- Antianginal Agent
- Beta-Blocker; β1 Selective
Preferential effect on the β1-adrenoreceptors, chiefly located in cardiac muscle. This preferential effect is not absolute, however, and at higher doses, Metoprolol also inhibits β2-adrenoreceptors, chiefly located in the bronchial and vascular musculature. Metoprolol has no membrane-stabilizing or partial agonism (intrinsic sympathomimetic) activities
Pharmacodynamics / Pharmacokinetics
- 20 minutes when infused
- Following intravenous administration the half-life of the distribution phase is approximately 12 minutes
- There is a linear relationship between the log of plasma levels and reduction of exercise heart rate
Equivalent maximal Beta-blocking effect is achieved with oral and intravenous doses in the ratio of approximately 2.5:1.
- Symptomatic Atrial Fibrillation/Flutter with rapid ventricular response
- 2nd or 3rd degree AV block
- Sick sinus syndrome or Sinus Bradycardia
- Cardiogenic Shock
- Overt Heart Failure – to be treated with synchronized electrical cardioversion.
- Bronchospastic disease: In general, patients with bronchospastic disease should not receive beta-blockers; however, metoprolol, with B1selectivity, has been used cautiously with close monitoring.
- Heart failure: Use with caution in patients with compensated heart failure; monitor for a worsening of heart failure
- Metoprolol does cross the placental barrier
- CVS: secondary effects of decreased cardiac output which include
- Neurological: headache, weakness, dizziness, sedation, light-headedness,
- Respiratory: shortness of breath; wheezing; bronchospasm; rhinitis; status asthmaticus; exertional dyspnea.
- Repeat q 5mins to max of 15.0mg or HR <110/min or BP <100mmHg systolic
Metoprolol: Drug information (2017). Lexicomp.
Lopresor® PR metoprolol tartrate (2016, May). ECPS.
OLD / ORIGINAL MONOGRAPH Written by A. Mills is below:
5.0mg slow IV push
Repeat q 5 mins to max of 15.0mg or HR <110/min or BP <100mmHg systolic.
- Hypersensitivity to metoprolol
- Second and third degree AV blocks
- Systolic BP less than 100 mmHg
- Severe acute heart failure
- Recent (less than 24 hrs) cocaine use
Level of Evidence
Reference Level I