This review summarizes the effects of ractopamine hydrochloride (RAC) dose (5, 7.5, 10, and 20 mg/kg) on market weight pig welfare indicators. Ractopamine hydrochloride (trade name Paylean) is a β-adrenergic agonist that was initially approved in the U.S. in 1999 at doses of 5 to 20 mg/kg to improve feed efficiency and carcass leanness. However, anecdotal reports suggested that RAC increased the rate of non-ambulatory (fatigued and injured) pigs at U.S. packing plants. This led to the addition of a caution statement to the Paylean label, and a series of research studies investigating the effects of RAC on pig welfare. Early research indicated that: (1) regardless of RAC administration, fatigued (non-ambulatory, non-injured) pigs are in a state of metabolic acidosis; (2) aggressive handling increases stress responsiveness at 20 mg/kg RAC, while 5 mg/kg reduces stress responsiveness to aggressive handling. Given this information, dosage range for Paylean was changed in 2006 to 5 to 10 mg/kg in market weight pigs. Subsequent research on RAC demonstrated that: (1) RAC has minimal effects on mortality, lameness, and home pen behavior; (2) RAC fed pigs demonstrated inconsistent prevalence and intensity of aggressive behaviors; (3) RAC fed pigs may be more difficult to handle at doses above 5 mg/kg; and (4) RAC fed pigs may have increased stress responsiveness and higher rates of non-ambulatory pigs when subjected to aggressive handling, especially when 20 mg/kg of RAC is fed.