Maximum dosage of metoprolol in hypertension treatment
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Maximum Dosage of Metoprolol for Hypertension Treatment
Recommended Dosage Range for Metoprolol in Hypertension
Clinical studies consistently report that metoprolol is effective for treating hypertension at daily doses ranging from 100 mg to 450 mg, depending on patient response and tolerability 123. Most patients with mild to moderate hypertension achieve good blood pressure control with 100 mg twice daily (200 mg total per day) 235. In some cases, doses up to 300 mg or even 450 mg per day have been used, especially when lower doses do not provide adequate blood pressure reduction 169.
Efficacy and Tolerability at Higher Doses
Studies show that increasing the dose of metoprolol can improve blood pressure control in patients who do not respond to lower doses, with 300 mg to 450 mg daily being both effective and generally well tolerated 169. In a multicenter study, doses up to 450 mg daily were found to be effective and safe for long-term use in patients with essential hypertension . Another study found that patients with hypertension and dilated cardiomyopathy tolerated higher doses, averaging around 190 mg per day, and experienced significant improvements in blood pressure and heart function .
Once-Daily vs. Multiple-Daily Dosing
Metoprolol can be administered as a single daily dose or divided into two or three doses per day. Sustained-release formulations allow for once-daily dosing, with studies showing that 200 mg to 300 mg once daily provides similar blood pressure control as divided doses 45689. However, some evidence suggests that multiple daily doses may provide more stable blood levels and beta-blockade, though the difference in blood pressure control is not significant .
Special Considerations in Elderly and Comorbid Patients
In elderly patients, starting with 100 mg once daily is effective and safe, with the option to add a diuretic if blood pressure is not adequately controlled . Metoprolol is also well tolerated in patients with asthma and diabetes, likely due to its cardioselectivity 23.
Side Effects and Dose Limitation
The most common side effects at higher doses are gastrointestinal disturbances and dizziness, leading to treatment withdrawal in a small percentage of patients (about 6-7%) 23. Side effects tend to decrease over time, and most patients tolerate the medication well even at higher doses 123.
Conclusion
The maximum recommended dosage of metoprolol for hypertension treatment is generally up to 450 mg per day, with most patients achieving effective blood pressure control at 200–300 mg daily. Higher doses may be used in select patients who do not respond to standard doses, provided they are well tolerated. Both once-daily and divided dosing regimens are effective, and metoprolol is considered safe for use in elderly and comorbid patients.
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