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Intravenous Dilution Guidelines

Metoprolol (Lopressor ®)

The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents

D5W, NS

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]

[0 to 20 mg] [50 ml] [30 min]
[21 to 40 mg] [100 ml] [60 min]

Stability / Miscellaneous

EXP: 1 DAY (RT).

The dilutions listed are conservative guidelines that can be used in non-acute conditions. The infusion times were formulated to mimic the onset of an oral formulation. (@ onset-oral= 45-60min).

Oral to IV conversion (2.5 to 1) : eg 50mg oral=20mg IV (equivalent beta-blockade).

Lopressor may be given by IV bolus (HR, BP, and EKG should be carefully monitored). IV therapy permits rapid control of HR and contractility.

Post MI (early tx): 5 mg IV bolus x 3 doses q2 minutes. In patients who tolerate full 15 mg dose, oral lopressor 50mg po q6h should be started 15 min after last IV dose x 48 hours.

Unstable angina: 5 mg IV bolus x3 q2min f/b 2 to 5 mg hourly titrated to min HR of 55 to 60 BPM or min systolic BP of 80 . May switch to oral dosing (50 to 100mg po q6h) after IV bolus therapy.

Supraventricular tachycardias(PAT, A-fib/flutter): 5 to 15 mg (usually 5 mg) over 2.5 min at 7.5min intervals-usually a high response rate.


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DOSAGE AND ADMINISTRATION
Myocardial Infarction

Early Treatment: During the early phase of definite or suspected acute myocardial infarction, treatment with metoprolol tartrate can be initiated as soon as possible after the patient’s arrival in the hospital. Such treatment should be initiated in a coronary care or similar unit immediately after the patient’s hemodynamic condition has stabilized.

Treatment in this early phase should begin with the intravenous administration of three bolus injections of 5 mg of metoprolol tartrate each; the injections should be given at approximately 2-minute intervals. During the intravenous administration of metoprolol tartrate, blood pressure, heart rate, and electrocardiogram should be carefully monitored.

In patients who tolerate the full intravenous dose (15 mg), metoprolol tartrate tablets, 50 mg every 6 hours, should be initiated 15 minutes after the last intravenous dose and continued for 48 hours. Thereafter, patients should receive a maintenance dosage of 100 mg twice daily (see Late Treatment below).

Patients who appear not to tolerate the full intravenous dose should be started on metoprolol tartrate tablets either 25 mg or 50 mg every 6 hours (depending on the degree of intolerance) 15 minutes after the last intravenous dose or as soon as their clinical condition allows. In patients with severe intolerance, treatment with metoprolol should be discontinued.

Late Treatment: 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 metoprolol tartrate tablets, 100 mg twice daily, as soon as their clinical condition allows. Therapy should be continued for at least 3 months. Although the efficacy of metoprolol beyond 3 months has not been conclusively established, data from studies with other beta blockers suggest that treatment should be continued for 1 to 3 years.

Note: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

HOW SUPPLIED
Metoprolol Tartrate Injection, USP is available as:
NDC Container Concentration Fill Quantity
0409–1778–35 CARPUJECT with Luer Lock 1 mg/mL 5 mL 3 cartridges per carton
0409–2285–05 Ampul 1 mg/mL 5 mL 3 ampuls

Store at 20 to 25°C (68 to 77°F). [See USP Controlled Room Temperature.] Do not freeze.

PROTECT FROM LIGHT. Retain in carton until time of use.
Discard unused portion.

Revised: February, 2008
EN-1722
Hospira, Inc., Lake Forest, IL 60045 USA

Source: [package insert]
Disclaimer
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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