From the Guidelines
The maximum dose for metoprolol pushes is 15 mg, given in 5-mg increments by slow intravenous administration (5 mg over 1 to 2 min), repeated every 5 min. When administering metoprolol as an IV push, it's essential to monitor the patient's heart rate and blood pressure closely during and after administration, as recommended in the 2013 ACCF/AHA guidelines 1. The medication should be stopped if the heart rate drops below 50-60 beats per minute, if systolic blood pressure falls below 90-100 mmHg, or if the patient develops signs of heart failure or bronchospasm. Some key points to consider when administering metoprolol include:
- Monitoring during intravenous beta-blocker therapy should include frequent checks of heart rate and blood pressure and continuous ECG monitoring, as well as auscultation for rales and bronchospasm 1
- The target resting heart rate is 50 to 60 beats per minute unless a limiting side effect is reached 1
- Selection of the oral agent should include the clinician’s familiarity with the agent 1
- Maintenance doses are given in Table 15 of the guidelines, with metoprolol maintenance dose of up to 100 mg twice daily 1 Metoprolol works by blocking beta-1 adrenergic receptors in the heart, which reduces heart rate, contractility, and blood pressure, making it useful for managing acute situations like supraventricular tachycardias, acute coronary syndromes, or hypertensive emergencies. However, caution is needed in patients with bradycardia, heart block, cardiogenic shock, decompensated heart failure, or reactive airway disease as metoprolol can worsen these conditions, as noted in the 2013 ACCF/AHA guidelines 1.
From the Research
Maximum Dose for Metoprolol Pushes
- The maximum dose for metoprolol pushes is not explicitly stated in the provided studies, but we can look at the dosages used in the studies to get an idea of the typical dosing range.
- In the study 2, metoprolol was administered at a dose of 15 mg i.v. in three divided doses.
- In the study 3, a continuous infusion of metoprolol (3 mg.min-1 i.v) was started, and the accumulated dose ranged from 15-180 mg.
- In the study 4, metoprolol was given intravenously (15 mg) as soon as possible after admission to hospital.
- In the study 5, the full intravenous dose of 15 mg of metoprolol was tolerated by 85% of all individuals treated.
Dosing Considerations
- The studies suggest that metoprolol can be administered at a dose of 15 mg i.v. initially, followed by additional doses as needed to achieve the desired effect.
- The accumulated dose of metoprolol can range from 15-180 mg, depending on the patient's response to the medication 3.
- It's worth noting that the dosing of metoprolol may need to be adjusted based on the patient's heart rate, blood pressure, and other factors 2, 4.