Adult Dosing
Early Treatment in acute MI
- After patient's hemodynamic condition has stabilized start therapy as soon as possible
- Start 5 mg IV q2 mins up to total of 15 mg; monitor blood pressure, heart rate, and ECG
- Patients who tolerate the full IV dose can be given 50 mg PO metoprolol q6 hrs X 48 hrs; first dose given 15 mins after the final IV dose. Thereafter 100 mg PO bid
- Patients unable to tolerate full IV dose may be given 25 mg PO q6 hrs; first dose given 15 mins after the final IV dose. In patients with severe intolerance, treatment should be discontinued
Hypertension [Non-FDA Approved]
- 2.5-5 mg IV q5 minutes x 3 doses (if tolerated), then administer 50 mg oral/NGT
Acute Coronary Syndromes [Non-FDA Approved]
- Initially IV bolus of 2-5 mg at 5 min intervals up to 15 mg
Rate control in Atrial fibrillation
- 2.5 to 5 mg IV bolus, may repeat q5 minutes to a total of 3 doses
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- Do not discontinue therapy abruptly as it may lead to severe exacerbation of angina, myocardial infarction and ventricular arrhythmias. Reinstitute drug administration promptly, at least temporarily if angina markedly worsens or acute coronary insufficiency develops. Avoid treatment interruption or discontinuation without medical advice [US Black box Warning]
- Taper chronic use gradually over 1-2 wks and monitor when discontinuing chronic treatment [US Black box Warning]
- It should not be used in patients with bronchospastic disease unless patients do not respond to or cannot tolerate other therapy. Administer beta-2 stimulating agent concomitantly and use lowest possible dose; start smaller doses tid to avoid higher plasma levels
- Metoprolol should be withdrawn with caution in patients undergoing surgery as it may augment the risks of GA and surgical procedures
- Metoprolol should be used with caution in diabetic patients if a beta-blocking agent is required; as it may mask tachycardia occurring with hypoglycemia
- It may mask signs of hyperthyroidism; avoid abrupt withdrawal due to the risk of precipitating a thyroid storm
- Do not administer in patients with known or suspected pheochromocytoma; if necessary, should only be given after initiation of an alpha-blocker
- Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of therapy, which might precipitate a thyroid storm
Cautions: Use cautiously in
Pregnancy Category:C
Breastfeeding: Metoprolol is excreted in breast milk in small amounts. It would be unlikely to cause adverse effects in breastfed infants. Due to its low protein binding, it presents a moderately low risk for accumulation in infants. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 19 January 2011)
0.24 sec); systolic blood pressure <100 mm Hg; or moderate-to-severe cardiac failure
