Metoprolol is a selective Beta-1 antagonist, with a therapeutic classification of an antianginal and antihypertensive. It is commonly referred as a beta blocker. Metoprolol is one of many beta blockers, such as atenolol, bisoprolol, acebutolol.

Indications for Use

Metoprolol is commonly used to treat high blood pressure, chest pain due to poor blood flow to the heart, as an early intervention during a myocardial infarction (MI), and in several heart conditions involving an abnormally fast heart rate.

Off label, it can sometimes be used for migraine therapy and treatment of tremors.

Mechanism of Action

Metoprolol primarily blocks Beta-1 receptors in the heart, causing decreased heart rate and decreased blood pressure. However, higher doses can also block Beta-2 receptors in the lungs, causing bronchoconstriction.

Nursing Considerations

Administration: Can be given oral or IV routes. Do not crush extended-release (ER) formulations.

• Orally, it works within 15 minutes with a duration of action of 6-12 hours.
• IV: monitor BP and HR, with telemetry, q 5-15 minutes when therapy initiated.

Assessment and Monitoring

• Prior to dose: Always check client’s apical pulse rate x one minute. Withhold the drug and call the prescriber if the heart rate is slower than 60 beats/minute, unless other parameters are provided.
• During therapy: Assess for signs of heart failure (SOB, rales or crackles, weight gain, peripheral edema).
• Discontinuing Metoprolol: dosages are tapered over 1-2 weeks because abrupt discontinuation may cause chest pain or myocardial infarction (MI).

It crosses the blood brain barrier. It crosses the placenta and only used if maternal benefit justifies potential risk to fetus.

Cautious use with hepatic and renal failure.

Contraindicated with uncompensated heart failure, pulmonary edema and bradycardia.

Beta-1 antagonists can be given to pediatric and older adult clients, but doses should be individualized based on client response.

Diabetic clients: monitor glucose level closely because the drug masks common signs and symptoms of hypoglycemia.

Adverse / Side Effects

• Serious potential adverse effects: pulmonary edema, bradycardia, and worsening heart failure. Report immediately to physician.
• Other adverse effects:
  • CNS: fatigue, dizziness, depression, insomnia, nightmares,
  • Resp: dyspnea, and wheezing.
  • GI/GU: gastrointestinal upset, diarrhea
  • Erectile dysfunction

Client Teaching

• Take the med only as prescribed. Do not abruptly stop medication therapy or life-threatening arrhythmias may occur.
• Teach client how to self-check pulse and blood pressure to assess the effectiveness of medication therapy.
• avoid sudden changes in position due to orthostatic blood pressure changes.
• May experience increase sensitivity to cold. Avoid caffeinated beverages.
• Tell HCP if starting on any new OTC or prescription medication, including herbal remedies. Ie. cold remedies.

UpToDate, 2021; Vallerand & Sanoski, 2024;

Metoprolol Medication Card

Now let’s take a closer look at the medication card for metoprolol. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.

Downloadable file (.docx): Metoprolol Medication Card CH4.12

Interactive Activity

References

• uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
• UpToDate (2021). Metoprolol. https://www.uptodate.com/contents/search ↵
• Vallerand, A. & Sanoski, C. (2024). Davis’s Canadian drug guide for nurses (19th ed.). F.A. Davis Company: Canada