Page 160 - 2023 SMOG Digital

METOPROLOL Lactation?(Not Recommended) Trade Name: Lopressor
Class / Mechanism of Action
Beta-1 Selective Beta-Blocker; Antihypertensive; Antianginal Agent
Selective inhibitor of beta-1 adrenergic receptors; competitively blocks beta1-receptors, with little or no
effect on beta-2 receptors at oral doses <100 mg (in adults); does not exhibit any membrane stabilizing
or intrinsic sympathomimetic activity.
Onset of action: IV: 5 minutes, Duration 3-5 hours
Indications
Labeled Indications: Angina, Hypertension, Myocardial infarction
Unlabeled: Atrial fibrillation/flutter; Hypertrophic cardiomyopathy; Marfan syndrome with aortic aneurysm;
Migraine prophylaxis; Supraventricular tachycardia (AVNRT, AVRT, focal atrial tachycardia);
Thyrotoxicosis; Ventricular arrhythmias
Contraindications
• Hypersensitivity to metoprolol, any component of the formulation, or other beta-blockers; second- or
third-degree heart block
• Severe sinus bradycardia (heart rate <45 beats/minute); significant first-degree heart block (P-R
interval ≥0.24 seconds); systolic blood pressure <100mmHg; moderate to severe cardiac failure
Adverse Reactions / Precautions
• Cardiovascular: Hypotension, bradycardia, first degree atrioventricular block, arterial insufficiency,
cardiac failure, CVA, cold extremities, palpitations, peripheral edema, claudication
• Central nervous system: Dizziness, fatigue, depression, vertigo, confusion, disturbed sleep,
hallucination, headache, insomnia, nightmares, temporary amnesia, tinnitus
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Atrial fibrillation or atrial flutter (off-label use): Note: Guidelines do not recommend beta-
Acute ventricular rate control: blockers as initial therapy in pediatric
IV: patients; beta-blockers should be reserved
• 2.5-5mg over 2-5 minutes; q5min prn; maximum for use in patients who have
total dose: 15mg. contraindications to preferred agents or
after ≥2 preferred agents have failed in
Supraventricular tachycardia/Ventricular patients with hypertension and chronic
arrhythmias (off-label use): kidney disease, proteinuria, or diabetes
mellitus.
Note: For hemodynamically stable patients if vagal
maneuvers and/or adenosine are unsuccessful.
IV:
• 2.5-5mg over 2-5 minutes; q5min prn to achieve a
ventricular rate of 90–100; maximum total dose:
15mg.
Note: For sustained ventricular tachycardia, beta-
blockers are generally administered in addition to an
antiarrhythmic drug (eg, Amiodarone) for these
indications. A beta-blocker is also used to reduce
shocks in patients who receive an implantable
cardioverter defibrillator for these indications;
propranolol may be the preferred beta-blocker in these
situations

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