From the Guidelines
Metoprolol is a recommended treatment option for supraventricular tachycardia (SVT), with a dosing regimen of 5 mg IV given slowly over 1 to 2 minutes, which can be repeated as required every 5 minutes to a maximum dose of 15 mg 1.
Treatment Overview
For acute SVT episodes, intravenous metoprolol can be administered, and for long-term prevention of recurrent SVT, oral metoprolol is typically prescribed.
- The dose for oral metoprolol is usually adjusted based on patient response and tolerance, starting at a lower dose (25 mg twice daily) and gradually increasing as needed.
- Metoprolol works by blocking beta-1 adrenergic receptors in the heart, which slows conduction through the AV node, reduces heart rate, and decreases myocardial contractility.
Important Considerations
- Patients should be monitored for potential side effects including bradycardia, hypotension, fatigue, and bronchospasm.
- Metoprolol should be used cautiously in patients with asthma, COPD, heart failure, or diabetes, and should not be abruptly discontinued as this can precipitate rebound tachycardia or worsen underlying cardiac conditions.
Clinical Guidelines
According to the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia, intravenous beta blockers, such as metoprolol, are reasonable for acute treatment in hemodynamically stable patients with AVNRT 1.
- The guideline also recommends that patients with SVT should be educated on how to perform vagal maneuvers for ongoing management of SVT 1.
Dosing and Administration
The dosing regimen for metoprolol in SVT treatment is as follows:
- Intravenous metoprolol: 5 mg given slowly over 1 to 2 minutes, which can be repeated as required every 5 minutes to a maximum dose of 15 mg 1.
- Oral metoprolol: 25-100 mg twice daily, with the dose adjusted based on patient response and tolerance.
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. The FDA drug label does not answer the question.
From the Research
SVT Treatment with Metoprolol
- Metoprolol is a beta blocker that can be used to treat supraventricular tachycardia (SVT) 2, 3, 4.
- Beta blockers, including metoprolol, can be used acutely or as long-term therapy for SVT 2.
- The use of beta blockers, such as metoprolol, is recommended as a management option for SVT, along with calcium channel blockers and antiarrhythmic agents 4.
- Pharmacologic therapy, including beta blockers like metoprolol, is commonly used for the acute treatment and termination of paroxysmal SVT, and continues to be an important long-term option for some patients 5.
Alternative Treatment Options
- Vagal maneuvers and adenosine are often used as first-line therapies in the acute diagnosis and management of SVT 2, 3, 4.
- Calcium channel blockers, such as verapamil and diltiazem, can also be used to treat SVT, and have been shown to be safe and efficacious in terminating spontaneous SVT 6.
- Catheter ablation is a highly effective treatment option for SVT, with a success rate of 95% and a recurrence rate of less than 5% 2, 4.