Metoprolol Dosing for Supraventricular Tachycardia

Intravenous Administration Protocol

The American Heart Association recommends administering metoprolol 5 mg IV over 1-2 minutes, which can be repeated every 5 minutes as needed up to a maximum total dose of 15 mg 1
The standard IV dosing regimen consists of 5 mg boluses given slowly over 1-2 minutes, repeated at 5-minute intervals based on heart rate and blood pressure response, not exceeding 15 mg total 2, 1

The American College of Cardiology recommends oral metoprolol can be initiated 15 minutes after the last IV dose at 25-50 mg every 6 hours for 48 hours, then transitioned to twice-daily dosing 1
For ongoing management, the maintenance dose ranges from 25 mg twice daily up to 200 mg twice daily for metoprolol tartrate, or 50 mg once daily up to 400 mg once daily for metoprolol succinate extended-release 3, 1

The American Heart Association advises against administering metoprolol IV in patients with signs of heart failure, low output state, or increased risk for cardiogenic shock 1
The American College of Cardiology recommends avoiding metoprolol IV in patients with PR interval >0.24 seconds, second- or third-degree heart block without a pacemaker 1
The American Thoracic Society warns against administering metoprolol IV in patients with active asthma or reactive airways disease 1
The American College of Cardiology advises against metoprolol IV in patients with systolic BP <100-120 mmHg with symptoms 1
The American Heart Association recommends avoiding metoprolol IV in patients with heart rate <60 bpm with symptoms or >110 bpm (paradoxical risk factor for shock) 1
The American College of Cardiology warns against metoprolol IV in patients with pre-excited atrial fibrillation or flutter (WPW syndrome) 3, 2

The American Heart Association recommends continuous ECG monitoring during IV metoprolol administration, with frequent blood pressure and heart rate checks 1
The American College of Cardiology advises monitoring for symptomatic bradycardia (HR <60 bpm with dizziness or lightheadedness) 1
The American Thoracic Society recommends monitoring for hypotension (systolic BP <100 mmHg with symptoms like dizziness or blurred vision) 1
The American College of Cardiology advises monitoring for new or worsening bronchospasm, particularly in patients with any history of reactive airway disease 1
The American Heart Association recommends monitoring for signs of heart failure (rales on auscultation) 1

The American College of Cardiology recommends metoprolol tartrate: starting 25 mg twice daily, titrating up to 200 mg twice daily as needed 3
The American Heart Association advises metoprolol succinate (extended-release): starting 50 mg once daily, titrating up to 400 mg once daily as needed 3