IV Metoprolol Dosing and Administration
Dosing Protocol
- The American College of Cardiology recommends initial IV dosing of metoprolol in 5 mg increments given slowly over 1-2 minutes, repeated every 5 minutes for a total initial dose of 15 mg 1, 2, 3, 4, 5
- The American College of Cardiology suggests a maximum initial IV dose of 15 mg (three 5-mg doses) 2, 3, 4
- The American College of Cardiology recommends transitioning to oral therapy 15 minutes after the last intravenous dose in patients who tolerate the total 15-mg IV dose 2, 3
- Initial oral dosing after IV administration should be 25 to 50 mg every 6 hours for 48 hours, according to the American College of Cardiology 2, 3, 4
- Maintenance oral dosing should be up to 100 mg twice daily, as recommended by the American College of Cardiology 2, 3, 4
Monitoring and Contraindications
- The American College of Cardiology recommends frequent checks of heart rate and blood pressure, as well as continuous ECG monitoring and auscultation for rales and bronchospasm 2, 3, 4
- The target resting heart rate should be 50-60 beats per minute unless a limiting side effect is reached, according to the American College of Cardiology 2, 3, 4
- The American College of Cardiology advises against administering metoprolol to patients with low-output state, significant sinus bradycardia, hypotension, severe left ventricular dysfunction or heart failure, or high risk for cardiogenic shock 2, 3, 4
- The American College of Cardiology recommends using metoprolol with caution in patients with chronic obstructive pulmonary disease with reactive airway component, history of asthma, or mild wheezing 1, 2, 3, 4
Administration Precautions
- The American College of Cardiology warns that administering IV metoprolol too rapidly can lead to excessive hypotension 2, 3, 4
- Failing to monitor vital signs between doses may result in missing early signs of adverse effects, according to the American College of Cardiology 2, 3, 4
- The American College of Cardiology advises against abrupt discontinuation of beta-blockers to prevent rebound hypertension or tachycardia 7