By Najm Haque, PGY2 Atrial fibrillation with rapid ventricular response is a common emergency room problem. Patient with stable blood pressure who present in Afib with RVR need medications to control their heart rate (unstable patients require more cardioversion). Traditionally, these patients receive beta blockers or calcium channel blockers in IV form for rate control. The most common medications used in the US are metoprolol and diltiazem, but it is unclear which is superior. Fromm et al This study was published in the Journal of Emergency Medicine in April 2015 and compared how fast rate control was achieved in diltiazem vs metoprolol. This was a prospective, double-blind study which compared the effects of both medications at 30 minutes, as well as looking at mean decrease in heart rate, and adverse effects. Patients were randomized and either received Diltiazem 0.25 mg/kg IVP (maximum dose of 30mg) or Metoprolol 0.15mg/kg IVP (maximum dose of 10mg). Abrupt cessation my precipitate angina, MI, arrhythmias, or rebound HTN; discontinue by tapering over 1-2 weeks. Immediate-release form is metoprolol tartrate; extended-release form is metoprolol succinate. When switching from immediate release to extended-release product, use same total daily dose. The immediate and extended release products may not give same clinical response on mg:mg basis; monitor response and side effects when interchanging between metoprolol products. Concomitant amiodarone, digoxin, disopyramide, or non-dihydropyridine calcium channel blockers may increase the risk of bradycardia. Monitor closely for HF exacerbation and hypotension when titrating dose. Diflucan instructions Cheap avodart uk That facility only allows IV push Lopressor in Stepdown, ICU, or ER on a cardiac. If you choose to move forward in your review of Lopressor administration in a. Human Resources for the University of Oklahoma. Serving Faculty and Staff in Norman, Oklahoma City, and Tulsa campuses. Digoxin, IV 0.25mg q2hrs up to 1.5mg, then 0.125-0.375mg daily; PO. Metoprolol, IV 2.5-5mg bolus over 2 min up to 3 doses; PO 25-100mg bid, may use. METOPROLOL TARTRATE IMMEDIATE RELEASE TABLETS: Initial dose: 100 mg orally per day in single or divided doses Maintenance dose: 100 to 450 mg orally per day Comments: -May increase dose at weekly, or longer, intervals. -Lower once-daily doses may not maintain full effect at the end of the 24-hour period; larger or more frequent daily doses may be required. Beta-1 selectivity diminishes as the dose is increased. METOPROLOL SUCCINATE EXTENDED RELEASE TABLETS: Initial dose: 25 to 100 mg orally once a day Maintenance dose: 100 to 400 mg orally once a day Comments: -May increase dose at weekly, or longer, intervals. Initial dose: -Metoprolol tartrate immediate release tablets: 50 mg orally twice a day -Metoprolol succinate extended release tablets: 100 mg orally once a day Maintenance dose: 100 to 400 mg per day Comments: -Increase dose at weekly intervals until optimum clinical response has been obtained or pronounced slowing of heart rate occurs. METOPROLOL TARTRATE: Early Treatment: Initial dose: 5 mg IV every 2 minutes as tolerated for 3 doses -Patients tolerant of full IV dose (15 mg): 50 mg orally every 6 hours starting 15 minutes after the last IV dose and continued for 48 hours -Patients intolerant of full IV dose (15 mg): 25 or 50 mg orally every 6 hours depending on the degree of intolerance starting 15 minutes after the last IV dose or as soon as their clinical condition allows Late Treatment: Maintenance dose: 100 mg orally twice a day Comments: -Patients with contraindications to treatment during the early phase of suspected or definite myocardial infarction, patients who appear not to tolerate the full early treatment, and patients in whom the physician wishes to delay therapy for any other reason should be started on 100 mg orally twice a day as soon as their clinical condition allows. -Continue therapy for at least 3 months; efficacy beyond 3 months has not been conclusively established; data from studies with other beta blockers suggest a treatment duration of 1 to 3 years. Use: Treatment of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality. Treatment with the IV formulation can be initiated as soon as the patient's clinical condition allows. Alternatively, treatment can begin within 3 to 10 days of the acute event. I am a 53 yo man diagnosed ~8 years ago with lone paroxysmal atrial flutter and afib. Long term history of endurance sports but nothing outrageous - running 20 miles a week since my teens. Episodes are generally less than an hour, but frequent - typically one every day or couple of days. Have been trying a "pill in a pocket" appproach - that is, I will take some metoprolol (50 mg tablet) if the tachycardia lasts more than 5 minutes. I am a 25 yr old who is on metoprolol tart 50mg BID because almost 2 yrs ago I had my tricuspid valve replaced (now pig valve). Long story short, recovering IV drug abuser who gave myself staph which led to endocarditis and after 2 months of IV antibiotics finally got cracked open and given a new valve. I take my bp meds everyday bid (not exactly the same time ALL the time, but mostly). Metoprolol iv push METOPROLOL TARTRATE Drug BNF content published by NICE, Employees OU Human Resources Dapoxetine premature ejaculationSertralinaZithromax pediatric dosing SUDDEN DEATH AFTER IV METOPROLOL. ADMINISTRATION IN A PATIENT WITH CARDIOMYOPATHY. To the Editor—We present a case of a patient with. References SUDDEN DEATH AFTER IV METOPROLOL.. Dosing Guideline for Drugs commonly used to treat AFib - HRS. Metoprolol Intravenous Route Side Effects - Mayo Clinic. DESCRIPTION. Lopressor, metoprolol tartrate USP, is a selective betai-adrenoreceptor blocking agent, available in 5-mL ampuls for intravenous administration. Parenteral administration of Lopresor should be supervised by experienced staff in a. plasma clearance of metoprolol after intravenous administration is. Toprol XL is used for treating high blood pressure, angina, and heart failure. Metoprolol 5 Mg Iv Push. Affordable Health Care. Low Cost Metoprolol!