This subject just came up, so I looked it up, and our Mosby guide gives weird instructions
In the "usual dose" section:
MI- 5mg ivp X 3 at two minute intervals. In parenthesis it states that AHA guidelines are q5 not q2. No mention of how fast to push it, just two contradictory sets of instructions on intervals.
A-fib- 2.5-5mg over two minutes, may repeat twice.
unstable angina: 5 mg over 5 minutes.
In the "rate of administration" section:
a single dose over 1 minute
There is mention of iv use for tachycardia or hypertension.
So- I generally push it over 1 minute, unless the bp or hr are borderline. I have been told that when it is ordered 5mg q5min x 3, slow push is not the way to go.
I had a per diem job doing CT angiography (64 slice cardiac CTs). We would push metoprolol like it was water. To get optimal images the pulse needed to be slow--45-55 bpm. At first it was a bit nerving giving so much metoprolol, but people tended to tolerate it. Patients would get up to 35 mg (overall, not in one push)!! I'd get away w/ 5mg over one minute (undiluted), too slow and you wouldn't get the optimal rate.
kmoonshine, RN
346 Posts
I give metoprolol 5mg IV push over 5 minutes and I wait around 2 minutes before administering another dose.