol XL or Kapspargo. These extended-release tablets or capsules can be taken once per day, a more convenient dosing schedule than immediate-release metoprolol.

Metoprolol succinate forms and strengths

Metoprolol comes in two dosage forms: tablets and capsules.

• Tablets: 25 mg, 50 mg, 100 mg, 200 mg

• Capsules: 25 mg, 50 mg, 100 mg, 200 mg

Metoprolol succinate dosage for adults

The FDA has approved metoprolol succinate to treat high blood pressure in adults and children. It’s also approved to treat chest pain (angina pectoris) and heart failure in adults. Healthcare professionals commonly use it off-label for heart attack, heart rhythm abnormalities, migraine prevention, tremor, or thyrotoxicosis, a condition in which thyroid hormones reach dangerously high levels.

Metoprolol succinate dosage for hypertension

High blood pressure is one of the most common metabolic diseases in the U.S., affecting nearly half of all adults. Healthcare professionals follow well-documented guidelines when prescribing drugs, but metoprolol is usually not the first drug of choice. It’s usually added to the treatment regimen when other drugs aren’t working at controlling blood pressure. It’s not uncommon for people to take metoprolol along with other medications in different drug classes.

Metoprolol belongs to a popular class of antihypertensives called beta blockers. These drugs lower blood pressure by slowing down the heart and reducing the force of each heartbeat. 

• Starting adult dosage for hypertension: 25–100 mg taken once daily

• Maximum adult dosage for hypertension: 400 mg daily

Metoprolol succinate dosage for angina

Chest pain can be caused by many problems, but the chest pain doctors worry about is when the heart muscle doesn’t get enough oxygen. Called angina pectoris, it’s a common experience in people with coronary artery disease. It’s often worse when people exercise. Beta blockers like metoprolol are used because they make the heart work less strenuously by slowing it down and reducing the strength of heartbeats. 

• Standard adult dosage for angina: 100–400 mg taken once daily

• Maximum adult dosage for angina: 400 mg daily

Metoprolol succinate dosage for heart failure

Unlike immediate-release metoprolol tartrate, the FDA has approved metoprolol succinate as a heart failure treatment. Heart failure is a condition in which the heart cannot pump enough blood to the rest of the body. It has many causes, but the condition raises the risk of blood clots and, over time, causes the heart to grow bigger. As the heart gets larger, heart failure worsens. 

Beta blockers like metoprolol are long-term treatments that improve outcomes for heart failure patients. They are used to reduce the risk of severe cardiovascular events, hospitalizations, and death.

• Standard adult dosage for heart failure: 25–200 mg taken once daily

• Standard adult dosage for heart failure: 200 mg daily

Metoprolol succinate dosage for children

The FDA has approved metoprolol succinate as a high blood pressure treatment in pediatric patients as young as 6 years old. As with adults, doses are given once daily. For children who cannot swallow a tablet, caregivers can ask for Kapspargo capsules. These can be opened and sprinkled on applesauce for easier dosing.

• Standard metoprolol succinate dosage for children 6 years of age and older: 1 mg/kg given once daily

Metoprolol succinate dosage restrictions

Metoprolol succinate has no specific dosage modifications for people with kidney disease or liver impairment. However, people with liver problems will be started on a lower dose. 

Metoprolol succinate dosage for pets 

Veterinarians use metoprolol tartrate and metoprolol succinate in dogs and cats to treat heart failure or heart rhythm problems. Veterinary guidelines do not provide specific dosing guidelines for extended-release metoprolol. The recommended dosage of immediate-release metoprolol in dogs is 0.25 mg to 1 mg per kilogram of body weight given once or twice daily. The standard metoprolol dosage for cats is 2–15 mg daily.

How to take metoprolol succinate

Because metoprolol is used for serious health conditions, the most important tip about taking metoprolol succinate is to not miss a dose. Taking doses is not difficult:

• Take doses as instructed. The dose may change several times, particularly at first.

• Take each tablet or capsule at the same time every day.

• Take this medicine with a meal or right after a meal, but take it the same way each time.

• How to take metoprolol succinate tablets:

  • Swallow the extended-release tablet whole with a glass of water. Do not crush or chew the tablet.

  • The tablet is scored to allow it to be cut into two smaller doses. If you don’t know how to do this, ask a pharmacist or other healthcare provider.

• How to take metoprolol succinate capsules:

  • Swallow the extended-release capsule whole. 

  • Do not crush, break, or chew it. 

  • For children or others who cannot swallow a capsule, open the capsule and sprinkle the contents over a small amount (teaspoonful) of soft food such as applesauce, pudding, or yogurt. Swallow the mixture within 60 minutes. 

  • If the capsule needs to be given through a nasogastric tube, mix the contents of the opened capsule with water into a syringe. Gently shake the mixture for about 10 seconds, then flush it through the tube. Rinse the tube with water until all of the medicine is washed out.

• Store metoprolol succinate tablets or capsules at room temperature. 

Metoprolol succinate dosage FAQs

Metoprolol tartrate vs. metoprolol succinate ER: What’s the difference in doses?

Metoprolol succinate and its brand-name versions are the extended-release versions of metoprolol. Metoprolol tartrate and its brand-name version, Lopressor, are the immediate-release formulations of metoprolol. Metoprolol succinate extended-release tablets and capsules are taken once daily, and metoprolol tartrate doses are taken twice daily. Both drugs treat the same conditions, but metoprolol tartrate is not FDA-approved to treat heart failure. 

How long does it take metoprolol succinate to work?

Metoprolol succinate's peak effects occur about two hours after a dose is taken. People with high blood pressure or angina should notice improvements after the first dose. Success in heart failure is measured in the long term.

What happens if I miss a dose of metoprolol succinate?

Skip any missed dose. Take the next dose at its regular time. Do not take a double dose to make up for a missed dose.

How long can you take metoprolol succinate?

Healthcare providers use metoprolol succinate as a long-term treatment that can last for months or years. 

How do I stop taking metoprolol succinate?

Do not stop taking metoprolol until talking to the prescriber. Although metoprolol does not cause withdrawal effects, the sudden discontinuation of metoprolol succinate can cause serious issues in people with heart problems or other medical conditions:

• People with angina may experience a dramatic worsening of chest pain.

• People with heart disease or a history of heart attacks are at a higher risk of heart attack.

• People with an overactive thyroid (hyperthyroidism) are at risk of suddenly experiencing the symptoms—even severe or life-threatening symptoms—of hyperthyroidism.

For these reasons, doctors will steadily decrease the dose of metoprolol when it’s time to stop.

What is the maximum dosage for metoprolol succinate?

The maximum dosage of metoprolol succinate is 400 mg per day.

Can you overdose on metoprolol succinate?

Call a poison control center or get emergency medical attention in case of overdose. Too much metoprolol can cause significant heart problems, including slow heart rate (bradycardia), low blood pressure, heart block, heart failure, and cardiogenic shock. Symptoms of an overdose can include nausea, vomiting, trouble breathing (bronchospasm), impaired consciousness, and coma.

What interacts with metoprolol succinate?

To avoid possible drug interactions, tell the prescriber about all prescription drugs, over-the-counter medications, and supplements being taken, particularly:

• Calcium channel blockers, particularly verapamil of diltiazem

• Other beta blockers, such as propranolol

• The blood pressure drugs clonidine or reserpine

• Drugs that treat heart rhythm problems, particularly digitalis drugs, quinidine, and propafenone

• Migraine treatments called ergot drugs

• HIV/AIDS drugs

• MAO inhibitors (MAOIs)

Metoprolol blocks the effects of epinephrine, a drug used to treat severe allergic reactions. That makes epinephrine shots less effective at treating medical emergencies. 

Some drugs block the ability of the body to break down metoprolol, raising the risk of serious side effects. The prescriber is aware of these drugs and may modify dosages.

What happens when you mix metoprolol succinate and alcohol?

Though not prohibited, drinking alcohol may worsen some minor side effects of metoprolol, such as lightheadedness, tiredness, or drowsiness. People taking Kapspargo capsules should avoid alcohol. Alcohol causes the metoprolol succinate in the capsule to be released faster, increasing the risk of side effects. 

Is it safe to take metoprolol succinate during pregnancy?

Pregnant women are given metoprolol succinate cautiously. There is no evidence it causes birth defects or affects the pregnancy. However, newborns may experience adverse effects such as slow heart rate or low blood sugar. Ask the prescriber for medical advice if there are any concerns.

Is it safe to take metoprolol succinate when breastfeeding?

Women who are nursing can take metoprolol. A tiny amount of the drug can be found in breast milk, but there is no evidence it affects lactation or causes problems in the infant. 

What are the side effects of metoprolol succinate?

The most common side effects of metoprolol are tiredness, dizziness, sleepiness, slow heart rate, hypotension, shortness of breath, diarrhea, and dry mouth. Serious side effects include weight gain, severely slow heart rate, heart block, heart failure, heart rhythm abnormalities, trouble breathing, and severe allergic reactions.

Who should not take metoprolol succinate?

Metoprolol is not safe for some people to take, including people with known allergies to metoprolol or people with certain heart problem,s including a very slow heart rate (severe bradycardia), moderate or severe heart block, symptomatic heart failure, or an abnormal heartbeat called sick sinus syndrome.

Though not prohibited, doctors are discouraged from prescribing metoprolol to people with bronchospastic diseases such as asthma. Metoprolol can bring on bronchospasms. If it is prescribed, people with these conditions should carry a rescue inhaler.

People with diabetes should be careful because beta blockers can mask the symptoms of low blood sugar (hypoglycemia). Additionally, people with an overactive thyroid should be careful not to miss doses, or they might start experiencing symptoms.

Healthcare professionals also use it cautiously in people with slow heartbeats, problems with peripheral blood vessels, or adrenal gland cancer (pheochromocytoma). 

Sources

• High blood pressure facts, Centers for Disease Control and Prevention (CDC)

• Metoprolol succinate tablet prescribing information, NIH National Library of 

• Kapspargo metoprolol succinate capsule prescribing information, NIH National Library of Medicine

• Metoprolol, StatPearls

• Pharmacokinetic considerations of formulation: Extended-release metoprolol succinate in the treatment of heart failure, Journal of Cardiovascular Pharmacology

• Plumb’s Veterinary Drug Handbook, 7th ed.

• The importance of beta blockers in the treatment of heart failure, American Family Physician

• Toprol drug summary, Prescriber’s Digital Reference

• Toprol XL metoprolol succinate tablet prescribing information, NIH National Library of Medicine