From the Guidelines
Medications such as esmolol, metoprolol, labetalol, fenoldopam, clevidipine, nicardipine, nitroglycerine, nitroprusside, enalaprilat, urapidil, clonidine, and phentolamine can be safely administered via IV push for the treatment of hypertensive emergencies, as long as proper guidelines and precautions are followed 1. When administering these medications, it is crucial to consider the onset of action, duration of action, and potential adverse effects. For instance, esmolol has a rapid onset of action (1-2 minutes) and a short duration of action (10-30 minutes), making it suitable for acute blood pressure control 1.
- Key considerations for IV push administration include:
- Proper dilution of the medication
- Appropriate administration rate
- Patient-specific factors, such as history of allergies or contraindications
- Monitoring for adverse reactions during administration
- The most recent guidelines, such as those published in 2019, provide recommendations for the safe administration of these medications via IV push 1.
- It is essential to note that other medications, such as those listed in the 2023 ACC/AHA/ACCp/HRS guideline for the diagnosis and management of atrial fibrillation, may also be administered via IV push, but with different guidelines and precautions 1.
- Healthcare providers must verify compatibility with other medications, check for contraindications, and monitor patients closely for adverse reactions during administration, as emphasized in the guidelines 1.
From the FDA Drug Label
DOSAGE & ADMINISTRATION Myocardial Infarction Early Treatment During the early phase of definite or suspected acute myocardial infarction, initiate treatment with metoprolol tartrate as soon as possible after the patient’s arrival in the hospital. Such treatment should be initiated in a coronary care or similar unit immediately after the patient’s hemodynamic condition has stabilized Begin treatment in this early phase with the intravenous administration of three bolus injections of 5 mg of metoprolol tartrate injection each; give the injections at approximately 2-minute intervals. Method of Administration Parenteral administration of metoprolol tartrate should be done in a setting with intensive monitoring
Medications safe for IV push administration include:
- Metoprolol tartrate: can be administered as an intravenous bolus injection, with a dose of 5 mg given at approximately 2-minute intervals, for a total of three injections 2.
From the Research
Medications Safe for IV Push Administration
The following medications are considered safe for IV push administration:
- Several antibiotics, including many beta-lactams, are Food and Drug Administration-approved for IV push administration 3
- Cefepime, ceftriaxone, ertapenem, gentamicin, and tobramycin have primary literature data to support IV push administration 3
- Norepinephrine, dopamine, and phenylephrine are approved for use through peripheral intravenous access 4
- Lacosamide can be administered undiluted as an IV push, with a maximum rate of 80 mg per minute 5
Medications Not Recommended for IV Push Administration
The following medications are not recommended for IV push administration:
- Amikacin, ciprofloxacin, imipenem/cilastatin, and metronidazole have limited primary literature data on IV push administration, and available data do not support that route 3
Best Practices for IV Push Administration
Best practices for IV push administration include:
- Following practical considerations, such as IV push best practices and pharmacodynamic considerations 3
- Ensuring patient safety by monitoring for potential adverse effects, such as infusion site reactions, hypotension, and bradycardia 4, 5
- Administering medications via peripheral intravenous access when possible, to reduce the need for central venous access 4