The aim of this study was to conduct a comprehensive review with meta-analysis to determine the effects of the dose–response relationship between monensin supplementation and dairy cow performance and milk composition. Results from 566 full-text articles and 48 articles with 52 studies were meta-analyzed for pooled estimates. Monensin supplementation up to 23 ppm increased milk production, with the optimal dose being 12.6 ppm. Monensin supplementation at doses ranging from 16 to 96 ppm increased milk production in the prepartum phase (− 28 to 0 day relative to calving). From 60 to 150 DIM, monensin supplementation up to 21 ppm had a significant positive effect on this outcome, while supplementation in the 37 to 96 ppm range caused a decrease in this variable. At 0 to 60 and > 150 DIM, monensin supplementation had no effect on milk yield. At dosages of 22 to 96 ppm, 12 to 36 ppm, and below 58 ppm and 35 ppm, respectively, monensin supplementation resulted in significant decreases in dry matter intake (DMI), milk protein percentage, milk fat percentage, and milk fat yield. Overall, based on the results of this meta-analysis and considering all variables, the recommended optimal dose of monensin could be about 16 ppm.