Metoprolol tartrate dosage, forms, and strengths

Metoprolol tartrate is the immediate-release version of metoprolol, a generic prescription drug used to treat a number of cardiovascular conditions, including high blood pressure, chest pain (angina pectoris), and heart attack. Those are the FDA-approved uses, but healthcare professionals use metoprolol off-label to prevent migraines or treat atrial fibrillation, arrhythmias, tremor, or thyroid storm (a life-threatening elevation in thyroid hormones called thyrotoxicosis). In addition, metoprolol succinate, the extended-release formulation of metoprolol, is approved by the Food and Drug Administration (FDA) to treat heart failure, Doses will depend on the condition being treated and are taken with food twice per day.

Metoprolol tartrate forms and strengths

Metoprolol is usually taken orally as a tablet. For heart attacks, emergency room or coronary care doctors will give the initial doses as intravenous injections. Metoprolol tartrate is also available under the brand name Lopressor.

• Tablet: 25 milligrams (mg), 37.5 mg, 50 mg, 75 mg, 100 mg

• Injection: 5 mg/5 mL

Metoprolol tartrate dosage for adults

Healthcare professionals commonly use metoprolol tartrate in adults for a variety of conditions, including high blood pressure, chest pain, heart attack, and migraine prevention. Only the first three are FDA approved. Migraine prevention is an off-label use. Metoprolol belongs to a family of drugs called cardioselective beta blockers. These drugs slow down the heart, decrease the strength of heartbeats, and reduce systolic blood pressure. Doses should be taken with a meal or immediately afterward.

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Metoprolol tartrate dosage for hypertension

People take two daily doses of 50 mg to 200 mg for high blood pressure. The dosage strength will be based on how well the drug controls blood pressure. As with other beta blockers, metoprolol lowers blood pressure by decreasing the heart rate and the strength of each heartbeat. Metoprolol is rarely prescribed as the sole antihypertensive medication. It is often prescribed with other antihypertensives, including thiazide diuretics like hydrochlorothiazide. 

• Starting adult dosage for hypertension: 100 taken once per day or divided into two daily doses

• Standard adult dosage for hypertension: 100–450 mg daily divided into two daily doses

Metoprolol tartrate dosage for angina

Angina pectoris, or chest pain, is due to the heart muscle not getting enough oxygen. It is a common symptom in people with coronary artery disease, especially when they exercise or exert themselves. Metoprolol prevents angina by reducing the amount of work the heart has to do. 

• Starting adult dosage for angina: 50 mg taken twice per day 

• Standard adult dosage for angina: 100–400 mg daily divided into two daily doses

Metoprolol tartrate dosage for heart attack

Metoprolol and other similar beta blockers are a standard part of the immediate and follow-up treatment of heart attack. Early treatment involves intravenous injections given in the emergency room or coronary intensive care unit (ICU). These initial doses help prevent another heart attack or decrease the risk of complications. Oral metoprolol is given starting the same day. Treatment will continue for at least three months to prevent another heart attack or complications like heart failure or stroke.

• Starting adult dosage for heart attack: 5 mg intravenous injection every two to five minutes for up to three doses followed by 50 mg oral metoprolol every six to 12 hours starting 15 minutes after the last IV dose with continued dosing for 48 hours

• Standard adult dosage for heart attack: 100 mg twice daily for three months

Metoprolol tartrate dosage for migraine prevention

Migraine prevention is not an FDA approved use of metoprolol, but metoprolol is commonly prescribed as a migraine prophylactic. Many migraine symptoms, such as headache pain, are caused by blood vessel constriction. Metoprolol decreases the force of blood flow, helping to prevent migraine symptoms.

• Starting adult dosage for migraine prevention: 25 taken twice per day

• Standard adult dosage for migraine prevention: 25–100 mg twice per day

Metoprolol tartrate dosage for children

Metoprolol is not approved for use in children younger than 18 years of age. Some healthcare providers may prescribe it off-label to children with high blood pressure. 

Metoprolol tartrate dosage restrictions

The FDA has not specified dosage restrictions for people with kidney impairment or liver impairment. The prescribing information advises healthcare professionals to start people with liver problems with a lower starting dose because of the increased risk of side effects. The same applies to geriatric patients.

Metoprolol tartrate dosage for pets 

Metoprolol is commonly prescribed to dogs and cats to treat or prevent heartbeat irregularities and other heart conditions. According to Plumb’s Veterinary Manual, the standard dosage for dogs is 0.25 mg to 1 mg per kilogram of body weight given once or twice daily. The standard dosage for cats is 2–15 mg daily, given in four divided doses.

How to take metoprolol tartrate

Most people take metoprolol for serious conditions, so it’s important to take it faithfully and correctly.

• Take this medicine as instructed.

• Because it is not a long-acting version of metoprolol, there are two daily doses. Take each dose at the same scheduled time each day, one in the morning and one later in the day.

• Metoprolol doses must be taken with a meal or right after one. 

• Swallow the tablets whole with a glass of water.

• If a dose is missed, skip the missed dose. Take the next dose at the regularly scheduled time.

• Do not stop taking metoprolol until talking to the prescriber.

• Store this medicine at room temperature in a closed container that protects the medicine from moisture.

Metoprolol tartrate dosage FAQs

Metoprolol tartrate vs. metoprolol succinate ER

Metoprolol tartrate is the immediate-release dosage form of metoprolol. Metoprolol succinate and brand-name Toprol XL are the extended-release versions of metoprolol. These two drugs work the same way. They are often used for the same conditions, but the dosing schedules differ. Metoprolol succinate extended-release tablets and capsules are taken once daily compared to twice-daily dosing for metoprolol tartrate. For some conditions like congestive heart failure, healthcare professionals only prescribe the extended-release version.

How long does it take metoprolol tartrate to work?

Oral metoprolol significantly affects the heart within one hour of taking a dose. Metoprolol reduces systolic blood pressure within 12 hours of starting a twice-daily dosing regimen. 

How long does metoprolol tartrate stay in your system?

Metoprolol tartrate has a half-life of three to four hours, so doses must be taken twice daily. Metoprolol tartrate will fall to undetectable levels in the bloodstream in about 15 hours.

What happens if I miss a dose of metoprolol tartrate?

Do not take a missed dose if you forget it. Take the next dose as scheduled. Do not take extra medicine to make up for a missed dose.

How long can you take metoprolol tartrate?

Metoprolol is intended for long-term or even lifelong treatment. Prescribers will continue to use the medicine as long as it’s necessary and effective with minimal side effects. 

How do I stop taking metoprolol tartrate?

Do not stop taking this medicine unless instructed to by a doctor. The safety of stopping metoprolol depends on the condition being treated. 

People taking metoprolol tartrate for hypertension can stop treatment without causing withdrawal symptoms other than increased blood pressure. However, get medical advice first. Metoprolol blocks the symptoms of hyperthyroidism. In those cases, sudden discontinuation of metoprolol can cause severe problems, including thyroid storm. 

Sudden discontinuation of metoprolol for people with angina or heart attack may cause serious problems such as a worsening of angina or heart attack. The clinician will use a gradually tapering dose to stop metoprolol treatment in those cases.

What is the maximum dosage for metoprolol tartrate?

The maximum dosage for metoprolol tartrate immediate-release tablets is 450 mg per day, but doses this high do not benefit people with some conditions such as migraines or angina. For the extended-release version (metoprolol succinate ER), the maximum dosage is 400 mg per day.

Can you overdose on metoprolol tartrate?

Get emergency help if too much metoprolol is taken. This is especially true for anyone with heart disease. A metoprolol overdose can cause heart problems such as a dangerously slow heart rate (bradycardia), heart block, heart failure, and cardiogenic shock. Other adverse effects include severely low blood pressure (hypotension), trouble breathing, and coma.

What interacts with metoprolol tartrate?

Because of its beta-blocking effects, metoprolol has several significant drug interactions. 

The most concerning drug interactions involve drugs that slow the heart, like the blood pressure drug clonidine or calcium channel blockers. The combination may cause the heart to slow down to dangerous levels.

Some drugs decrease a substance called catecholamine, which increases the rate and strength of heartbeats. Metoprolol blocks this substance to slow down and weaken the heart. The combination can increase metoprolol’s effects on the heart and cause problems. Prominent examples include MAO inhibitors and the blood pressure drug reserpine.

Metoprolol also blocks epinephrine, another substance that speeds up the heart. That means epinephrine shots for severe allergic reactions are less effective in people taking metoprolol. 

Finally, some drugs slow down the body’s ability to break down metoprolol. This results in a higher concentration of metoprolol in the blood and an increased risk of side effects. Prescribers and pharmacists are aware of these drugs and will adjust dosages accordingly.

What happens when you mix metoprolol tartrate and alcohol?

Alcohol can increase some of the side effects of metoprolol, such as drowsiness and dizziness. Alcohol should be avoided when taking extended-release metoprolol capsules because of the way it interacts with the capsule. 

Is it safe to take metoprolol tartrate during pregnancy?

Healthcare professionals prescribe metoprolol tartrate to pregnant women but do so cautiously. Metoprolol tartrate has not been shown to cause birth defects or other problems. However, there have been reports of adverse effects in newborns, such as slow heart rate and low blood sugar. 

Is it safe to take metoprolol tartrate when breastfeeding?

Healthcare providers do use metoprolol in women who are breastfeeding. When breastfeeding women take metoprolol, a tiny amount of the drug can be found in the breast milk. No adverse reactions in nursing infants have been reported. 

When is it not safe to take metoprolol tartrate?

Metoprolol treatment can be risky in people with certain medical conditions, so the drug is never used in those people. Contraindications include various types of heart disease, such as severely slow heart rate, heart block, cardiogenic shock, severe heart failure, low blood pressure, or sick sinus syndrome not corrected with a permanent pacemaker. Healthcare providers will not use metoprolol in anyone with a severe allergic reaction to the drug.

Metoprolol is used cautiously in people with heart failure, asthma, chronic obstructive pulmonary disease, low blood sugar, or adrenal gland cancer (pheochromocytoma). Doctors avoid using metoprolol in high doses after any surgery that doesn’t involve the heart.

What are the possible side effects of metoprolol tartrate?

Most of the side effects are due to its mechanism of action: slowing down the heart. The most common adverse effects of metoprolol tartrate therapy are drowsiness, dizziness, fatigue, low blood pressure, slow heart rate, and shortness of breath. Weight gain is also possible and may require the drug to be discontinued. Serious side effects include severely slow heart rate, heart block, heart failure, heart rhythm problems, trouble breathing, and severe allergic reactions.

Sources

• Metoprolol tartrate drug summary, Prescriber’s Digital Reference

• Metoprolol tartrate injection prescribing information, NIH National Library of Medicine

• Metoprolol tartrate tablet prescribing information, NIH National Library of Medicine

• What is metoprolol tartrate: uses, warnings & interactions, SingleCare