|Acute Heart Failure
|Chronic Heart Failure
Use IV must be with close cardiac and physiological monitoring.
- Block Beta-adrenergic receptors in heart, peripheral vessels, lungs, pancreas and liver
- Hypertension - reduced Cardiac output, block peripheral receptors, some reduce plasma renin activity. Full dose often not needed.
- Angina - reduces cardiac oxygen demand. Avoid verapamil as can precipitate heart failure
- Post-MI - STEMI and NSTEMI can reduce mortality
- AF rate control - reduce automaticity and conduction. Use with or instead of Digoxin.
- Thyrotoxicosis - useful to control sympathetic symptoms
- Anxiety, Benign essential tremor
- Hypertension: Metoprolol 100-200 mg od PO (max rarely needed 400 mg od)
- Angina: Metoprolol 50-100 mg bd or tds PO
- Arrhythmias: Metoprolol 50-100 mg bd or tds PO
- Migraine prevention: Metoprolol 50-100 mg bd PO
- Hyperthyroidism: Metoprolol 50 mg qds PO
- Post MI: Metoprolol 5 mg slow IV every 5 minutes as tolerated. (Max dose 10-15 mg). Start Oral Beta-blocker e.g. Bisoprolol once daily as a regular therapy.
- Fast AF: Metoprolol 1-5 mg IV at a rate not exceeding 1 mg per minute. Reassess after 5 minutes and repeat if required. (Max dose 10-15 mg). Start Oral Beta-blocker e.g. Bisoprolol once daily as a regular therapy.
Metoprolol and AF
- Metoprolol is preferred for intravenous administration given its short half-life, it is given as a bolus injection, without
dilution at a rate not exceeding 1 mg per minute. Titrate up to 5 mg initially, reassess after 5 minutes and repeat if
required. If no ill effects observed, administer 25 mg orally and commence 2.5 mg bisoprolol once daily as a regular
therapy. This can be titrated up to a maximum dose of 20 mg once daily
Dose range:You must check with BNF or drug datasheet
|Metoprolol (CCF/AF/Hyperthyroid)||25-100 mg||BD||PO|
|Metoprolol (HTN/Angina)||50-100 mg||BD||PO|
|Metoprolol (post MI)||5 mg every 2 mins up to 15 mg on telemetry||stat||IV then start oral dose 50 mg 6 hourly|
|Metoprolol (Fast AF)||5 mg reassess after 5 minutes and repeat if required.
||stat||Slow IV rate not exceeding 1 mg per minute
- Bradycardia <60bpm, systolic BP <100mmHg
- 2nd or 3rd degree heart block
- Avoid in Diabetes especially with thiazide
- Uncontrolled Heart failure
- Severe hypotension
- Phaeochromocytoma except with an alpha blocker
- Sick sinus syndrome
- Significant peripheral vascular disease
- Concomitant use of verapamil
- Fatigue, Cold peripheries, Worsening diabetic control
- Postural hypotension, Dizziness, Worsening psoriasis, Impotence
- Claudication, Insomnia