Metoprolol - Queensland Ambulance Service

Drug Therapy Protocols: Metoprolol
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Date
October, 2015
Purpose
Scope
Author
To ensure a consistent procedural approach to Metoprolol administration.
Applies to all QAS clinical staff.
Clinical Quality & Patient Safety Unit, QAS
Review date
October, 2017
URL
https://ambulance.qld.gov.au/clinical.html
This work is licensed under the Creative Commons
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Metoprolol
October, 2015
Drug class
β1 selective adrenoceptor blocker
Contraindications
UNCONTROLLED WHEN PRINTED
Pharmacology
Metoprolol is a selective β1 receptor blocker used in the
treatment of cardiovascular disease. Metoprolol blocks the action of the sympathetic nervous system thereby reducing heart rate, the force of myocardial contraction and thereby reducing blood pressure and
myocardial oxygen demand.[1–4]
• KSAR or hypersensitivity to metoprolol
• Acute heart failure
• Heart rate < 60 beats
• Systolic BP < 90 mmHg
• Second OR third degree AV block
• Concomitant antiarrhythmic medication
UNCONTROLLED WHEN PRINTED
Metabolism
• Bronchospasm OR allergic disorders which may
suggest a predisposition to bronchospasm
Hepatic and excreted by the kidneys.[1] Precautions
Indications
• History of heart failure
UNCONTROLLED WHEN PRINTED
• ACS (unresponsive to sublingual nitrates and narcotic analgesia)
• Heart rate control (in the setting of ACS)
• First degree AV block
• Diabetes Mellitus (patient receiving insulin or oral hypoglycaemics)
Side effects
• Hypotension
UNCONTROLLED WHEN PRINTED
• Bradycardia
• Palpitations
• Dizziness
Figure 4.32
• Headache
QUEENSLAND AMBULANCE SERVICE
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Metoprolol
October, 2015
Adult dosages
Presentation
UNCONTROLLED WHEN PRINTED
• ACS (unresponsive to sublingual nitrates and • Ampoule, 5 mg/5 mL metoprolol
narcotic analgesia)
Onset (IV)
Duration (IV)
Half-life
1 – 2 minutes
5 – 8 hours
3 – 7 hours
E CCP
• Heart rate control (in the setting of ACS)
IV
RSQ Clinical Coordinator consultation and approval required in all situations.
1 – 2 mg
Repeated every 5 minutes.
Total maximum dose 10 mg.
UNCONTROLLED WHEN PRINTED
Schedule
• S4 (Restricted drugs).
Paediatric dosages
Routes of administration
Intravenous injection (IV)
(RSQ taskings only)
E CCP
UNCONTROLLED WHEN PRINTED
Note: QAS officers are NOT authorised to administer
metoprolol to paediatric patients.
Special notes
UNCONTROLLED WHEN PRINTED
• Metoprolol 5 mg/5 mL ampoules are not currently available via QAS warehouse – for procurement information please refer to the QAS Drug Management Code of Practice.
QUEENSLAND AMBULANCE SERVICE
805