Metoprolol Conversion and Administration Guidelines

Introduction to Metoprolol Conversion

When converting from oral metoprolol tartrate to IV metoprolol, a ratio of 1:1 can be used, with 50 mg oral metoprolol tartrate equivalent to 5 mg IV metoprolol given as bolus doses, as recommended by the American College of Cardiology 1, 2

The conversion from oral to IV metoprolol follows a 10:1 ratio (50 mg oral = 5 mg IV), with standard IV dosing of 2.5-5.0 mg IV bolus over 2 minutes, and a maximum IV dosing that can be repeated up to 3 doses (maximum 15 mg), according to the American College of Cardiology 1
The following table outlines the oral to IV metoprolol conversion:
For acute situations, the initial dose is 5 mg IV bolus over 2 minutes, with monitoring of blood pressure, heart rate, and ECG during administration, and subsequent dosing can be repeated at 10-minute intervals if needed, up to a maximum total dose of 15 mg (three 5 mg boluses), as recommended by the American College of Cardiology 1

IV metoprolol achieves more rapid beta-blockade than oral formulations, and continuous cardiac monitoring is essential during IV administration, according to the American College of Cardiology 1
Contraindications for IV metoprolol include cardiogenic shock, decompensated heart failure, significant bradycardia, or heart block greater than first degree, as stated by the American College of Cardiology 1
Elderly patients should start with lower doses (2.5 mg IV) due to increased risk of adverse effects, and IV administration carries a higher risk of hypotension compared to oral dosing, according to the American College of Cardiology 1