From the Guidelines
Recommended Beta Blocker for Tachycardia
Metoprolol tartrate is the most recommended beta blocker for managing tachycardia, with an optimal starting dose of 25-50mg orally every 6-8 hours as needed, or 50-100mg orally twice daily for sustained release formulations 1.
Alternative Options and Dosing
Alternatively, atenolol may be considered, with a starting dose of 25-50mg orally daily 1. The dose may be titrated upwards every 1-2 weeks to achieve a resting heart rate of 60-100 beats per minute, with a maximum daily dose of 200-400mg for metoprolol and 100mg for atenolol 1.
Key Considerations
- Metoprolol succinate can be used at a dose of 50-400mg daily or twice daily in divided doses 1.
- Esmolol can be used intravenously for acute rate control, with a dose of 500 μg/kg bolus over 1 min, then 50-300 μg/kg/min 1.
- It is essential to monitor the patient's response to the medication and adjust the dose accordingly to achieve the desired heart rate control while minimizing potential side effects 1.
Important Notes
- The choice of beta blocker and dosing regimen should be individualized based on the patient's specific clinical characteristics, such as the presence of heart failure or renal impairment 1.
- Regular monitoring of the patient's heart rate, blood pressure, and overall clinical status is crucial to ensure the safe and effective use of beta blockers for tachycardia management 1.
From the FDA Drug Label
DOSAGE & ADMINISTRATION Hypertension The initial dose of atenolol is 50 mg given as one tablet a day either alone or added to diuretic therapy. Angina Pectoris The initial dose of atenolol is 50 mg given as one tablet a day If an optimal response is not achieved within one week, the dosage should be increased to atenolol 100 mg given as one tablet a day.
The recommended beta blocker for tachycardia is atenolol.
- The optimal starting dose is 50 mg given as one tablet a day. 2
From the Research
Beta Blocker Recommendation for Tachycardia
- Metoprolol is a commonly used beta blocker for the management of tachycardia, as seen in studies 3, 4, 5, 6.
- The optimal starting dose of metoprolol for tachycardia is not explicitly stated in the provided studies, but a dose of 25 mg is mentioned in studies 3, 6 as a starting point.
Dosing Considerations
- Study 3 mentions that patients were randomly assigned to 6.25 mg metoprolol tartrate or 25 mg metoprolol succinate orally, and the dose was gradually increased to a target of 50 mg twice a day or 100 mg once a day, respectively.
- Study 6 used a dose of 25 mg metoprolol twice a day for 7 days in patients with inappropriate sinus tachycardia following coronary artery bypass graft surgery.
Comparison with Other Beta Blockers
- Study 5 compares the beta-blocking effects of metoprolol and carvedilol, and finds that metoprolol tends to decrease heart rate during exercise to a greater extent than carvedilol.
- Study 6 compares the effectiveness of metoprolol, ivabradine, and its combination in the management of inappropriate sinus tachycardia, and finds that the combination of ivabradine and metoprolol is more effective in reducing heart rate than metoprolol alone.