Generic Drug Name: Metoprolol
Brand Names: Lopressor, Toprol XL
Classification:
Therapeutic: Antianginal, Antihypertensive
Pharmacologic: Beta-Blocker
Indications:
- Hypertension
- Chest pain
- Heart failure
Mechanism of Action:
Blocks stimulation of beta₁-adrenergic receptors.
Expected Response: decreased HR and BP, decreased chest pain.
Common Adult Doses: (ALWAYS CHECK YOUR ORDERS)
Oral max dose 200 mg/day
Immediate Release: initial 25 mg – 50 mg twice daily
Extended Release: initial 50 mg once daily (12.5 mg – 25 mg in heart failure patients)
IV max dose 15 mg
2.5 mg – 5 mg over 2 minutes (can be given every 5 minutes as needed)
Contraindications:
- Hypersensitivity to Metoprolol or other beta-blockers
- Second or third degree heart block
- Significant bradycardia
- Cardiogenic shock
- Sick Sinus Syndrome without pacemaker
Side Effects:
Common
- Fatigue
- Weakness
- Erectile dysfunction
- Dizziness upon standing
Life-Threatening
- Bradycardia
- Heart Failure
- Pulmonary edema
Nursing Considerations:
Assessment
- Monitor HR and check with provider if less than 60bpm
- Monitor BP and check with provider if SBP less than 90mmHg
- If used for heart failure, monitor daily weights as well as intake and output.
Nursing Diagnoses
- Decreased cardiac output (side effects)
- Noncompliance (patient/family teaching)
Implementation
- IV Metoprolol is a vasoactive agent and doses should be double checked before administration. IV dose is given undiluted over a minimum of 1 minute.
- Educate patient to
- take at the same time every day
- take with meals or soon after
- monitor their own HR and BP weekly
- change positions slowly as their blood pressure may drop more easily
- do not abruptly stop this medication as it can cause life-threatening arrhythmia, hypertension, or myocardial ischemia
Expected Outcomes
- Lower BP
- Less frequent anginal attacks
- Increased activity tolerance
- Prevention of an MI
Reference
Vallerand, A. H. & Sanoski, C. A. (2019). Davis’s drug guide for nurses. (16th ed., pp. 847-850). F.A. Davis Company.
