Metoprolol

Metoprolol

Drug monograph · NCLEX study reference
Trade names	Lopressor, Toprol-XL
Therapeutic class	Antihypertensive, antianginal, heart failure agent
Pharmacologic class	Selective beta-1 adrenergic blocker
Onset / peak / duration	PO onset about 1 hour; IV within minutes; succinate ER lasts 24 hours.
Half-life / level	Half-life 3 to 7 hours; no routine level.
Routes	PO (oral), IV
High-alert (ISMP)	No
Black box warning	None
Antidote / reversal	Atropine for bradycardia; glucagon for refractory beta blocker overdose.
Pregnancy / lactation	Use only if benefit outweighs risk.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Metoprolol (brand names Lopressor, Toprol-XL) — Antihypertensive, antianginal, heart failure agent; Selective beta-1 adrenergic blocker.

Identification

• Therapeutic class: Antihypertensive, antianginal, heart failure agent.
• Pharmacologic class: Selective beta-1 adrenergic blocker.

Pharmacology

• Mechanism of action: Blocks beta-1 receptors in the heart, lowering heart rate, contractility, and blood pressure and reducing myocardial oxygen demand.
• Onset / peak / duration: PO onset about 1 hour; IV within minutes; succinate ER lasts 24 hours.
• Half-life / therapeutic level: Half-life 3 to 7 hours; no routine level.

Clinical use

• Indications: Hypertension, angina, heart failure (succinate), post-MI, rate control.
• Usual dose, route, frequency: Tartrate 25 to 100 mg PO twice daily; succinate 25 to 200 mg PO once daily; IV 5 mg increments for acute use.
• Maximum dose / adjustments: Up to about 400 mg/day; reduce in hepatic impairment; titrate heart failure dose slowly.

Safety

• Contraindications: Severe bradycardia, high-degree heart block, decompensated heart failure, cardiogenic shock.
• Black box warning: No formal boxed warning; strong warning against abrupt discontinuation, which can precipitate angina, MI, or rebound hypertension.
• Interactions: Calcium channel blockers (additive bradycardia), other antihypertensives, insulin (may mask hypoglycemia symptoms), CYP2D6 inhibitors.
• Pregnancy / lactation: Use only if benefit outweighs risk.
• High-alert: No.

Adverse effects

• Common side effects: Bradycardia, fatigue, dizziness, cold extremities.
• Serious effects to report: Symptomatic bradycardia, heart block, bronchospasm at high doses, worsening heart failure.
• Antidote / reversal: Atropine for bradycardia; glucagon for refractory beta blocker overdose.

Nursing process

• Assessment before administration: Apical heart rate, blood pressure, signs of heart failure.
• Interventions during therapy: Hold and notify if heart rate below 60 or systolic blood pressure below 90; taper to discontinue.
• Monitor: Heart rate, blood pressure, signs of heart failure, blood glucose in diabetics.
• Evaluation / expected outcome: Controlled heart rate and blood pressure; improved heart failure status.

Patient teaching

• Patient teaching: Check pulse daily; never stop abruptly.
• Notify provider if: Very slow heartbeat, fainting, worsening shortness of breath or swelling.
• Administration tips: Take consistently; succinate ER swallowed whole; tartrate with food.