IV Metoprolol Repeat Dosing Protocol
Lopressor (metoprolol) 5mg IV can be repeated every 5 minutes up to a maximum total dose of 15mg (three 5mg boluses). 1, 2, 3
Standard Dosing Protocol
The FDA-approved regimen consists of three separate 5mg IV boluses administered at approximately 2-minute intervals, for a maximum cumulative dose of 15mg. 3
- Administer the first 5mg dose as a slow IV bolus over 1-2 minutes 4, 1, 2
- Wait 5 minutes and assess hemodynamic response before each subsequent dose 1, 2
- Repeat 5mg boluses can be given every 5 minutes as tolerated 4, 1, 2
- Stop at a maximum total of 15mg (three doses total) 4, 1, 2, 3
Required Monitoring Between Each Dose
Continuous monitoring is mandatory throughout the entire administration period. 1, 2
- Check blood pressure before each dose and frequently thereafter 1, 2
- Maintain continuous ECG monitoring 1, 2
- Monitor heart rate continuously 1, 2
- Auscultate for new rales (pulmonary congestion) after each dose 1, 2
- Auscultate for bronchospasm after each dose 1, 2
Critical Contraindications to Verify Before Each Dose
Do not administer any dose if the following conditions develop during treatment: 1, 2
- Systolic blood pressure drops below 100-120 mmHg 1, 2
- Heart rate falls below 60 bpm or rises above 110 bpm 1, 2
- Signs of heart failure emerge (rales, low output state) 1, 2, 3
- New second or third-degree heart block develops 1, 2
- PR interval exceeds 0.24 seconds 1, 2
- Bronchospasm occurs 1, 2
Common Pitfalls to Avoid
Never administer the full 15mg as a single rapid bolus—this significantly increases the risk of severe hypotension and bradycardia. 1
- Do not give doses faster than every 5 minutes 1, 2
- Do not exceed the 15mg maximum total dose 4, 1, 2, 3
- Do not continue dosing if hemodynamic instability develops 1, 2
- Do not use in patients with decompensated heart failure 1, 2
Alternative for High-Risk Patients
For patients at high risk of hemodynamic compromise, consider esmolol instead of metoprolol. 1, 2