Metoprolol
Rate control (atrial fibrillation/flutter), Hypertensive emergency (adjunct), ACS
Indications
- Rate control (atrial fibrillation/flutter)
- Hypertensive emergency (adjunct)
- ACS
Adult dosing
- rate control: dose: 5; unit: mg; route: IV; interval: q5min, max 15mg; fixed: true; oral: dose: 25; maxDose: 100; unit: mg; route: PO; interval: q6-12h; fixed: true
Pediatric dosing
- iv: dose: 0.1; unit: mg/kg; maxDose: 5; maxDoseAbsolute: true; route: IV; weightBased: true; pedNote: Use in children >1 year only
Contraindications
- Heart rate < 60
- SBP < 100
- Decompensated heart failure
- Second/third degree AV block
- Severe reactive airway disease
Clinical pearls
- Give 5mg IV q5min x3 doses (max 15mg) for acute rate control
- Contraindicated in decompensated HF and pre-excited AF (WPW)
- Consider diltiazem instead if faster rate control needed
Source and review
- ACC/AHA Atrial Fibrillation Guidelines 2023. Last reviewed: 2024-10-01