Metoprolol Tartrate 5mg/5ml Inj 5ml
It is used after a heart attack to help prevent future heart attacks and lengthen life. It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antihypertensive, Antiarrhythmic, Antianginal
Pharmacologic Class
Beta-1 Selective Adrenergic Blocker
Pregnancy Category
Not available
FDA Approved
Jun 1981
DEA Schedule
Not Controlled
Overview
What is this medicine?
Metoprolol is a medicine given by injection, usually in a hospital setting. It belongs to a group of drugs called 'beta-blockers'. It works by slowing down your heart rate and relaxing your blood vessels, which helps to lower your blood pressure and reduce the strain on your heart. It's often used in emergencies like a heart attack or to control a very fast heart rhythm.
How to Use This Medicine
To use this medication correctly, follow your doctor's instructions and carefully read all accompanying information. Administer the medication exactly as directed, and be sure to follow all instructions provided. This medication is administered via intravenous injection.
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
In the event that you miss a dose, contact your doctor promptly to receive guidance on the appropriate course of action.
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
In the event that you miss a dose, contact your doctor promptly to receive guidance on the appropriate course of action.
Lifestyle & Tips
- Follow all instructions from your healthcare provider.
- Report any unusual symptoms immediately, especially dizziness, slow heart rate, or difficulty breathing.
- Do not stop taking this medication abruptly if you are switched to an oral form, as it can worsen heart conditions.
Available Forms & Alternatives
Available Strengths:
- Metoprolol Tartrate 50mg Tablets
- Metoprolol HCT 100/25mg Tablets
- Metoprolol HCT 50/25mg Tablets
- Metoprolol HCT 100/50mg Tablets
- Metoprolol Tartrate 100mg Tablets
- Metoprolol Tartrate 25mg Tablets
- Metoprolol Tartrate 100mg Tablets
- Metoprolol ER Succinate 100mg Tabs
- Metoprolol ER Succinate 50mg Tabs
- Metoprolol ER Succinate 200mg Tabs
- Metoprolol ER Succinate 25mg Tabs
- Metoprolol ER Succinate 25mg Tabs
- Metoprolol Tartrate 5mg/5ml Inj 5ml
- Metoprolol Tartrate 37.5mg Tablets
- Metoprolol Tartrate 75mg Tablets
- Metoprolol Tartrate 5mg/5ml Inj 5ml
Dosing & Administration
Adult Dosing
Standard Dose:
Acute Myocardial Infarction: 5 mg IV bolus, repeated every 2 minutes for 2 additional doses (total 15 mg). If tolerated, initiate oral metoprolol tartrate 50 mg every 6 hours, starting 15 minutes after the last IV dose.
Dose Range:
5 - 15 mg
Condition-Specific Dosing:
Hypertension (off-label IV):
2.5-5 mg IV bolus, may repeat every 6-12 hours as needed, up to 15 mg/day.
Supraventricular Tachycardia (off-label IV):
2.5-5 mg IV bolus over 1-2 minutes, may repeat every 5 minutes up to a total of 15 mg.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Not established
Dose Adjustments
Renal Impairment:
Mild:
No adjustment needed
Moderate:
No adjustment needed
Severe:
No adjustment needed
Dialysis:
Metoprolol is not significantly removed by hemodialysis. No supplemental dose needed.
Hepatic Impairment:
Mild:
No specific adjustment recommended, but monitor for increased effects.
Moderate:
Consider dose reduction, monitor closely for adverse effects (e.g., bradycardia, hypotension).
Severe:
Significant dose reduction may be necessary due to reduced metabolism; monitor closely.
Pharmacology
Mechanism of Action
Metoprolol is a cardioselective beta-1 adrenergic receptor blocker. It selectively blocks beta-1 receptors primarily located in the heart, reducing heart rate, myocardial contractility, and cardiac output. This leads to a decrease in blood pressure and myocardial oxygen demand. At higher doses, it can also block beta-2 receptors.
Pharmacokinetics
Absorption:
Bioavailability:
Not applicable (IV administration)
Tmax:
Not applicable (IV administration)
FoodEffect:
Not applicable (IV administration)
Distribution:
Vd:
3.2-5.6 L/kg
ProteinBinding:
10-12%
CnssPenetration:
Limited
Elimination:
HalfLife:
3-7 hours
Clearance:
Not available
ExcretionRoute:
Renal (primarily metabolites)
Unchanged:
Approximately 5% (IV), 10% (oral)
Pharmacodynamics
OnsetOfAction:
Within minutes (IV)
PeakEffect:
Within 20 minutes (IV)
DurationOfAction:
5-8 hours (IV effects may be shorter than oral)
Safety & Warnings
BLACK BOX WARNING
Ischemic Heart Disease: Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. When discontinuing chronically administered metoprolol, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, metoprolol administration should be reinstituted promptly, at least temporarily, and other measures appropriate for the management of unstable angina pectoris should be taken. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue metoprolol therapy abruptly even in patients treated only for hypertension.
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. Immediately contact your doctor or seek medical attention if you experience any of the following symptoms:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of low blood sugar, including:
+ Dizziness
+ Headache
+ Feeling sleepy
+ Feeling weak
+ Shaking
+ Fast heartbeat
+ Confusion
+ Hunger
+ Sweating
Depression
Severe dizziness or passing out
New or worsening chest pain
New or worsening abnormal heartbeat
Slow heartbeat
Shortness of breath, significant weight gain, or swelling in the arms or legs
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor or seek medical help:
Feeling dizzy, tired, or weak
Diarrhea
Upset stomach
Vomiting
Reporting Side Effects
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. Immediately contact your doctor or seek medical attention if you experience any of the following symptoms:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of low blood sugar, including:
+ Dizziness
+ Headache
+ Feeling sleepy
+ Feeling weak
+ Shaking
+ Fast heartbeat
+ Confusion
+ Hunger
+ Sweating
Depression
Severe dizziness or passing out
New or worsening chest pain
New or worsening abnormal heartbeat
Slow heartbeat
Shortness of breath, significant weight gain, or swelling in the arms or legs
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor or seek medical help:
Feeling dizzy, tired, or weak
Diarrhea
Upset stomach
Vomiting
Reporting Side Effects
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or fainting
- Very slow heart rate (less than 50 beats per minute)
- Shortness of breath or wheezing
- Swelling in your ankles or feet
- Unusual weight gain
- Chest pain or discomfort
- Coldness or numbness in hands or feet
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction and its symptoms.
Certain heart conditions, such as:
+ Abnormal heart rhythms (heart block or sick-sinus syndrome)
+ Heart failure (a weak heart)
+ Low blood pressure
+ Poor blood circulation to the arms or legs
+ Shock caused by heart problems
+ A slow heartbeat
* Respiratory issues, including:
+ Asthma
+ Chronic obstructive pulmonary disease (COPD) or other breathing problems
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine if it is safe to take this medication with your existing treatments and health status. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction and its symptoms.
Certain heart conditions, such as:
+ Abnormal heart rhythms (heart block or sick-sinus syndrome)
+ Heart failure (a weak heart)
+ Low blood pressure
+ Poor blood circulation to the arms or legs
+ Shock caused by heart problems
+ A slow heartbeat
* Respiratory issues, including:
+ Asthma
+ Chronic obstructive pulmonary disease (COPD) or other breathing problems
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine if it is safe to take this medication with your existing treatments and health status. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
Precautions & Cautions
Important Warnings and Precautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Avoid driving and performing tasks that require alertness until you understand how this medication affects you. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and exercise caution when climbing stairs.
Monitoring Your Condition
Follow your doctor's instructions for checking your blood pressure and heart rate. Additionally, have your blood work and other laboratory tests done as directed by your doctor.
Interference with Lab Tests
This medication may affect certain laboratory tests. Inform all your healthcare providers and laboratory personnel that you are taking this medication.
Risk of Low Blood Sugar
This medication may mask symptoms of low blood sugar, such as a rapid heartbeat, which can increase the risk of severe or prolonged low blood sugar. This is particularly concerning for individuals with diabetes, children, and those who are fasting, undergoing surgery, or experiencing nausea and vomiting. If you have questions or concerns, discuss them with your doctor.
Diabetes Management
If you have high blood sugar (diabetes), closely monitor your blood sugar levels while taking this medication.
Interactions with Other Medications
If you have high blood pressure and are taking this medication, consult your doctor before using over-the-counter products that may increase blood pressure, such as cough and cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Discontinuing the Medication
Do not stop taking this medication abruptly, as this may lead to worsened chest pain or even a heart attack, particularly if you have certain types of heart disease. To avoid side effects, your doctor will instruct you on how to gradually discontinue the medication. If you experience new or worsening chest pain or other heart problems, contact your doctor immediately.
Thyroid Conditions
This medication may make it more challenging to recognize symptoms of an overactive thyroid, such as a rapid heartbeat. If you have an overactive thyroid and stop taking this medication suddenly, your condition may worsen and become life-threatening. Discuss this with your doctor.
Allergic Reactions
If you have a history of severe allergic reactions, inform your doctor. You may be at risk of an even more severe reaction if you are exposed to the allergen again. If you use epinephrine to treat severe allergic reactions, consult your doctor, as epinephrine may be less effective while taking this medication.
Alcohol Consumption
Discuss alcohol consumption with your doctor before drinking while taking this medication.
Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. You will need to discuss the benefits and risks of this medication to both you and your baby.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Avoid driving and performing tasks that require alertness until you understand how this medication affects you. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and exercise caution when climbing stairs.
Monitoring Your Condition
Follow your doctor's instructions for checking your blood pressure and heart rate. Additionally, have your blood work and other laboratory tests done as directed by your doctor.
Interference with Lab Tests
This medication may affect certain laboratory tests. Inform all your healthcare providers and laboratory personnel that you are taking this medication.
Risk of Low Blood Sugar
This medication may mask symptoms of low blood sugar, such as a rapid heartbeat, which can increase the risk of severe or prolonged low blood sugar. This is particularly concerning for individuals with diabetes, children, and those who are fasting, undergoing surgery, or experiencing nausea and vomiting. If you have questions or concerns, discuss them with your doctor.
Diabetes Management
If you have high blood sugar (diabetes), closely monitor your blood sugar levels while taking this medication.
Interactions with Other Medications
If you have high blood pressure and are taking this medication, consult your doctor before using over-the-counter products that may increase blood pressure, such as cough and cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Discontinuing the Medication
Do not stop taking this medication abruptly, as this may lead to worsened chest pain or even a heart attack, particularly if you have certain types of heart disease. To avoid side effects, your doctor will instruct you on how to gradually discontinue the medication. If you experience new or worsening chest pain or other heart problems, contact your doctor immediately.
Thyroid Conditions
This medication may make it more challenging to recognize symptoms of an overactive thyroid, such as a rapid heartbeat. If you have an overactive thyroid and stop taking this medication suddenly, your condition may worsen and become life-threatening. Discuss this with your doctor.
Allergic Reactions
If you have a history of severe allergic reactions, inform your doctor. You may be at risk of an even more severe reaction if you are exposed to the allergen again. If you use epinephrine to treat severe allergic reactions, consult your doctor, as epinephrine may be less effective while taking this medication.
Alcohol Consumption
Discuss alcohol consumption with your doctor before drinking while taking this medication.
Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. You will need to discuss the benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe bradycardia (very slow heart rate)
- Hypotension (very low blood pressure)
- Cardiogenic shock
- Bronchospasm (difficulty breathing)
- Heart failure
- Hypoglycemia
- Loss of consciousness
- Seizures
What to Do:
Seek immediate medical attention. Call 911 or your local emergency number. For poison control, call 1-800-222-1222.
Drug Interactions
Contraindicated Interactions
- Fingolimod (risk of severe bradycardia)
- Clonidine (risk of rebound hypertension upon clonidine withdrawal)
Major Interactions
- Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem - risk of severe bradycardia, heart block, heart failure)
- Digoxin (additive bradycardia)
- Other beta-blockers (additive effects)
- MAO inhibitors (risk of hypertension or bradycardia)
- Sympathomimetics (e.g., epinephrine, norepinephrine - attenuated pressor response, risk of hypertension followed by bradycardia)
- Insulin and oral hypoglycemics (masking of hypoglycemia symptoms, prolonged hypoglycemia)
Moderate Interactions
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine, propafenone, ritonavir, bupropion, terbinafine - increased metoprolol levels)
- NSAIDs (reduced antihypertensive effect)
- Alpha-1 blockers (e.g., prazosin, doxazosin - increased risk of first-dose hypotension)
- Class I antiarrhythmics (e.g., disopyramide, flecainide - additive negative inotropic/chronotropic effects)
- Ergot alkaloids (increased peripheral vasoconstriction)
Minor Interactions
- Alcohol (increased metoprolol levels)
- Cimetidine (increased metoprolol levels)
Monitoring
Baseline Monitoring
Heart Rate (HR)
Rationale: To establish baseline and identify bradycardia.
Timing: Prior to first dose
Blood Pressure (BP)
Rationale: To establish baseline and identify hypotension.
Timing: Prior to first dose
ECG
Rationale: To assess cardiac rhythm and conduction (e.g., PR interval, heart block).
Timing: Prior to first dose
Cardiac function (e.g., signs of heart failure)
Rationale: To assess for contraindications or risk of decompensation.
Timing: Prior to first dose
Routine Monitoring
Heart Rate (HR)
Frequency: Continuously during IV administration, then regularly (e.g., every 4-6 hours or as clinically indicated)
Target: 50-90 bpm (individualized)
Action Threshold: <50 bpm or symptomatic bradycardia; >90 bpm if target is lower
Blood Pressure (BP)
Frequency: Continuously during IV administration, then regularly (e.g., every 4-6 hours or as clinically indicated)
Target: Individualized based on indication
Action Threshold: Systolic BP <90 mmHg or symptomatic hypotension
ECG
Frequency: As clinically indicated, especially with dose adjustments or new symptoms
Target: Normal sinus rhythm, no new blocks
Action Threshold: New onset heart block, significant arrhythmias
Signs/Symptoms of Heart Failure
Frequency: Daily or as clinically indicated
Target: Absence of worsening symptoms
Action Threshold: Dyspnea, edema, weight gain, crackles
Symptom Monitoring
- Dizziness
- Lightheadedness
- Fatigue
- Shortness of breath
- Wheezing
- Chest pain
- Cold extremities
- Depression
- Insomnia
- Sexual dysfunction
Special Patient Groups
Pregnancy
Use during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus. Beta-blockers can cause fetal bradycardia, hypoglycemia, and growth restriction. Neonates exposed to beta-blockers in utero may be at risk for hypoglycemia and bradycardia.
Trimester-Specific Risks:
First Trimester:
Limited data, but generally considered low risk for major malformations.
Second Trimester:
Potential for fetal growth restriction and reduced placental perfusion.
Third Trimester:
Risk of neonatal bradycardia, hypoglycemia, and respiratory depression at birth.
Lactation
Metoprolol is excreted into breast milk in small amounts. The amount ingested by the infant is generally low. Monitor breastfed infants for signs of beta-blockade (e.g., bradycardia, drowsiness, poor feeding). Generally considered compatible with breastfeeding (L2).
Infant Risk:
Low risk; monitor for bradycardia, hypotension, and hypoglycemia.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established. Use is generally not recommended.
Geriatric Use
No overall differences in effectiveness or safety have been observed between elderly and younger patients. However, elderly patients may be more sensitive to the effects of beta-blockers and may have reduced renal or hepatic function, requiring careful dose titration and monitoring.
Clinical Information
Clinical Pearls
- IV metoprolol is typically used for acute management in hospital settings, often as a bridge to oral therapy.
- Always check heart rate and blood pressure before administering each IV dose.
- Contraindicated in patients with severe bradycardia, heart block greater than first degree (unless a pacemaker is present), cardiogenic shock, or decompensated heart failure.
- Use with caution in patients with asthma or COPD, as beta-1 selectivity is dose-dependent and bronchospasm can occur.
- Patients with diabetes should be monitored closely as beta-blockers can mask symptoms of hypoglycemia.
- Abrupt discontinuation, especially in patients with ischemic heart disease, can lead to rebound angina or myocardial infarction.
Alternative Therapies
- Esmolol (another IV beta-blocker, ultra-short acting)
- Labetalol (alpha/beta-blocker, IV)
- Diltiazem (non-dihydropyridine calcium channel blocker, IV)
- Verapamil (non-dihydropyridine calcium channel blocker, IV)
- Adenosine (for SVT)
- Digoxin (for rate control in AFib/flutter)
Cost & Coverage
Average Cost:
Not available Not available
Generic Available:
Yes
Insurance Coverage:
Tier 1 (Generic)
General Drug Facts
If your symptoms or health problems persist or worsen, it is essential to contact your doctor for further guidance. To ensure safe use, never share your medication with others, and do not take medication prescribed for someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly; do not flush them down the toilet or pour them down the drain unless instructed to do so by a healthcare professional. If you are unsure about the proper disposal method, consult your pharmacist, who can also inform you about potential drug take-back programs in your area. Some medications may come with an additional patient information leaflet, which your pharmacist can provide. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it was taken to ensure prompt and effective treatment.